Psykisk sygdom og socialkognitive vanskeligheder

I de senere år er der kommet et øget fokus på såkaldte socialkognitive vanskeligheder hos patienter med psykiatriske lidelser (Cotter et al., 2018). Social kognition handler om de komplekse færdigheder, som mennesker anvender, når de interagerer med hinanden. Det drejer sig for eksempel om forståelsen af andre menneskers sindstilstand, ønsker og behov samt en forståelse af, at andre mennesker ikke nødvendigvis tænker og føler det samme, som man selv gør. Social kognition er et stort og omfattende felt, og det er derfor af stor interesse at undersøge, hvilke områder der især kan give udfordringer hos mennesker med svær psykisk sygdom. Fokus for dette temanummer er en beskrivelse af de socialkognitive vanskeligheder, som kan være til stede hos mennesker med forskellige former for svær psykisk sygdom, særligt autismespektrumlidelser og skizofreni, samt de metoder, som kan anvendes ved undersøgelse af vanskelighedernes art og omfang

Implementing a singing-based intervention for postpartum depression in Denmark and Romania: a brief research report

BackgroundThere is a burgeoning evidence-base that demonstrates the positive impact of the arts on our health, wellbeing, and health behaviors. However, very few studies have focused on how to optimize the implementation of these activities for different sociocultural contexts. Due to the increasing interest in scaling effective arts interventions as part of public health strategies, and in line with global goals of achieving health equity, this is an essential focus.AimUsing the case study of a singing for post-partum depression (PPD) intervention with empirically-demonstrated clinical effects, this brief research report explores implementation of an arts and health intervention that has been successful in the United Kingdom (“Music and Motherhood”) for the new contexts of Silkeborg (Denmark) and Cluj-Napoca (Romania).MethodsData was collected from participants at all levels of the implementation structure including at local and management levels. The study draws on qualitative implementation data to explore participant experiences, including one-to-one interviews, written testimonies, meeting minutes, ethnographic researcher reflections and focus groups, including data from 46 participants in total.Results and conclusionWe explore implementation and adaptation across five key themes: (1) acceptability and feasibility; (2) practical and structural barriers and enablers; (3) adoption and sustainability; (4) broader contextual factors affecting implementation and sustainability; and (5) project structure and processes. Taken together, the themes demonstrate that arts interventions need to be adapted in culturally sensitive ways by stakeholders who have local knowledge of their environments. This research serves as an informative foundation for use by other researchers that aim to expand the reach and impact of arts-based interventions

Cognitive Abilities in the Wild: Population-scale game-based cognitive assessment

Psychology and the social sciences are undergoing a revolution: It has become increasingly clear that traditional lab-based experiments fail to capture the full range of differences in cognitive abilities and behaviours across the general population. Some progress has been made toward devising measures that can be applied at scale across individuals and populations. What has been missing is a broad battery of validated tasks that can be easily deployed, used across different age ranges and social backgrounds, and employed in practical, clinical, and research contexts. Here, we present Skill Lab, a game-based approach allowing the efficient assessment of a suite of cognitive abilities. Skill Lab has been validated outside the lab in a crowdsourced population-size sample recruited in collaboration with the Danish Broadcast Company (Danmarks Radio, DR). Our game-based measures are five times faster to complete than the equivalent traditional measures and replicate previous findings on the decline of cognitive abilities with age in a large population sample. Furthermore, by combining the game data with an in-game survey, we demonstrate that this unique dataset has implication for key questions in social science, challenging the Jack-of-all-Trades theory of entrepreneurship and provide evidence for risk preference being independent of executive functioning.Comment: 11 pages, 4 figures, and 2 table

Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis.

BACKGROUND: Sleep disturbance symptoms are common in major depressive disorder (MDD) and have been found to hamper the treatment effect of conventional face-to-face psychological treatments such as cognitive behavioral therapy. To increase the dissemination of evidence-based treatment, blended cognitive behavioral therapy (bCBT) consisting of web-based and face-to-face treatment is on the rise for patients with MDD. To date, no study has examined whether sleep disturbance symptoms have an impact on bCBT treatment outcomes and whether it affects bCBT and treatment-as-usual (TAU) equally. OBJECTIVE: The objectives of this study are to investigate whether baseline sleep disturbance symptoms have an impact on treatment outcomes independent of treatment modality and whether sleep disturbance symptoms impact bCBT and TAU in routine care equally. METHODS: The study was based on data from the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment Versus Treatment-as-Usual) study, a 2-arm, multisite, parallel randomized controlled, noninferiority trial. A total of 943 outpatients with MDD were randomized to either bCBT (476/943, 50.5%) or TAU consisting of routine clinical MDD treatment (467/943, 49.5%). The primary outcome of this study was the change in depression symptom severity at the 12-month follow-up. The secondary outcomes were the change in depression symptom severity at the 3- and 6-month follow-up and MDD diagnoses at the 12-month follow-up, assessed using the Patient Health Questionnaire-9 and Mini-International Neuropsychiatric Interview, respectively. Mixed effects models were used to examine the association of sleep disturbance symptoms with treatment outcome and treatment modality over time. RESULTS: Of the 943 patients recruited for the study, 558 (59.2%) completed the 12-month follow-up assessment. In the total sample, baseline sleep disturbance symptoms did not significantly affect change in depressive symptom severity at the 12-month follow-up (β=.16, 95% CI -0.04 to 0.36). However, baseline sleep disturbance symptoms were negatively associated with treatment outcome for bCBT (β=.49, 95% CI 0.22-0.76) but not for TAU (β=-.23, 95% CI -0.50 to 0.05) at the 12-month follow-up, even when adjusting for baseline depression symptom severity. The same result was seen for the effect of sleep disturbance symptoms on the presence of depression measured with Mini-International Neuropsychiatric Interview at the 12-month follow-up. However, for both treatment formats, baseline sleep disturbance symptoms were not associated with depression symptom severity at either the 3- (β=.06, 95% CI -0.11 to 0.23) or 6-month (β=.09, 95% CI -0.10 to 0.28) follow-up. CONCLUSIONS: Baseline sleep disturbance symptoms may have a negative impact on long-term treatment outcomes in bCBT for MDD. This effect was not observed for TAU. These findings suggest that special attention to sleep disturbance symptoms might be warranted when MDD is treated with bCBT. Future studies should investigate the effect of implementing modules specifically targeting sleep disturbance symptoms in bCBT for MDD to improve long-term prognosis

Social cognitive impairment in patients with depression

Depression er en hyppigt forekommende psykisk lidelse, som forbindes med en lang række psykiske og fysiske symptomer. Disse symptomer kan påvirke dagligdagen i væsentlig grad og er typisk kendetegnet ved sænket stemningsleje, nedsat lyst eller interesse samt nedsat energi og øget trætbarhed. En stor andel af personer med en depressiv lidelse oplever ydermere udtalte vanskeligheder inden for det sociale domæne. For enkelte psykiatriske lidelser er sociale og interpersonelle vanskeligheder selvstændigt medregnet som et diagnostisk kriterium; fx inden for autismespektrumforstyrrelser. Dette er ikke tilfældet for depression, der ikke desto mindre ofte er kendetegnet ved betydelige og fremtrædende vanskeligheder inden for det samme domæne. Personer ramt af depression isolerer sig, oplever mindre glæde, og ofte udspiller der sig et større konfliktniveau i kontakten med deres nærmeste (Hirschfeld et al., 1999; Weightman, Knight, & Baune, 2019). Den deprimerede persons sociale vanskeligheder er belastende i sig selv og øger samtidig risikoen for tab af social støtte, hvilket i sig selv kan udgøre en barriere for bedring i tilstanden. Det er bl.a. af disse grunde vigtigt at opnå indsigt i de kognitive mekanismer, der kan ligge til grund for hhv. adaptiv og maladaptiv social adfærd. Kognitiv svækkelse optræder typisk også i forbindelse med en depressiv episode, og talrige studier har dokumenteret vanskeligheder inden for en række kognitive domæner, herunder psykomotorisk tempo, opmærksomhed, hukommelse, indlæring og eksekutive funktioner (Rock, Roiser, Riedel, & Blackwell, 2013). Socialkognitive vanskeligheder er anerkendt som et fremtrædende symptom ved en række psykiske lidelser, herunder autismespektrumforstyrrelser og skizofreni (Fernandes, Cajão, Lopes, Jerónimo, & Barahona-Corrêa, 2018). I hvilket omfang samme type af deficits ligeledes er af betydning ved depression, har igennem en årrække stået mindre klart. Der er dog nu en voksende anerkendelse af socialkognition som et værdifuldt konstrukt i forståelsen af kognitive forstyrrelser ved depression og i forbindelse med velkendte psykosociale vanskeligheder ved samme. En introduktion til socialkognition vil blive givet i det følgende efterfulgt af en præsentation af fund inden for unipolar depressiv lidelse.Social cognition is a valuable construct in understanding cognitive impairment in depression and well-known psycho-social difficulties. The article is critical towards the one-sided focus on non-social cognitive assessment in unipolar depression. A basic taxonomy for social cognition is presented including the following domains: decoding of emotional stimuli, representation of mental states and reflectivity. An overview of scientific findings on social cognitive impairment in unipolar depression is presented as is the interdependence between social- and non-social cognition and social cognitive impairment and psycho-social difficulties. Finally, psychotherapeutic and pharmacological interventions targeting social cognitive impairment are presented

Scalability of a singing-based intervention for postpartum depression in Denmark and Romania: protocol for a single-arm feasibility study

Introduction Postpartum depression (PPD) affects around one in seven women globally, with these women in need of non-pharmaceutical treatment strategies. There is a long history of the benefits of singing for maternal mental health, and promising research exists showing the clinical effectiveness of group singing. Group singing interventions are being scaled up to support new mothers in the United Kingdom, but we do not know if such an intervention may benefit women in different cultural contexts. This protocol focuses on exploring the feasibility of implementation and perceived impact of a 10-week group singing intervention for new mothers in Romania and Denmark eliciting signs of PPD.Methods and analysis Data will be collected from up to 48 women with a score ≥10 on the Edinburgh Postnatal Depression Scale (EPDS) participating in a 10-week group singing intervention in Denmark or Romania, as well as a range of project stakeholders. The singing classes will take place in person and be facilitated by professional singing leaders. Feasibility of implementation will be analysed through qualitative data (eg, focus groups, interviews) and quantitative data (eg, the Feasibility of Intervention Measure). Perceived impact will be explored via surveys that include mental health measures (EPDS, Multidimensional Scale of Perceived Social Support, WHO Five Well-Being Index) from singing intervention participants (at weeks 1, 6, 10) and focus groups. Descriptive statistics, repeated measures analysis of variance and analysis of covariance will be used to analyse quantitative data. Framework method and thematic analysis will be used to analyse qualitative data.Ethics and dissemination The national ethics committees in Romania (IRB-PH Protocol #2021-211217-012) and Denmark (case number 1-10-72-274-21) have approved the study, as has the Ethics Review Committee at the World Health Organization (ERC.0003714). All participants will be required to provide informed consent. Results will be disseminated by reports published by the WHO Regional Office for Europe, peer-reviewed publications and at conferences