Web-Based Rumination-Focused Cognitive Behavioural Therapy (i-RFCBT) for High-Ruminating University Students: an examination of feasibility and efficacy

Depression is both highly prevalent and highly impactful in the student population. The aim of the PhD was to assess internet-based rumination-focused cognitive-behavioural therapy (i-RFCBT) as an intervention to reduce the impact of depression in university students. The intervention was first implemented as a treatment within a university Wellbeing service. An audit of treatment usage and clinical outcomes (N = 82) found the intervention significantly reduced acute depressive and anxious symptoms. Within a case series subsample (N = 26) there were improvements in clinical outcomes as well as significant reductions in rumination, consistent with the hypothesised mechanism of change. Acute treatment has a limited impact on the disease burden of depression within a population. A greater focus on prevention is identified as a priority. A qualitative study was conducted to investigate the acceptability of i-RFCBT as a preventive intervention. Having established that the intervention was acceptable, the RESPOND randomised-controlled trial (N = 235) tested whether guided i-RFCBT was an efficacious at preventing the incidence of depression in UK undergraduates with elevated rumination and worry. The trial found that guided i-RFCBT reduced the incidence of a major depressive episode (MDE) over the course of the 12-month follow-up period by 34% relative to usual care, although this difference was not significant. Baseline stress was a significant moderator of the intervention effect, such that participants with higher stress levels experienced a significant benefit of i-RFCBT in reducing the incidence of MDE relative to usual care. Short- to- medium- term improvements in worry, rumination and depressive symptoms were also found. As guided interventions are limited in terms of scalability, an additional, quasi phase-II pilot feasibility arm was incorporated within the RESPOND trial to test the acceptability and estimate the effect sizes of unguided i-RFCBT. The pattern of effects for unguided i-RFCBT was similar to that of guided i-RFCBT. The clinical implications of the thesis findings are discussed

Predicting and preventing relapse of depression in primary care: a mixed methods study

BackgroundMost people with depression are managed in primary care. Relapse (reemergence of depression symptoms after improvement) is common and contributes to the burden and morbidity associated with depression. There is a lack of evidence-based approaches for risk-stratifying people according to risk of relapse and for preventing relapse in primary care.MethodsIn this mixed methods study, I initially reviewed studies looking to predict relapse of depression across all settings. I then attempted to derive and validate a prognostic model to predict relapse within 6-8 months in a primary care setting, using multilevel logistic regression analysis on individual participant data from seven studies (n=1244). Concurrently, a qualitative workstream, using thematic analysis, explored the perspectives of general practitioners (GPs) and people with lived experience of depression around relapse risk and prevention in practice.ResultsThe systematic review identified eleven models; none could currently be implemented in a primary care setting. The prognostic model developed in this study had inadequate predictive performance on internal validation (Cstatistic 0.60; calibration slope 0.81). I carried out twenty-two semi-structured interviews with GPs and twenty-three with people with lived experience of depression. People with lived experience of depression and GPs reflected that a discussion around relapse would be useful but was not routinely offered. Both participant groups felt there would be benefits to relapse prevention for depression being embedded within primary care.ConclusionsWe are currently unable to accurately predict an individual’s risk ofdepression relapse. The longer-term care of people with depression ingeneral practice could be improved by enabling continuity of care, increased consistency and clarity around follow-up arrangements, and focussed discussions around relapse risk and prevention. Scalable, brief relapse prevention interventions are needed, which would require policy change and additional resource. We need to better understand existing interventions and barriers to implementation in practice

Pitkäaikaistutkimus perusterveydenhuollon masennuspotilaiden ennusteesta, itsemurhayrityksistä, toiminta- ja työkyvystä sekä samanaikaisesta epävakaasta persoonallisuushäiriöstä

This study is the first naturalistic prospective long-term follow-up with a life-chart among primary care patients with depressive disorders. Patients with lifetime MDD spent 34% of follow-up time in MDEs, 24% in partial and only 42% in full remission. Nine in ten achieved at least partial and two-thirds full remission. Baseline severity of depression and substance use comorbidity predicted time spent in MDEs: a rise in Hamilton Rating Scale for Depression (HAMD) score of ten at baseline predicted 14 months and comorbid substance use disorder 25 months more time in MDEs. One-half of those who achieved partial remission and one-third of those who reached full remission were having at least one recurrence. The recurrences were predicted by personality disorders. The time from remission to recurrence was predicted by generalized anxiety disorder and somatoform disorder. One-tenth of patients attempted suicide one to three times. The incidence rate varied robustly depending on the level of depression, being 0 per 1000 patient-years during full remission, 5.8 during partial remission and 107 during MDEs. Functional and work ability were strongly associated with duration and severity of depression. Patients who belonged to the labour force spent one-third of the follow-up off work due to depression; two-thirds were granted sick leave, and one-tenth a disability pension due to depression. Longer duration of depression, comorbid disorders and having received social assistance predicted dropping out from work. A quarter of patients suffered from concurrent borderline personality disorder (BPD). Comorbid anxiety and substance use disorders were common among them. Concurrent BPD increased the severity and duration of depression, suicidal behaviour, unemployment and economic difficulties. This study revealed often slow and incomplete recovery and a common recurrent course, which needs to be taken into account when developing services. The use of measurement scales is warranted when planning and monitoring treatment. Comorbidity, concurrent substance use disorder, anxiety disorders, somatoform disorder and BPD all need to be taken into account in clinical practice guidelines. Duration of depression appears most decisive for suicide attempts among primary care patients with depression. Efforts should focus on the continuity of care.Terveyskeskusten masennuspotilaat sairastavat usein kroonista tai toistuvaa masennusta ja heillä on paljon muitakin sairauksia. Tieto masennuksen aktiivisesta tunnistamisesta ja riittävän pitkäaikaisesta hoidosta on tärkeää, sillä valtaosa masennuspotilaista hoidetaan perusterveydenhuollossa. ------ Tutkimus on ensimmäinen terveyskeskuspotilaiden keskuudessa elämänjanamenetelmällä tehty pitkäaikaisseuranta masennuksen kulusta ja ennusteesta, itsemurhayrityksistä, toiminta- ja työkyvystä, samanaikaisesta epävakaasta persoonallisuushäiriöstä sekä niihin liittyvistä tekijöistä. Valtaosa masennuspotilaista, myös monihäiriöisistä, hoidetaan perusterveydenhuollossa, joten tämän tutkimuksen löydöksillä on kansanterveydellistä merkitystä. Tieto ennusteesta on tärkeää palveluita kehitettäessä ja hoitosuosituksia laadittaessa. Masennusta on tutkittu psykiatrisessa erikoissairaanhoidossa ja työterveydessä, mutta niissä potilaat ovat erilaisia. ----- Viisivuotisseurannan aikana perusterveydenhuollon masennuspotilaat toipuivat hitaasti ja epätäydellisesti ja masennusjaksot uusiutuivat usein. Viiden vuoden seuranta-ajasta potilaat olivat 34% masennustilassa ja vain 40% täysin toipuneina. Masennuksen syvyys ennusti vahvasti sekä huonoa toipumista että alentunutta toiminta- ja työkykyä, joten oiremittareiden systemaattinen käyttö on suositeltavaa masennuksen vaikeusasteen kartoittamisessa. Samanaikaiset muut psykiatriset häiriöt, etenkin päihdehäiriö mutta myös ahdistuneisuushäiriöt, somatoforminen häiriö ja epävakaa persoonallisuushäiriö, vaikuttavat masennuksen kulkuun ja ne on syytä huomioida hoitosuosituksia laadittaessa. Itsemurhayrityksiä oli joka 10. potilaalla ja masennusjaksojen pituus osoittautui niiden merkittävimmäksi riskitekijäksi, joten jatko- ja ylläpitohoitoihin on kiinnitettävä huomiota. Toiminta- ja työkyky olivat vahvasti yhteydessä masennusjaksojen pituuteen sekä masennuksen vaikeusasteeseen. Työvoimaan kuuluvat potilaat olivat kolmanneksen seuranta-ajasta poissa työstä masennuksen takia: kahdelle kolmasosalle oli määrätty sairauslomaa ja joka kymmenes oli päätynyt työkyvyttömyyseläkkeelle. Masennusjaksojen kesto, monihäiriöisyys ja toimeentulotuen saaminen olivat yhteydessä työelämästä poistumiseen. Joka neljäs potilas kärsi samanaikaisesta epävakaasta persoonallisuushäiriöstä ja heidän ennusteensa oli erityisen huono

Internet-based Treatment for Depression and Panic disorder : From development to deployment

Major depression (MD) and panic disorder (PD) are two common disorders for which evidence based psychological treatments such as cognitive behaviour therapy (CBT) have been developed. The accessibility of such treatment is however limited. The use of Internet-based CBT (self-help programmes accompanied by brief therapist support by e-mail) is a promising way to increase accessibility. The first aim of this thesis was to investigate if Internet treatment was effective in reducing depressive symptoms and if it was possible to predict which participants would benefit from such treatment. The second aim of the thesis was to investigate if Internet treatment was effective for PD patients in a regular care setting, in comparison with traditional group-administered CBT, and in addition, to compare the cost-effectiveness of the two treatments. In Study I 85 participants were randomised to either an Internet treatment or to an attention control condition (an online discussion group). Post-treatment measures of depression showed large effect sizes and improvements were sustained at a 6-month follow-up, thus showing that Internet treatment was effective in reducing mild to moderate symptoms of depression. Study II analysed predictors of treatment outcome at the 6-month follow-up of Study I. Higher selfreported severity at baseline was associated with poorer outcome and a negative correlation was found between number of previous episodes of depression and improvement in treatment. Study III was an open effectiveness trial evaluating Internet treatment, which in previous studies had been shown to be effective with self-recruited participants, within a regular psychiatric setting for 20 PD patients referred for treatment. After treatment 75% of patients were considered to have responded to treatment, and at the 6-month follow-up this proportion was 70%, indicating that this treatment form was transferable to a regular care setting with sustained effectiveness. Study IV was a randomised clinical trial comparing Internet- and groupadministered CBT for PD with 104 patients in a psychiatric setting. Both treatments produced significant improvements, and there were no statistically significant differences between them at post-treatment or at the 6-month follow up. A cost-effectiveness analysis showed that the Internet treatment was more cost-effective than the group treatment with regard to therapist time. This thesis provides evidence that Internet treatment is effective in reducing symptoms of depression and of PD. Internet treatment is as effective as traditionally administered group CBT in a regular care setting with PD patients referred for treatment. The thesis also provides evidence that Internet treatment for PD is more cost-effective than group treatment. Taken together, the results support the implementation of Internet treatment for depression and PD within regular health care settings

Predicting and preventing relapse of depression in primary care: a mixed methods study

Background Most people with depression are managed in primary care. Relapse (re-emergence of depression symptoms after improvement) is common and contributes to the burden and morbidity associated with depression. There is a lack of evidence-based approaches for risk-stratifying people according to risk of relapse and for preventing relapse in primary care. Methods In this mixed methods study, I initially reviewed studies looking to predict relapse of depression across all settings. I then attempted to derive and validate a prognostic model to predict relapse within 6-8 months in a primary care setting, using multilevel logistic regression analysis on individual participant data from seven studies (n=1244). Concurrently, a qualitative workstream, using thematic analysis, explored the perspectives of general practitioners (GPs) and people with lived experience of depression around relapse risk and prevention in practice. Results The systematic review identified eleven models; none could currently be implemented in a primary care setting. The prognostic model developed in this study had inadequate predictive performance on internal validation (C-statistic 0.60; calibration slope 0.81). I carried out twenty-two semi-structured interviews with GPs and twenty-three with people with lived experience of depression. People with lived experience of depression and GPs reflected that a discussion around relapse would be useful but was not routinely offered. Both participant groups felt there would be benefits to relapse prevention for depression being embedded within primary care. Conclusions We are currently unable to accurately predict an individual’s risk of depression relapse. The longer-term care of people with depression in general practice could be improved by enabling continuity of care, increased consistency and clarity around follow-up arrangements, and focussed discussions around relapse risk and prevention. Scalable, brief relapse prevention interventions are needed, which would require policy change and additional resource. We need to better understand existing interventions and barriers to implementation in practice

\u3ci\u3eCourt Review\u3c/i\u3e, Volume 46, Issues 1-2 (Complete)

Articles 6 A Review of Findings from the “Gender and Aggression Project” Informing Juvenile Justice Policy and Practice Through Gender-Sensitive Research (Candice L. Odgers, Marlene M. Moretti, & N. Dickon Reppucci) 10 Racial Disparities among Female Juvenile Offenders: The Contribution of Neighborhood Disadvantage and Exposure to Violence in Antisocial Behavior (Preeti Chauhan, Mandi L. Burnette, & N. Dickon Reppucci) 16 Profiles of Mental Disorder among Incarcerated Adolescent Females (Michael A. Russell & Emily G. Marston) 24 Substance Dependence Disorders and Patterns of Psychiatric Comorbidity among At-Risk Teens: Implications for Social Policy and Intervention (Ingrid Obsuth, Gillian K. Watson, & Marlene M. Moretti) 30 Incarcerated Girls’ Physical Health: Can the Juvenile Justice System Help to Reduce Long-Term Health Costs? (Summer J. Robins, Candice L. Odgers, & Michael A. Russell) 36 Predicting and Preventing Aggression and Violence Risk in High-Risk Girls: Lessons Learned and Cautionary Tales from the Gender and Aggression Project (Stephanie R. Penney & Zina Lee) 44 Social-Cognitive Processes Related to Risk for Aggression in Adolescents (Tania Bartolo, Maya Peled, & Marlene M. Moretti) 52 Romantic Relationships Matter for Girls’ Criminal Trajectories: Recommendations for Juvenile Justice (Barbara A. Oudekerk & N. Dickon Reppucci) 58 Translating Research into Intervention: Lessons Learned and New Directions (Marlene M. Moretti, Margaret Jackson, & Ingrid Obsuth) Departments 2 Editor’s Note 3 Outgoing President’s Column 4 Incoming President’s Column 64 The Resource Pag

Of Mice and Medicine: An Examination of the Anti-Depressant Enterprise

Anti-depressants (ADs) appear not to work very well, and present a sequence of puzzling problems: side effects, a long latency period before recovery, an uncertain theoretical foundation for psychopharmacology, the high relative efficacy of placebos, and the generally low efficacy of ADs. Behind these empirical and scientific problems lie a host of ethical issues within drug development: publication bias, conflicts of interest, ghost authorship, and informed consent. I review these issues and find that: (1) there is no reason why ADs should be effective for humans, given their origin in rodent research; (2) the placebo effect rivals the drug effect, showing that ADs are ineffective; (3) drug companies andf doctors unethically continue to push the use of ADs; (4) analyses from science and the philosophy of science show that ADs are scientifically unsound; and (5) ethical analyses show that Ads are ethically intolerable

General Psychology: An Introduction

The NOBA Project is a growing collection of expert-authored, open-licensed modules in psychology, funded by the Diener Education Fund. From these open modules, Tori Kearns and Deborah Lee created an arranged open textbook for her introductory psychology class. This textbook was created under a Round One ALG Textbook Transformation Grant. Accessible files with optical character recognition (OCR) and auto-tagging provided by the Center for Inclusive Design and Innovation.https://oer.galileo.usg.edu/psychology-textbooks/1000/thumbnail.jp