A meta-analysis of randomized trials of behavioural treatment of depression

Reproduced with permission of the publisher. Copyright © 2008 Cambridge University Press.Background. Depression is a common, disabling condition for which psychological treatments, in particular cognitive behavioural therapies are recommended. Promising results in recent randomized trials have renewed interest in behavioural therapy. This systematic review sought to identify all randomized trials of behavioural therapy for depression, determine the effect of such interventions and examine any moderators of such effect. Method. Randomized trials of behavioural treatments of depression versus controls or other psychotherapies were identified using electronic database searches, previous reviews and reference lists. Data on symptom-level, recovery/ dropout rate and study-level moderators (study quality, number of sessions, severity and level of training) were extracted and analysed using meta-analysis and meta-regression respectively. Results. Seventeen randomized controlled trials including 1109 subjects were included in this meta-analysis. A random-effects meta-analysis of symptom-level post-treatment showed behavioural therapies were superior to controls [standardized mean difference (SMD)-0.70, 95% CI -1.00 to -0.39, k=12, n=459], brief psychotherapy (SMD -0.56, 95% CI -1.0 to -0.12, k=3, n=166), supportive therapy (SMD -0.75, 95% CI -1.37 to -0.14, k=2, n=45) and equal to cognitive behavioural therapy (SMD 0.08, 95% CI -0.14 to 0.30, k=12, n=476). Conclusions. The results in this study indicate behavioural therapy is an effective treatment for depression with outcomes equal to that of the current recommended psychological intervention. Future research needs to address issues of parsimony of such interventions

Sudden gains in behavioural activation for depression

Sudden gains have been linked to improved outcomes in cognitive behaviour therapy for depression. The relationship between sudden gains and outcome is less clear in other treatment modalities, including interpersonal psychotherapy and supportive expressive therapy, which may indicate different mechanisms of change between treatment modalities. The current study examined sudden gains in adults meeting diagnostic criteria for depression (N = 40) offered up to 12 sessions of behavioural activation treatment. Sudden gains were found in 42.5% of the sample. Sudden gains occurred early (median pre-gain session 2) and were related to outcome: those who experienced a sudden gain had significantly lower post-treatment scores on the PHQ-9. Furthermore, the proportion meeting the reliable and clinically significant change criteria at end of treatment was higher in the sudden gain group. These findings highlight the importance of understanding the mechanisms by which sudden gains relate to therapy outcome in behavioural activation

Australia Telescope Compact Array Radio Continuum 1384 and 2368 Mhz Observations of Sagittarius B

We present images of the Sagittarius (Sgr) B giant molecular cloud at 2368 and 1384 MHz obtained using new, multi-configuration Australia Telescope Compact Array (ATCA) observations. We have combined these observations with archival single-dish observations yielding images at resolutions of 47" by 14" and 27" by 8" at 1384 and 2368 MHz respectively. These observations were motivated by our theoretical work (Protheroe et al. 2008) indicating the possibility that synchrotron emission from secondary electrons and positrons created in hadronic cosmic ray (CR) collisions with the ambient matter of the Sgr B2 cloud could provide a detectable (and possibly linearly polarized) non-thermal radio signal. We find that the only detectable non-thermal emission from the Sgr B region is from a strong source to the south of Sgr B2, which we label Sgr B2 Southern Complex (SC). We find Sgr B2(SC) integrated flux densities of 1.2+/-0.2 Jy at 1384 MHz and 0.7+/-0.1 Jy at 2368 MHz for a source of FWHM size at 1384 MHz of ~54". Despite its non-thermal nature, the synchrotron emission from this source is unlikely to be dominantly due to secondary electrons and positrons. We use polarization data to place 5-sigma upper limits on the level of polarized intensity from the Sgr B2 cloud of 3.5 and 3 mJy/beam at 1384 and 2368 MHz respectively. We also use the angular distribution of the total intensity of archival 330 MHz VLA and the total intensity and polarized emission of our new 1384 MHz and 2368 MHz data to constrain the diffusion coefficient for transport of the parent hadronic CRs into the dense core of Sgr B2 to be no larger than about 1% of that in the Galactic disk. Finally, we have also used the data to perform a spectral and morphological study of the features of the Sgr B cloud and compare and contrast these to previous studies.Comment: 7 pages, 4 figures, matches version published in the Astronomical Journa

Behavioural activation for overweight and obese adolescents with low mood delivered in a community setting : feasibility study

Background Mood and weight problems are common in young people, yet few treatments address both conditions concurrently. Behavioural activation (BA) has shown promise as a treatment for adults with comorbid obesity and depression. This study aimed to examine the feasibility and acceptability of a manualised BA treatment targeting weight and mood problems in young people. Methods Young people with low mood and weight difficulties were identified via a school-based screening process. Following a diagnostic interview, young people with clinically significant mood problems and concurrent overweight/obesity were invited to participate. A total of 8–12 sessions of BA were delivered by a graduate therapist to eight adolescents (four male) aged 12–15 years. Weight, mood and functioning were assessed before, during and after treatment, and a semistructured qualitative interview was conducted, along with selected outcome measures at 4 months’ follow-up. Results Low attrition and positive qualitative feedback suggested the intervention was acceptable. Trends towards a reduction in reported depression symptoms and improved functioning scores were observed at follow-up, with more mixed results for change in body mass index. Of those attending the 4-month follow-up, 57% (4/7) no longer met the screening threshold for major depressive disorder. However, low screening and baseline recruitment rates would pose challenges to executing a larger trial. Conclusions BA delivered by a graduate therapist in a British community setting is an acceptable, feasible treatment for comorbid mood and weight problems in adolescence, and its effectiveness should be evaluated in an adequately powered randomised controlled trial

ROSAT Evidence for Intrinsic Oxygen Absorption in Cooling Flow Galaxies and Groups

Using spatially resolved, deprojected ROSAT PSPC spectra of 10 of the brightest cooling flow galaxies and groups with low Galactic column densities we have detected intrinsic absorption over energies ~0.4-0.8 keV in half of the sample. Since no intrinsic absorption is indicated for energies below ~0.4 keV, the most reasonable model for the absorber is collisionally ionized gas at temperatures T=10^{5-6} K with most of the absorption arising from ionized states of oxygen but with a significant contribution from carbon and nitrogen. The soft X-ray emission of this warm gas can explain the sub-Galactic column densities of cold gas inferred within the central regions of most of the systems. Attributing the absorption to ionized gas reconciles the large columns of cold H and He inferred from EINSTEIN and ASCA with the lack of such columns inferred from ROSAT. Within the central ~10-20 kpc, where the constraints are most secure, the estimated mass of the ionized absorber is consistent with most (perhaps all) of the matter deposited by a cooling flow over the lifetime of the flow. Since the warm absorber produces no significant H or He absorption the large absorber masses are consistent with the negligible atomic and molecular H inferred from HI and CO observations of cooling flows. It is also found that if T > ~2x10^5 K then the optical and UV emission implied by the warm gas does not violate published constraints. Finally, we discuss how the prediction of warm ionized gas as the product of mass drop-out in these and other cooling flows can be verified with new CHANDRA and XMM observations. (Abridged)Comment: 17 pages (5 figures), Accepted for publication in ApJ, expanded discussion of multiphase spectral models, theoretical implications of warm gas in cooling flows, and the statistical significance of the oxygen absorptio

A Candidate Neutron Star Associated with Galactic Center Supernova Remnant Sagittarius A East

We present imaging and spectral studies of the supernova remnant (SNR) Sagittarius (Sgr) A East from deep observations with the {\it Chandra X-Ray Observatory}. The spatially-resolved spectral analysis of Sgr A East reveals the presence of a two-temperature thermal plasma ($kT$ $\sim$ 1 keV and 5 keV) near the center of the SNR. The central region is dominated by emission from highly-ionized Fe-rich ejecta. We estimate a conservative upper limit on the total Fe ejecta mass of the SNR, M$_{Fe}$ $<$ 0.27 M$_{\odot}$. Comparisons with standard SN nucleosynthesis models suggest that this Fe mass limit is consistent with a Type II SN explosion for the origin of Sgr A East. On the other hand, the soft X-ray emission extending toward the north of the SNR can be described by a single-temperature ($kT$ $\sim$ 1.3 keV) thermal plasma with normal chemical composition. This portion of the SNR is thus X-ray emission from the heated interstellar medium rather than the metal-rich stellar ejecta. We point out that a hard pointlike source CXOGC J174545.5$-$285829 (the so-called ``cannonball'') at the northern edge of the SNR shows unusual X-ray characteristics among other Galactic center sources. The morphological, spectral, and temporal characteristics of this source suggest an identification as a high-velocity neutron star. Based on the suggested Type II origin for the SNR Sgr A East and the proximity between the two, we propose that CXOGC J174545.5$-$285829 is a high-velocity neutron star candidate, born from the core-collapse SN which also created the SNR Sgr A East.Comment: ApJ preprint style 28 pages, 1 color fig (fig1), Accepted by Ap

Food insecurity in adults with severe mental illness living in Northern England: Peer research interview findings

Food insecurity means that a person does not have access to sufficient nutritiousfood for normal growth and health. Food insecurity can lead to many healthproblems such as obesity, heart disease, diabetes, and other long term healthconditions. People living with a severe mental illness are more likely to experiencefood insecurity than people without mental illness. Peer-ledin-depthinterviewswere conducted with adults with severe mental illness from Northern England,during which their experiences of food insecurity and strategies to tackle foodinsecurity were discussed. Interviews took place between March and December2022, with interviews being transcribed and analysed using deductive andinductive thematic analysis. Thirteen interviews were conducted, finding that foodinsecurity in adults with severe mental illness was often a long-standingissue.Unemployment, the cost-of-livingcrisis and fuel poverty impacted on experiencesof food insecurity. Difficulties accessing food banks such as transport, stigma,and the limited selection of available food was also discussed. Strategies to tacklefood insecurity centred on making food banks more accessible and improving thequality of available food. Future research should aim to eradicate food insecurityfor adults with severe mental illness, as limited research and action focuses onthis population group over and above ‘mental illness’ or ‘poor mental health’.Removing barriers to accessing food such as lack of transport, and providing foodwhich is of adequate nutritional quality, should be prioritised, as well as tacklingthe stigma and accessibility issues surrounding food banks use

Behavioural Activation versus Treatment as Usual for Depressed Older Adults in Primary Care:A Pragmatic Cluster-Randomised Controlled Trial

Introduction: Effective non-pharmacological treatment options for depression in older adults are lacking.Objective: The effectiveness of behavioural activation (BA) by mental health nurses (MHNs) for depressed older adults in primary care compared with treatment as usual (TAU) was evaluated.Methods: In this multicentre cluster-randomised controlled trial, 59 primary care centres (PCCs) were randomised to BA and TAU. Consenting older (=65 years) adults (n = 161) with clinically relevant symptoms of depression (PHQ-9 = 10) participated. Interventions were an 8-week individual MHN-led BA programme and unrestricted TAU in which general practitioners followed national guidelines. The primary outcome was self-reported depression (QIDS-SR16) at 9 weeks and 3, 6, 9, and 12-month follow-up.Results: Data of 96 participants from 21 PCCs in BA and 65 participants from 16 PCCs in TAU, recruited between July 4, 2016, and September 21, 2020, were included in the intention-to-treat analyses. At post-treatment, BA participants reported significantly lower severity of depressive symptoms than TAU participants (QIDS-SR16 difference = -2.77, 95% CI = -4.19 to -1.35), p &lt; 0.001; between-group effect size = 0.90; 95% CI = 0.42-1.38). This difference persisted up to the 3-month follow-up (QIDS-SR16 difference = -1.53, 95% CI = -2.81 to -0.26, p = 0.02; between-group effect size = 0.50; 95% CI = 0.07-0.92) but not up to the 12-month follow-up [QIDS-SR16 difference = -0.89 (-2.49 to 0.71)], p = 0.28; between-group effect size = 0.29 (95% CI = -0.82 to 0.24).Conclusions: BA led to a greater symptom reduction of depressive symptoms in older adults, compared to TAU in primary care, at post-treatment and 3-month follow-up, but not at 6- to 12-month follow-up.</p