Tag: Mental Health Intervention

What is the Evidence for the Effectiveness of Psychological Interventions for Adults with Anti-Social Personality Disorder?

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Research Paper Title

Psychological interventions for antisocial personality disorder.

Background

Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review).

Therefore the purpose of this review was to evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD.

Methods

The researchers searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. They also searched reference lists and contacted study authors to identify studies.

Selection criteria concisted of randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment. The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events.

Data collection and analysis consisted of standard methodological procedures expected by Cochrane.

Results

This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called ‘standard Maintenance'(SM) in some studies).

Eight of the 18 psychological interventions reported data on our primary outcomes. Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD. Data were available from only 10 studies involving 605 participants.

Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands. Study duration ranged from 4 to 156 weeks (median = 26 weeks).

Most participants (75%) were male; the mean age was 35.5 years. Eleven studies (58%) were funded by research councils. Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%. Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention.

One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention. Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence).

One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up. Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. ‘Driving whilst intoxicated’ programme (DWI) + incarceration versus incarceration One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months.

Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years. The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19).

The certainty of the evidence for all outcomes was very low. Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants’ level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention. Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU.

Psychosocial risk management (PSRM; ‘Resettle’) versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison. It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence).

Conclusions

There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour.

Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies. This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.

Reference

Gibbon, S., Khalifa, N.R., Cheung, N.H-Y., Vollm, B.A. & McCarthy, L. (2020) Psychological interventions for antisocial personality disorder. The Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD007668.pub3.

Are Lifestyle Factors Advantageous as First-Line Interventions in Mental Health?

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Research Paper Title

The Effect of Exercise on Mental Health: A Focus on Inflammatory Mechanisms.

Background

A growing body of research suggests that neuropsychiatric disorders are closely associated with a background state of chronic, low-grade inflammation.

This insight highlights that these disorders are not just localised to dysfunction within the brain, but also have a systemic aspect, which accounts for the frequent comorbid presentation of chronic inflammatory conditions and metabolic syndromes.

It is possible that a treatment resistant subgroup of neuropsychiatric patients may benefit from treatment regimens that target their associated proinflammatory state.

Lifestyle factors such as physical activity (PA) and exercise (i.e. structured PA) are known to influence mental health. In turn, mental disorders may limit health-seeking behaviours – a proposed “bidirectional relationship” that perpetuates psychopathology. PA is renowned for its positive physical, physiological and mental health benefits.

Evidence now points to inflammatory pathways as a potential mechanism for PA in improving mental illness. Relevant pathways include:

  • Modulation of immune-neuroendocrine and neurotransmitter systems;
  • The production of tissue-derived immunological factors that alter the inflammatory milieu; and
  • Neurotrophins that are critical mediators of neuroplasticity.

Methods

In this paper, the researchers focus on the role of PA in positively improving mental health through potential modulation of chronic inflammation, which is often found in individuals with mental disorders.

In a related paper by Edirappuli and colleagues (2020), they will focus on the role of nutrition (another significant lifestyle factor) on mental health.

Results

Thus, inflammation appears to be a central process underlying mental illness, which may be mitigated by lifestyle modifications.

Conclusions

Lifestyle factors are advantageous as first-line interventions due to their cost efficacy, low side-effect profile, and both preventative and therapeutic attributes.

By promoting these lifestyle modifications and addressing their limitations and barriers to their adoption, it is hoped that their preventative and remedial benefits may galvanize therapeutic progress for neuropsychiatric disorders.

Reference

Venkatesh, A., Edirappuli, S.D., Zaman, H.P. & Zaman, R. (2020) The Effect of Exercise on Mental Health: A Focus on Inflammatory Mechanisms. Psychiatira Danubina. 32(Suppl 1), pp.105-113.

Could an ‘Apple a Day’ Keep the (Mental Health) Doctor Away?

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Research Paper Title

Fruit and vegetables intake in adolescents and mental health: a systematic review.

Background

The proper nutrition is indicated as a factor of a potential importance for the mental health early in life span, and among the potential products, which may influence, there are fruit and vegetables.

Therefore the purpose of this study was to conduct a systematic review of the observational studies analysing the association between the fruit and vegetables intake and the mental health in adolescents.

Methods

On the basis of PubMed and Web of Science databases, the papers presenting human studies and published in English until June 2019, analysing the association between intake of fruit and/ or vegetables, as well as related products (e.g. juices) and the mental health were included to the systematic review, while they analysed a group of adolescents.

Results

Based on the conducted systematic review, 17 studies were indicated as those which assess the influence of fruit and vegetables intake on the mental health in adolescents. For the assessment of mental health, diverse variables were taken into account, including positive (happiness, self-esteem), neutral (health-related quality of life, mental health status), and negative ones (loneliness, general difficulties, feeling worried, anxiety, stress and distress, depressive symptoms, depression, suicidal behaviours).

Conclusions

Based on the conducted systematic review of observational studies, it may be indicated that in a groups of adolescents there was a positive association between intake of fruit and vegetable products and mental health.

Especially beneficial for general mental health in adolescents, were such products as green vegetables, yellow vegetables and fresh fruit.

Reference

Glabska, D., Guzek, D., Groele, B. & Gutkowska, K. (2020) Fruit and vegetables intake in adolescents and mental health: a systematic review. Roxzniki Pantstwowego Zakladu Higieny. 71(1), pp.15-25. doi: 10.32394/rpzh.2019.0097.

A Brief Outline of Online Mental Health Services in China During the COVID-19 Outbreak

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Research Paper Title

Online Mental Health Services in China During the COVID-19 Outbreak.

Background

At the start of 2020, the 2019 coronavirus disease (COVID-19), originating from Wuhan in Hubei province, started to spread throughout China. As a result of the rapidly increasing numbers of confirmed cases and deaths, both medical staff and the public have been experiencing psychological problems, including anxiety, depression, and stress. Since January 2020, the National Health Commission of China have published several guideline documents, starting with the notification of principles for emergency psychological crisis intervention for the COVID-19 epidemic on 26 January, then the notice on establishing psychological assistance hotlines for the epidemic on 02 February, and most recently, guidelines for psychological assistance hotlines during the COVID-19 epidemic on 07 February 7.

During the severe acute respiratory syndrome epidemic in 2003, internet services and smartphones were not widely available. Therefore, few online mental health services were provided for those in need. The popularisation of internet services and smartphones, and the emergence of fifth generation (5G) mobile networks, have enabled mental health professionals and health authorities to provide online mental health services during the COVID-19 outbreak. Fast transmission of the virus between people hinders traditional face-to-face psychological interventions. By contrast, provision of online mental health services is safe. To date, several types of online mental health services have been implemented widely for those in need during the outbreak in China.

Firstly, as of 08 Febreuary 2020, 72 online mental health surveys associated with the COVID-19 outbreak could be searched for via the WeChat-based survey programme Questionnaire Star, which target different populations, including medical staff (23 of the surveys), patients with COVID-19 (one survey), students (18 surveys), the general population (nine surveys), and mixed populations (21 surveys); in Hubei province (five surveys), other provinces (15 surveys), all provinces, municipalities, and autonomous regions (36 surveys), and unspecified areas of China (16 surveys). One such multi-centre survey involving 1563 medical staff, with the centre at Nanfang Hospital, Southern Medical University (Guangzhou, China) as one of the study sites, found the prevalence of depression (defined as a total score of ≥5 in the Patient Health Questionnaire-9) to be 50·7%, of anxiety (defined as a total score of ≥5 in the Generalized Anxiety Disorder-7) to be 44·7%, of insomnia to be 36·1% (defined as a total score of ≥8 in the Insomnia Severity Index), and of stress-related symptoms (defined as a total score of ≥9 in the Impact of Events Scale-Revised) to be 73·4%. These findings are important in enabling health authorities to allocate health resources and develop appropriate treatments for medical staff who have mental health problems.

Secondly, online mental health education with communication programmes, such as WeChat, Weibo, and TikTok, has been widely used during the outbreak for medical staff and the public. In addition, several books on COVID-19 prevention, control, and mental health education have been swiftly published and free electronic copies have been provided for the public. As of 08 February, 29 books associated with COVID-19 have been published, 11 (37·9%) of which are on mental health, including the “Guidelines for public psychological self-help and counselling of 2019-nCoV pneumonia”, published by the Chinese Association for Mental Health.

Finally, online psychological counselling services (eg, WeChat-based resources) have been widely established by mental health professionals in medical institutions, universities, and academic societies throughout all 31 provinces, municipalities, and autonomous regions in mainland China, which provide free 24-h services on all days of the week. Online psychological self-help intervention systems, including online cognitive behavioural therapy for depression, anxiety, and insomnia (e.g. on WeChat), have also been developed. In addition, several artificial intelligence (AI) programmes have been put in use as interventions for psychological crises during the epidemic. For example, individuals at risk of suicide can be recognised by the AI programme Tree Holes Rescue, by monitoring and analysing messages posted on Weibo, and alerting designated volunteers to act accordingly.

In general, online mental health services being used for the COVID-19 epidemic are facilitating the development of Chinese public emergency interventions, and eventually could improve the quality and effectiveness of emergency interventions.

Reference

Liu, S., Yang, L., Zhang, C., Xiang, Y., Liu, Z., Hu, S. & Zhang, B. (2020) Online Mental Health Services in China During the COVID-19 Outbreak. Lancet Psychiatry. 7(4), pp.e17-e18. doi: 10.1016/S2215-0366(20)30077-8. Epub 2020 Feb 19.

Substance Use & Intervention Programmes: Remember to Address Social Issues Regardless of Deployment History

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Research Paper Title

Problems With Social Acceptance and Social Victimization Predict Substance Use Among U.S. Reserve/Guard Soldiers.

Background

The effects of negative social interactions/experiences on substance use have largely been studied in civilian populations, but less is known about United States Army Reserve/National Guard (USAR/NG) soldiers-a high-risk group.

Methods

The researchers examined the associations between problems with social acceptance, social victimisation, and substance use among USAR/NG soldiers, and examined potential differences by deployment history.

The sample consisted of soldiers who completed baseline and 1-year follow-up assessments (N = 445) of Operation: SAFETY, an ongoing study of USAR/NG soldiers.

They examined the effects of baseline problems with social acceptance/social victimization on nonmedical use of prescription drugs (NMUPD), illicit drug use, frequent heavy drinking (FHD), and alcohol problems at follow-up.

Results

Significant effects were small in magnitude but consistent in direction.

Greater problems with social acceptance were associated with higher odds of NMUPD and illicit drug use.

Greater social victimisation was associated with higher odds of NMUPD and illicit drug use.

There were no differences by deployment history.

Conclusions

Problems with social acceptance/social victimisation were not associated with FHD or alcohol problems.

Problems with social acceptance/social victimisation may contribute to drug use among USAR/NG soldiers.

Intervention programmes should address social issues, regardless of deployment history.

Reference

Hoopsick, R.A., Vest, B.M., Homish, D.L. & Homish, G.G. (2020) Problems With Social Acceptance and Social Victimization Predict Substance Use Among U.S. Reserve/Guard Soldiers. Stress and Health. doi: 10.1002/smi.2934. Online ahead of print.

Components & Principles of Effective Treatments in Mental Health

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For interventions (to at least be perceived) to be effective in the treatment of mental health conditions, from the perspective of the service user, there are a range of components that one must understand and appreciate.

  • Facilitative service environment(s):
    • Understand how the environment can affect a service user’s experience of treatment.
    • Prioritise good relationships between staff/volunteers and those using the services.
    • Taking a genuine interest in the service user.
    • Being respectful.
    • Helps service users feel at ease and prevent relapse.
  • Access to appropriate treatment(s).
  • Compassionate and non-judgemental support.
    • This can include peer, practical, and emotional support.
  • Interventions that are long enough in duration:
    • Treatment needs to be long enough in duration for the service user to avoid relapse and/or move into recovery.
    • Need for ongoing support.
    • Aftercare programme as a way of ensuring a supportive network to prevent relapse.
  • Interventions that offer stability.
  • Choices (in terms of treatment).
    • Service users like to feel they have a choice in their treatment.
    • Want to be treated as individuals.
    • Individualised care means provider must have flexibility in service delivery.
  • Opportunities to learn (or relearn) how to live.
    • Treatment should be seen as providing opportunities for service users to learn (vocational/life) skills to support them to live their lives.
    • This can aid service users to steer away from problematic patterns of behaviour by providing structure and purpose, alleviating boredom, and distraction from their condition.

The above should be provided with the following three principles in mind:

  1. Within the context of good relationships.
    • You are not there to be the service user’s best friend, but good/positive relationships aid effectiveness of treatment and perceptions of service.
  2. Person-centred care.
    • Where appropriate and practicable, the service/treatment should fit around the service user, not the service user around the service/treatment.
  3. Understanding the complexity of the service user’s (both personal and professional) circumstances.
    • Understanding of the service user’s circumstances can aid adherence to treatment and their journey through their condition.

Finally, remember that the way in which services and treatment are delivered, is considered by many service users, to be more important than the type of treatment provided.

Homelessness & Substance Use Treatment: Is the Way in which Services & Treatment are Delivered more Important than the Type of Treatment Provided?

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Research Paper Title

What Constitutes Effective Problematic Substance Use Treatment From the Perspective of People Who Are Homeless? A Systematic Review and Meta-Ethnography.

Background

People experiencing homelessness have higher rates of problematic substance use but difficulty engaging with treatment services. There is limited evidence regarding how problematic substance use treatment should be delivered for these individuals.

Previous qualitative research has explored perceptions of effective treatment by people who are homeless, but these individual studies need to be synthesised to generate further practice-relevant insights from the perspective of this group.

Methods

Meta-ethnography was conducted to synthesise research reporting views on substance use treatment by people experiencing homelessness. Studies were identified through systematic searching of electronic databases (CINAHL; Criminal Justice Abstracts; Health Source; MEDLINE; PsycINFO; SocINDEX; Scopus; and Web of Science) and websites and were quality appraised. Original participant quotes and author interpretations were extracted and coded thematically.

Concepts identified were compared to determine similarities and differences between studies. Findings were translated (reciprocally and refutationally) across studies, enabling development of an original over-arching line-of-argument and conceptual model.

Results

Twenty-three papers published since 2002 in three countries, involving 462 participants, were synthesised. Findings broadly related, through personal descriptions of, and views on, the particular intervention components considered effective to people experiencing homelessness. Participants of all types of interventions had a preference for harm reduction-oriented services.

Participants considered treatment effective when it provided a facilitative service environment; compassionate and non-judgemental support; time; choices; and opportunities to (re)learn how to live. Interventions that were of longer duration and offered stability to service users were valued, especially by women.

From the line-of-argument synthesis, a new model was developed highlighting critical components of effective substance use treatment from the service user’s perspective, including a service context of good relationships, with person-centred care and an understanding of the complexity of people’s lives.

Conclusions

This is the first meta-ethnography to examine the components of effective problematic substance use treatment from the perspective of those experiencing homelessness. Critical components of effective problematic substance use treatment are highlighted.

The way in which services and treatment are delivered is more important than the type of treatment provided. Substance use interventions should address these components, including prioritising good relationships between staff and those using services, person-centred approaches, and a genuine understanding of individuals’ complex lives.

Reference

Carver, H., Ring, N., Miler, J. & Parkes, T. (2020) What Constitutes Effective Problematic Substance Use Treatment From the Perspective of People Who Are Homeless? A Systematic Review and Meta-Ethnography. Harm Reduction Journal. 17(1), pp.10. doi: 10.1186/s12954-020-0356-9.

Education: Text-based Coaching Protocols for Digital Mental Health Interventions

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Research Paper Title

Guidance on defining the scope and development of text-based coaching protocols for digital mental health interventions.

Background

A body of literature suggests that the provision of human support improves both adherence to and clinical outcomes for digital mental health interventions.

While multiple models of providing human support, or coaching, to support digital mental health interventions have been introduced, specific guidance on how to develop coaching protocols has been lacking.

In this Education Piece, the authors provide guidance on developing coaching protocols for text-based communication in digital mental health interventions.

Researchers and practitioners who are tasked with developing coaching protocols are prompted to consider the scope of coaching for the intervention, the selection and training of coaches, specific coaching techniques, how to structure communication with clients and how to monitor adherence to guidelines, and quality of coaching.

Their goal is to advance thinking about the provision of human support in digital mental health interventions to inform stronger, more engaging, and effective intervention designs.

Reference

Lattie, E.G., Graham, A.K., Hadjistavropoulos, H.D., Dear, B.F., Titov, N. & Mohr, D.C. (2019) Guidance on defining the scope and development of text-based coaching protocols for digital mental health interventions. Digital Health. doi: 10.1177/2055207619896145. eCollection 2019 Jan-Dec.