Psychological treatments for persistent depression: A systematic review and meta-analysis of quality of life and functioning outcomes.

To date it is unclear whether psychological therapies have potential to improve quality of life and functioning in patients with persistent depression. This meta-analysis examines the effect of psychological therapies for improving quality of life and functioning in patients with persistent forms of depression. Data sources include Medline and Meta-Analytic Psychotherapy Database (METAPSY), searched 07/2021. Eligible studies were randomized controlled trials where participants had major depressive disorder on entry and met criteria for a persistent form of depression, for example, chronic, treatment resistant or recurrent depression. Standardized mean differences (Hedge’s g) were calculated in random-effects meta-analyses. Fourteen studies met inclusion criteria (N = 1898). Psychological interventions were associated with improvements in patients’ quality of life at the end of treatment: pooled g = 0.24 (95% confidence intervals [CIs] 0.13–0.34); low to moderate levels of heterogeneity (I² = 0% [95% CI 0%–41.2%]). Quality of life at follow-up: pooled g = 0.21 (95% CI 0.01–0.32); low to high levels of heterogeneity considering the wide CI for I² (I² = 10.36% [95% CI 0%–77.5%]). The psychological interventions were associated with improvements in patients’ functioning at end of treatment: pooled g = 0.34 (95% CI 0.21–0.48); low to high levels of heterogeneity considering the wide CI for I² (I² = 0% [95% CI 0%–81.7%]). Functioning at follow-up resulted in: pooled g = 0.33 (95% CI 0.15–0.50); low to high levels of heterogeneity considering the wide CI for I² (I² = 0% [95% CI 0%–86.2%]). This meta-analysis highlights the potential benefits of psychological therapies for improving quality of life and functioning in patients with persistent depression, with strongest long-term effects for mindfulness-based cognitive therapy, interpersonal therapy in combination with antidepression medication, and long-term psychoanalytic psychotherapy

Experiences of working-age adults with depression of psychodynamic couple therapy: a thematic analysis using a phenomenological approach

Background: Depression is a complex condition that affects over 320 million people worldwide and entails risks of relapse and suicide. As a result of the increasing number of adults experiencing symptoms of depression and anxiety in the United Kingdom, Improving Access to Psychological Therapies (IAPT) services have been established to assist individuals with these difficulties. The National Institute for Health and Care Excellence (NICE) guidelines have recommended behavioural couple therapy for the treatment of depression, but public provision is limited. Despite the wide range of literature that explains the link between couple wellbeing and mental health outcomes for adults and children, there is an evidence gap around the experiences of psychodynamic couple therapy. Method: Five participants completed a semi-structured interview, following at least six months of couple therapy for the treatment of severe distress and depression. They were recruited from an internationally renowned couple therapy provider in London, using a purposive sampling technique. Data was analysed using a phenomenological approach to thematic analysis. Results: Participants described the therapist as a “third person” who became a referee, and mediated the communication within the couple and provided a different perspective, which enabled a safe environment for reciprocal listening. A crucial aspect of couple therapy was the process of making links with the past, which enabled participants to understand their current behaviour as individual and dysfunctional areas as a couple. The process of creating connections with the past was meaningful for all participants, and some perceived fostering self-reflective skills as a practical tool, but others wanted to receive direct guidance. Three main active ingredients facilitated the therapeutic process: the therapist’s ability to understand the couple as individuals rather than as a unified entity; the therapist neutrality and capacity to empathise and connect with the couple. At the end of therapy, most participants reflected that their overall therapy experience has been helpful and highlighted a positive impact in terms of their depression, perspectives and connecting with emotions, not only for the couple involved but also in the wider system. Conclusions: This study highlighted the intertwined dynamic between relationship difficulties and depression. Participants were not able to make a clear distinction between these two experiences and this microcosm may reflect the difficulties that clients face in public services, which have historically held an individualistic perspective of distress

Experiences of working-age adults with depression of psychodynamic couple therapy: a thematic analysis using a phenomenological approach

The current study draws on interviews with service users about their experiences to inform the practice of psychodynamic couple therapy for depression. Five participants, who had received at least six months of psychodynamic couple therapy in London (UK) for the treatment of severe distress and depression, completed a semi‐structured interview. They were recruited using a purposive sampling technique. Data was analysed using a phenomenological approach to thematic analysis. Six themes were identified in relation to participants' experiences of couple therapy. Key aspects highlighted by participants include: the therapist, described as a ‘third person’, became a referee and mediated the communication within the couple, providing a different perspective, enabling a safe environment for reciprocal listening; the process of making links with the past enabled participants to understand their current behaviour as individual and dysfunctional areas as a couple; the therapist's ability to understand the couple as individuals rather than as a unified entity was key; therapist neutrality and capacity to empathise with the couple was valued by participants. The study highlighted the intertwined dynamic between relationship difficulties and depression. Participants were not able to make a clear distinction between these two experiences, and this microcosm may reflect the difficulties that clients face in accessing public services, which have historically held a more individualistic perspective of distress.</jats:p

Prevalence of Personality Disorders in Adults with Binge-Eating Disorder – a Systematic Review and Bayesian Meta-analysis

Binge eating disorder (BED) is a complex mental health problem entailing high risk for obesity, overweight, and other psychiatric disorders. However, there is still unclear evidence of the prevalence of personality disorders (PDs) in BED patients. We conducted a systematic review and a Bayesian meta‐analysis for studies examining the prevalence of any PD in adult BED patients. Data sources included PubMed, Cochrane library, EBSCO, PsycINFO, and Science Direct. A Bayesian meta‐analysis was conducted to estimate effect sizes for the prevalence of any PD in BED patients. Twenty eligible articles were examined with a total of 2945 BED patients. Borderline personality disorder and “Cluster C” PD, particularly obsessive‐compulsive and avoidant PD, were the most frequent PD found in BED patients. BED diagnosis was associated with 28% probability of a comorbid diagnosis of any PD (0.279, 95%CrI: [0.22, 0.34]), with high levels of between‐study heterogeneity (τ = 0.61, 95% CrI [0.40, 0.90]). Sensitivity analysis suggested effect sizes ranging from 0.27 to 0.28. The high comorbidity of PDs in BED patients draws attention to the potential complexity of BED clinical presentations, including those that might also be comorbid with obesity. Clinical practice should address this complexity to improve care for BED and obesity patients

Dissociation of Singly and Multiply Charged Nitromethane Cations: Femtosecond Laser Mass Spectrometry and Theoretical Modeling

Dissociation pathways of singly- and multiply charged gas-phase nitromethane cations were investigated with strong-field laser photoionization mass spectrometry and density functional theory computations. There are multiple isomers of the singly charged nitromethane radical cation, several of which can be accessed by rearrangement of the parent CH3–NO2 structure with low energy barriers. While direct cleavage of the C–N bond from the parent nitromethane cation produces NO2+ and CH3+, rearrangement prior to dissociation accounts for fragmentation products including NO+, CH2OH+, and CH2NO+. Extensive Coulomb explosion in fragment ions observed at high laser intensity indicates that rapid dissociation of multiply charged nitromethane cations produces additional species such as CH2+, H+, and NO22+.  On the basis of analysis of Coulomb explosion in the mass spectral signals and pathway calculations, sufficiently intense laser fields can remove four or more electrons from nitromethane

Ultrafast Dynamics of Nitro−Nitrite Rearrangement and Dissociation in Nitromethane Cation

We report new insights into the ultrafast rearrange- ment and dissociation dynamics of nitromethane cation (NM+) using pump−probe measurements, electronic structure calculations, and ab initio molecular dynamics simulations. The “roaming” nitro−nitrite rearrangement (NNR) pathway involving large- amplitude atomic motion, which has been previously described for neutral nitromethane, is demonstrated for NM+. Excess energy resulting from initial population of the electronically excited D2 state of NM+ upon strong-field ionization provides the necessary energy to initiate NNR and subsequent dissociation into NO+. Both pump−probe measurements and molecular dynamics simulations are consistent with the completion of NNR within 500 fs of ionization with dissociation into NO+ and OCH3 occurring ∼30 fs later. Pump−probe measurements indicate that NO+ formation is in competition with the direct dissociation of NM+ to CH3+ and NO2. Electronic structure calculations indicate that a strong D0 → D1 transition can be excited at 650 nm when the C−N bond is stretched from its equilibrium value (1.48 Å) to 1.88 Å. On the other hand, relaxation of the NM+ cation after ionization into D0 occurs in less than 50 fs and results in observation of intact NM+. Direct dissociation of the equilibrium NM+ to produce NO2+ and CH3 can be induced with 650 nm excitation via a weakly allowed D0 → D2 transition

Construction and psychometric testing of the EMPATHIC questionnaire measuring parent satisfaction in the pediatric intensive care unit

Abstract PURPOSE: To construct and test the reliability and validity of the EMpowerment of PArents in THe Intensive Care (EMPATHIC) questionnaire measuring parent satisfaction in the pediatric intensive care unit (PICU). METHODS: Structured development and psychometric testing of a parent satisfaction-with-care instrument with the results of two cohorts of parents (n = 2,046) from eight PICUs in the Netherlands. RESULTS: In the first cohort, 667/1,055 (63%) parents participated followed by 551/991 (56%) parents in the second cohort. The empirical structure of the instrument was established by confirmatory factor analysis with the first sample of parents confirming 65 statements within five theoretically conceptualized domains: information, care and cure, organization, parental participation, and professional attitude. The standardized factor loadings were greater than 0.40 in 63 statements. Cronbach's α, a measure of reliability, per domain ranged from 0.73 to 0.93 in both cohorts with no significant difference documenting the reliability over time. Beside rigorous content and face validity, the congruent validity of the instrument showed adequate correlation with four gold standard questions measuring overall satisfaction. The non-differential validity was confirmed with no significant differences between the population characteristics and the domains, except that parents with a child for a surgical admission were more satisfied on information issues. CONCLUSIONS: The final EMPATHIC questionnaire incorporates 65 statements. The empirical structure of the satisfaction statements and domains was satisfactory. The reliability and validity proved to be adequate. The EMPATHIC questionnaire is a valid quality performance indicator to measure quality of care as perceived by parents

Perceptions of parents on satisfaction with care in the pediatric intensive care unit: the EMPATHIC study

Abstract: PURPOSE: To identify parental perceptions on pediatric intensive care-related satisfaction items within the framework of developing a Dutch pediatric intensive care unit (PICU) satisfaction instrument. METHODS: Prospective cohort study in tertiary PICUs at seven university medical centers in The Netherlands. PARTICIPANTS: Parents of 1,042 children discharged from a PICU. RESULTS: A 78-item questionnaire was sent to 1,042 parents and completed by 559 (54%). Seventeen satisfaction items were rated with mean scores or =1.65, and thus considered of limited value. The empirical structure of the items was in agreement with the theoretically formulated domains: Information, Care a

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research