20 research outputs found
Cortisol levels and cognitive profile in major depression: A comparison of currently and previously depressed patients
Source at https://doi.org/10.1016/j.psyneuen.2018.08.024.The association between depressive symptoms and elevated cortisol levels, and depression and cognitive functioning, has been less robust in outpatients with symptoms in the mild to moderate range. Furthermore, the association between elevated cortisol levels and cognitive functioning is unclear. In the present study, currently depressed (nâ=â37), previously depressed (nâ=â81) and never depressed controls (nâ=â50) were assessed on a range of neuropsychological measures. Salivary cortisol was measured in the morning and evening. Participants with current depression were non-hospitalized and had symptoms predominately in the mild to moderate range. Elevated salivary evening cortisol, but not morning cortisol, was significantly related to depressive symptoms. The difference in cortisol levels between the previously depressed group and the never depressed controls was not significant. The groups had significantly different cognitive profiles, with the currently depressed performing poorer on tasks related to working memory compared to the never depressed controls. Both the currently and previously depressed performed worse on attentional tasks. The findings indicate that outpatients with mild to moderate depression have elevated cortisol levels and limited mild cognitive impairments. Furthermore, mild impairments in attention may persist after remission, indicating that this could be a trait-marker in depression. The present study did not find support for a significant relationship between cortisol and cognitive functioning
Do parental cognitions during pregnancy predict bonding after birth in a low-risk sample?
Parental bonding to their infant is important for healthy parent-infant interaction and infant development. Characteristics in the parents affect how they bond to their newborn. Parental cognitions such as repetitive negative thinking, a thinking style associated with mental health issues, and cognitive dispositions, e.g., mood-congruent attentional bias or negative implicit attitudes to infants, might affect bonding.
To assess the influence of cognitive factors on bonding, 350 participants (220 pregnant women and their partners) were recruited over two years by midwives at the hospital and in the communal health care services. Participants were followed throughout the pregnancy and until the infant was seven months old as a part of the Northern Babies Longitudinal Study. Both mothers and fathers took part. First, we measured demographics, repetitive negative thinking, attentional bias, and implicit attitudes to infants during pregnancy, as predictors of bonding two months postnatally. Second, we also measured infant regulatory problems, and depressive symptoms at two months postnatally as predictors of parentsâ perception of infant temperament at five months. Robust regression analyses were performed to test hypotheses.
Results showed that mothers and fathers differed on several variables. Parity was beneficial for bonding in mothers but not for fathers. Higher levels of mothersâ repetitive negative thinking during pregnancy predicted weaker bonding, which was a non-significant trend in fathers. For fathers, higher education predicted weaker bonding, but not for mothers. Mothersâ perception of their infant temperament at five months was significantly affected by bonding at two months, but for fathers, their depressive symptoms were the only significant predictor of perceived infant temperament.
In conclusion, for mothers, their relationship with their infant is essential for how they experience their infant, while for fathers their own wellbeing might be the most important factor. Health care providers should screen parentsâ thoughts and emotions already during pregnancy to help facilitate optimal bonding
Motivasjon for internettbasert kognitiv atferdsterapi ved hjelp av konsultasjonsstøtte: en kvalitativ studie
Motivation to persist with internet-based cognitive behavioural treatment using blended care: a qualitative study
Internet-based cognitive behavioural therapy: A novel approach to treating depression in primary care patients
The overall aim of this thesis was to explore the effectiveness and acceptability of a Web-based self-help program (MoodGYM) combined with brief face-to-face therapist support for adult primary care patients with mild to moderate depression.
Depression is a highly prevalent disorder causing substantial suffering and impairment. Many depressed patients will receive all their treatment in primary health care. Structured psychological interventions are infrequently delivered in general practice, despite the development of several effective psychological therapies for depression, patientsâ preferences for such treatments, and guideline recommendations. Studies indicate that guided internet-based treatments for depression are effective.
A randomised controlled trial compared the guided internet-based intervention comprising MoodGYM and therapist support with a waitlist control group. Participants (n = 106) were primary care patients with mild to moderate depressive symptoms. Results indicated that the intervention was effective in reducing symptoms of depression and anxiety and in increasing life satisfaction. Treatment gains were largely maintained at 6-month follow-up. Moderate levels of non-adherence and positive ratings of treatment satisfaction indicated that the intervention was acceptable to patients.
The intervention was introduced to general practitioners (GPs) through a 3-day educational course. Following the course most GPs recommended MoodGYM to their patients. However, follow-ups were not successfully implemented due to time constraints, competing tasks and inadequate module knowledge and practical training.
Taken together these results indicate that the intervention may be effective and acceptable to primary care patients with mild to moderate depressive symptoms. A short educational course for GPs may promote recommendation of the program, but other approaches are needed to implement the full intervention including follow-ups. More comprehensive educational approaches may reach a selected group of GPs. However, multifaceted interventions including patient education, clinician education and organisational changes are necessary to implement such interventions more widely
Cognitive function in mild to moderately depressed and previously depressed individuals
The present study explored differences between groups of Never Depressed (ND, n = 50), Previously Depressed (PD, n = 81) and Clinically Depressed (CD, n = 38) individuals with mild to moderate depression severity on tests of executive functions, working memory, memory, attention, and psychomotor speed and information processing. The most striking finding was the absence of significant differences between the CDs and NDs on the majority of tests. The CDs had significantly poorer performance than the other groups on working memory and one measure of psychomotor speed and information processing. The PDs did not differ significantly from the other groups on the vast majority of measures. This result supports the view that cognitive impairment in depression is reversible and state dependent, and recovers upon remission from depression. There were no significant differences between CDs and PDs with 2 or less depressive episodes versus those with 3 or more episodes, and, furthermore, increased depressive severity was not associated with cognitive impairment. The results suggest that cognitive impairment in mild to moderate depression is limited and recovers as depression remits
Perceived Parenting Stress Is Related to Cardiac Flexibility in Mothers: Data from the NorBaby Study
Heart rate variability (HRV) is an indicator of autonomic nervous system activity, and high levels of stress and/or depressive symptoms may reduce HRV. Here, we assessed whether (a) parental stress affected HRV in mothers during the perinatal period and whether this is mediated by bonding and (b) whether antenatal maternal mental states, specifically repetitive negative thinking, depressive symptoms, and pregnancy-related anxiety, have an impact on infant HRV, and lastly, we investigated (c) the relationship between maternal HRV and infant HRV. Data are from the Northern Babies Longitudinal Study (NorBaby). In 111 parentâinfant pairs, cardiac data were collected 6 months after birth. In the antenatal period, we used the Pregnancy-Related Anxiety QuestionnaireâRevised, the Edinburgh Postnatal Depression Scale, and the Perseverative Thinking Questionnaire; in the postnatal period, we used the Parenting Stress Index and the Maternal Postnatal Attachment Scale. Higher levels of perceived parenting stress but not depressive symptoms were associated with lower HRV in mothers (Ď = â0.146), and this relationship was not mediated by maternal bonding. Antenatal maternal mental states were not associated with infant HRV. There was no significant correlation between maternal HRV and infant HRV. Our observational data suggest that perceived stress reduces cardiac flexibility. Future studies should measure HRV and parenting stress repeatedly during the perinatal period
Patientsâ Experiences of Helpfulness in Guided Internet-Based Treatment for Depression: Qualitative Study of Integrated Therapeutic Dimensions
Background: Quantitative research on Internet-based cognitive behavioral therapy (ICBT) has collected substantial evidence for the effectiveness of this treatment approach on health outcomes. Less is known about how patients find ICBT to be generally meaningful and helpful for treating depression.
Objective: To explore patientsâ experiences of being in ICBT treatment with a focus on the treatment dimensions that they considered helpful.
Methods: Choosing a phenomenological-hermeneutical approach, 14 patients were interviewed with semistructured qualitative interviews to elicit their understanding of using ICBT. The patients took part in a clinical trial using ICBT with MoodGYM, which also featured brief consultations with a clinical psychologist. The interviews were transcribed and analyzed according to the chosen methodology and organized into significant themes.
Results: The phenomenological-hermeneutical analysis identified 5 themes relating overall to the meaning of this mode of treatment in terms of helpfulness. Two related to treatment in general: (1) taking action to address oneâs problems and (2) the value of talking to a professional. The next two themes specifically addressed guided self-help using the MoodGYM program: (3) acquiring relevant knowledge, and (4) restructuring the new knowledge acquired through ICBT. A fifth theme concerned (5) actual changes in patientsâ perceptions and interactions, related to either the self-help material or the face-to-face consultations with the therapist.
Conclusions: Three important dimensions were made explicit: the active engagement of the patient, the guidance of the therapist, and the content of the treatment program. The findings pointed to (1) the role of MoodGYM as a source of new knowledge providing patients with a structured approach to work with their depression, (2) the patientâs role as the primary agent of change through adapting relevant knowledge from MoodGYM to their situation, and (3) the dialogue with the therapist as a trusting relationship in which to share thoughts and feelings, receive feedback and advice, and to assist the patient in making use of the MoodGYM content
The Clinical Effectiveness of Web-Based Cognitive Behavioral Therapy With Face-to-Face Therapist Support for Depressed Primary Care Patients: Randomized Controlled Trial
This is the accepted manuscript version. Published version is available at http://dx.doi.org/10.2196/jmir.2714</a
Norwegian General Practitionersâ Perspectives on Implementation of a Guided Web-Based Cognitive Behavioral Therapy for Depression: A Qualitative Study
BACKGROUND: Previous research suggests that Internet-based cognitive behavioral therapy (ICBT) has a positive effect on symptoms of depression. ICBT appears to be more effective with therapist support, but it is unclear what this support should comprise. General practitioners (GPs) have positive attitudes toward ICBT. However, ICBT is rarely used in regular care in general practice. More research is warranted to integrate the potential of ICBT as part of regular care. OBJECTIVE: The aim of this study was to explore aspects perceived by GPs to affect the implementation of guided ICBT in daily practice. Understanding their perspectives may contribute to improving the treatment of depression in the context of general practice. METHODS: A training package (3-day course) introducing a Norwegian translation of the ICBT program MoodGYM was developed and presented to GPs in Norway. Following training, GPs were asked to include guided ICBT in their regular care of patients with symptoms of depression by providing brief, face-to-face follow-up consultations between modules. We interviewed 11 GPs who had taken the course. Our interview guide comprised open questions that encouraged GPs to frame their responses using examples from their experiences when implementing ICBT. Thematic analysis was chosen to explore patterns across the data. RESULTS: An overall belief that ICBT would benefit both the patientsâ health and the GPsâ own work satisfaction prompted the GPs to take the ICBT course. ICBT motivated them to invest time and effort in improving treatment. The most important motivating aspects in MoodGYM were that a program based on cognitive behavioral therapy could add a structured agenda to their consultations and empower depressed patients. Organizational aspects, such as a lack of time and varied practice, inhibited the use of ICBT. Inadequate knowledge, recalling the program, and changing own habits were also challenging. The GPs were ambivalent about whether ICBT had a negative impact on the doctorâpatient interaction in the module follow-ups. Generally, GPs made an effort to recommend MoodGYM, but the expected module follow-ups were often not provided to patients and instead the GPs returned to standard treatment. CONCLUSIONS: GPsâ feedback in the present study contribute to our understanding of the challenges of changing treatment for depression. Our findings indicated that recommending ICBT could add to the GPâs toolkit. Offering training and highlighting the following aspects may increase recommendation of ICBT by GPs: (1) ICBT is theory-based and credible, (2) ICBT increases the GPsâ work satisfaction by having a tool to offer, and (3) ICBT facilitates empowerment of patients in their own health. In addition, the present study also indicated that complex aspects must be accommodated before module follow-ups can be incorporated into GPsâ treatment of depression