REACHING PEOPLE IN NEED OF MENTAL HEALTH SERVICES THROUGH NOVEL MODELS OF INTERVENTION DELIVERY

The treatment gap refers to the difference in the proportion of people who have disorders and the proportion of those individuals who receive treatment. In developing and developed countries, the gap is enormous, i.e., most individuals in need of mental health services receive no treatment. Among the many barriers is the dominant model of delivering psychosocial interventions. That model includes one-to-one, in-person treatment, with a trained mental health professional, provided in clinical setting (e.g., clinic, private practice office, health-care facility). That model greatly limits the scale and reach of psychosocial interventions. The article discusses many novel models of delivering interventions that permit scaling treatment to reach people who are not likely to receiveservices. Four models (task shifting, best-buy, disruptive interventions, and Entertainment Education) are illustrated. These and other models are readily available, most have evidence in their behalf, but are still not sufficiently exploited to close the treatment gap. The article argues for the need for multiple models to optimize reaching the many diverse groups in need of care

Identifying evidence-based interventions for children and adolescents using the range of possible changes model: A meta-analytic illustration

We are very grateful to Kelly D. Brownell, Julia Kim-Cohen, Susan Nolen-Hoeksema, and Peter Salovey for extremely insightful discussions and commentaries on previous versions of this manuscript. We also thank Jennifer Thomas, Jessica Cronce, and Amelia Aldao for their careful and diligent participation as coders for this study. Please address correspondence to Andres De Los Reyes, Department of Psychology, University of Maryland at College Park, Biology/Psychology Building, Room 3123H, College Park, MD 20742; office: 301-405-7049; e-mail: [email protected] article discusses a study involving a framework (range of possible changes [RPC] Model) developed and applied to identify patterns in consistent and inconsistent intervention outcomes effects by informant, measurement method, and method of statistical analysis to the meta-analytic study of trials testing two evidence-based interventions for children and adolescents (youth-focused cognitive-behavioral treatment for child anxiety problems; parent-focused behavioral parent training for childhood conduct problems). This article illustrates how findings gleaned from applying the RPC Model allow for unique opportunities for hypothesis generation based on the patterns of consistent outcomes effects. Based on the RPC Model, studies can be closely examined to identify the specific instances in which interventions yield robust effects, and the authors illustrate how examining effects in this way can lead to new understandings of interventions and the outcomes they produce. Findings suggest that researchers can employ previously underutilized patterns of consistencies and inconsistencies in outcomes effects as new resources for identifying evidence-based interventions.This work was supported, in part, by National Institute of Mental Health Grant MH67540 (Andres De Los Reyes). This work was also supported by National Institute of Mental Health Grant MH59029 (Alan E. Kazdin)

Initial risk matrix, home resources, ability development and children’s achievement

This paper investigates the development of basic cognitive, motor and noncognitive abilities from infancy to adolescence. We analyse the predictive power of these abilities, initial risk conditions and home resources for children’s achievement. Our data are taken from the Mannheim Study of Children at Risk (MARS), an epidemiological cohort study, which follows the long-term outcome of early risk factors. Results indicate that differences in abilities increase during childhood, while there is a remarkable stability in the distribution of the economic and socio-emotional home resources during childhood. Initial risk conditions trigger a cumulative effect. Cognitive, motor and noncognitive abilities acquired during preschool age contribute to the prediction of children’s achievement at school age

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression among University Students:A Secondary Analysis of a Randomized Clinical Trial

Importance: Guided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT. Objective: To develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors. Design, Setting, and Participants: This prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022. Interventions: Participants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435). Main Outcomes and Measures: Remission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline. Results: The study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P =.003) or treatment as usual (40.0% [2.7%]; P =.001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P =.007; self-guided i-CBT: 25.4% [8.8%]; P =.004; treatment as usual: 31.0% [9.4%]; P =.001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P =.14; treatment as usual: 53.0% [6.0%]; P =.25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P =.001; treatment as usual: 41.8% [3.2%]; P &lt;.001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P =.07). Conclusions and Relevance: Guided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings. Trial Registration: ClinicalTrials.gov Identifier: NCT04780542.</p

Informant discrepancies in assessing child dysfunction relate to dysfunction within mother-child interactions.

We examined whether mother-child discrepancies in perceived child behavior problems relate to dysfunctional interactions between mother and child and stress in the mother. Participants included 239 children (6–16 years old; 58 girls, 181 boys) referred for oppositional, aggressive, and antisocial behavior, and their mothers. Mother-child discrepancies in perceived child behavior problems were related to mother-child conflict. Moreover, maternal stress mediated this relationship. The findings suggest that discrepancies among mother and child evaluations of child functioning are not merely reflections of different perspectives or artifacts of the assessment process, but can form components of conceptual models that can be developed and tested to examine the interrelations among critical domains of child, parent, and family functioning.This work was supported, in part, by a grant from the National Institute of Mental Health (MH67540) awarded to the first author and by grants from the Leon Lowenstein Foundation, the William T. Grant Foundation (98-1872-98), and the National Institute of Mental Health (MH59029) awarded to the second author

Self-productivity and complementarities in human development : evidence from MARS

This paper investigates the role of self-productivity and home resources in capability formation from infancy to adolescence. In addition, we study the complementarities between basic cognitive, motor and noncognitive abilities and social as well as academic achievement. Our data are taken from the Mannheim Study of Children at Risk (MARS), an epidemiological cohort study following the long-term outcome of early risk factors. Results indicate that initial risk conditions cumulate and that differences in basic abilities increase during development. Self-productivity rises in the developmental process and complementarities are evident. Noncognitive abilities promote cognitive abilities and social achievement. There is remarkable stability in the distribution of the economic and socio-emotional home resources during the early life cycle. This is presumably a major reason for the evolution of inequality in human development