Digital Interventions for People With Co-Occurring Depression and Problematic Alcohol Use: A Systematic Review and Meta-Analysis

Aims: This systematic review and meta-analysis assessed the effectiveness of digital interventions addressing depressive symptoms and alcohol use simultaneously among people with co-occurring depression and problematic alcohol use.Methods: Seven databases were searched for trials evaluating digital interventions aimed at depression and alcohol use. Random-effects meta-analyses were conducted to pool effects on depressive symptoms and alcohol use up to 3-month and 6-month follow-up. Overall quality for every outcome was assessed with GRADE (Grading of Recommendations Assessment, Development and Evaluation).Results: The pooled effect of digital interventions compared to their comparators was in favour of digital interventions. Small but significant effects on depressive symptoms at 3-month follow-up were found (g = 0.34, 95% confidence interval (CI): 0.06-0.62, P = 0.02, k = 6) and non-significant effects at 6-month follow-up (g = 0.29, 95% CI: -0.16 to 0.73, P = 0.15, k = 5). For alcohol use, the pooled effect of digital interventions was small and non-significant at 3-month follow-up (g = 0.14, 95% CI: -0.02 to 0.30, P = 0.07, k = 6) and significant at 6-month follow-up (g = 0.14, 95% CI: 0.07-0.20, P = 0.005, k = 5). Sensitivity analysis indicated the latter finding to be sensitive to statistical estimator choice. Quality of evidence was moderate, except for depressive symptoms at 6-month follow-up for which it was low.Conclusion: Based on the literature, digital interventions are effective in reducing depressive symptoms at 3-month follow-up and alcohol use at 6-month follow-up among people with comorbid depression and problematic alcohol use. More high-quality trials are needed to confirm the current findings.</p

Effectiveness of an add-on guided internet-based emotion regulation training (E-TRAIN) in adolescents with depressive and/or anxiety disorders: study protocol for a multicenter randomized controlled trial

During adolescence, depressive and anxiety disorders are among the most common mental health disorders. Both disorders tend to persist, are predictive for other mental disorders, and are associated with severe impairment in diverse areas. Although Cognitive Behavioral Therapy (CBT) has proven to be an effective treatment, a considerable number of adolescents do not respond to CBT and residual symptoms often remain. Therefore, it is of great importance to improve treatment outcomes for depressed and/or anxious adolescents. Dysfunctional emotion regulation appears to be a transdiagnostic factor in the development and maintenance of aforementioned disorders. Enhancing emotion regulation skills may therefore reduce symptom severity. In light of this, we developed a guided internet-based emotion regulation training (E-TRAIN) that will be added to CBT. This study aims to evaluate the effectiveness of E-TRAIN + CBT compared to CBT alone on depressive and anxiety outcomes among adolescents with depressive and/or anxiety disorder. Methods: In this multicenter two-arm randomized controlled trial with parallel group design, we aim to include 138 adolescents, aged 13–19 years, referred for treatment and diagnosed with depressive and/or anxiety disorder. Participants will be allocated to either CBT or CBT + E-TRAIN. Assessments will take place at baseline, and at 3 (T1), 6 (T2) and 12 (T3) months after baseline. We will conduct multi-informant assessments: the adolescent, a parent/caregiver, and the CBT therapist will be asked to fill in questionnaires. The continuous primary outcome measure is self-reported depressive and anxiety symptoms at six months after baseline, measured with the RCADS25. Secondary outcome measures include anxiety or depression diagnosis based on a semi-structured clinical interview, emotion (dys) regulation, and parent-report measures of anxiety, depression and emotion (dys) regulation. Discussion: This study is the first randomized controlled trial to examine the additional value of a guided internet-based emotion regulation training to regular CBT in adolescents with depressive and/or anxiety disorders. If this intervention is effective, it can be implemented in mental health care and improve treatment for these young people. Trial registration: Registered on June 23, 2021 in The Netherlands Trial Register (NL9564). Retrospectively registered. Recruitment started in May 2021 and is ongoing

Nothing is more permanent than the temporary: understanding protracted displacement and people's own responses

Across the world, 16 million refugees and an unknown number of internally displaced persons (IDPs) experience long-lasting conditions of economic precarity, marginalisation, rightlessness and future uncertainty. They live under conditions of protracted displacement. Policy solutions often fail to recognise displaced people’s needs and limit rather than widen the range of available solutions. This report brings together the central findings of the TRAFIG project’s empirical study in the Democratic Republic of the Congo (DRC), Ethiopia, Tanzania, Jordan, Pakistan, Greece, Italy and Germany. We engaged with more than 3,120 people in our three-year project. Our analysis centres around five factors that shape conditions of protracted displacement: 1) governance regimes of aid and asylum, 2) social practices and livelihoods, 3) networks and movements, 4) intergroup relations between displaced people and hosts, and 5) development incentives and economic interactions. We present multiple findings on each of these themes. Moreover, this report addresses gender and classbased differences and mental health related challenges in constellations of protracted displacement as well as political dynamics that impact on people’s own responses to protracted displacement. Overall, our research shows that refugees, IDPs and other migrants by and large find protection, shelter, livelihood support, a sense of belonging and opportunities to migrate elsewhere through their personal networks. These networks often stretch across several places or even extend across multiple countries. While they are not a panacea for all challenges, people’s own connections are an essential resource for sustainable and long-term solutions to their precarious situation. They must not be ignored in policy responses to protracted displacement. Understanding the needs and the local, translocal and transnational ties of displaced people is the foundation for finding solutions that last

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Into focus: Gaining insight into the prevalence, context, and prevention of violent victimization and revictimization among depressed patients

Psychiatric patients are at increased risk to fall victim to violence, which is called “victimization”. Although most studies have focused on patients with psychotic disorders or substance use disorders, research has demonstrated depressed patients to be at risk of (re)victimization as well. However, the highly scarce research has left many important questions unanswered. In the first part of this thesis, we describe our results regarding the prevalence, context, and correlates of (re)victimization in three separate populations with depressive disorders and other mental disorders. Chapter 2: In a large, representative sample of the general population (N = 5303), we demonstrated that, out of a wide range of common mental disorders, only alcohol dependence prospectively predicted violent victimization three years later after adjustment for childhood trauma. Furthermore, major depressive disorder, panic disorder, social phobia, generalized anxiety disorder, and alcohol dependence predicted future psychological victimization. Chapter 3: We compared the prevalence of violent victimization in remitted, formerly depressed patients (N = 140), currently depressed patients (N = 102), and a large, weighted sample of the Dutch general population (N = 9175). We demonstrated that 12-month prevalence rates of violent victimization among remitted patients were similar (12.1%) to those of the general population (11.7%), and lower than those of currently depressed patients (35.5%). Chapter 4 explored the context (e.g., perpetrator, location), gender differences, predictors, and disclosure rates regarding victimization among recently victimized depressed patients (N = 153). The second part of this thesis explores the relationship between sexual victimization, emotion dysregulation, and risk perception, and describes the unique impact of three types of childhood abuse on depressive symptoms among 276 female college students. In Chapter 5, we found no significant relationships between sexual victimization, emotion dysregulation, and risk perception (i.e., the ability to perceive risk in potentially threatening situations). In Chapter 6, we showed that only childhood emotional abuse, contrary to childhood physical and sexual abuse, was independently associated with current depressive symptoms, emotion dysregulation, and interpersonal problems. The third part of this thesis describes the development of an innovative add-on internet-based emotion regulation training (iERT) and the evaluation of its effectiveness in reducing revictimization. Chapter 7 describes the study protocol of our multicenter randomized controlled trial that primarily aimed to evaluate the effectiveness of guided iERT added to treatment as usual (TAU) in reducing violent revictimization and depressive symptoms in previously victimized, depressed patients compared to TAU alone. In chapter 8, we presented the key results of our randomized controlled trial among 153 recently victimized, depressed patients. These results remain under embargo. The fourth part of this thesis (Chapter 9) presents the results of our systematic review and meta-analysis on the effectiveness of internet- and computer-based cognitive behavioral therapy (cCBT) in adolescents and young adults aged 12-25 years with depressive and anxiety disorders. We concluded that cCBT is effective in treating depressive symptoms and anxiety symptoms compared to passive controls. Furthermore, we demonstrated that cCBT yields similar effects on anxiety symptoms as active treatment controls. For depressive symptoms, results remain inconclusive. The findings presented in this thesis lead to several recommendations for clinical practice, policy making, and future research. Among other recommendations, we strongly advocate the implementation of routine enquiry of childhood and adult victimization in clinical practice and stress the urgent need for longitudinal research focused on 1) unraveling the longitudinal relationship between victimization and mental disorders; 2) identifying risk factors and treatment targets regarding violent and psychological victimization among psychiatric patients, including factors of all ecological system levels; and 3) developing and evaluating interventions to reduce risk for violent and psychological (re)victimization in depressed patients and other psychiatric patients

Internet-based emotion-regulation training added to CBT in adolescents with depressive and anxiety disorders: A pilot randomized controlled trial to examine feasibility, acceptability, and preliminary effectiveness

Background: Dysfunctional emotion regulation (ER) is associated with symptoms of depression and anxiety in adolescents. This pilot study aimed to examine the acceptability and feasibility of a guided internet-based emotion regulation training (ERT) added to cognitive behavioral therapy (CBT). Furthermore, we aimed to examine the feasibility of the randomized study design and to provide a first estimate of the effectiveness of CBT + ERT compared with CBT alone in adolescents with depressive or anxiety disorders. Methods: In a pilot randomized controlled trial (RCT) with a parallel group design, 39 patients (13–18 years) with depressive or anxiety disorder were assigned to CBT + ERT (n = 21) or CBT (n = 18). Assessments at baseline, three-months and six-months follow-up included treatment adherence, satisfaction, depressive symptoms, anxiety symptoms, and ER strategies. Results: Adherence to ERT was 66.5 %, and treatment satisfaction was adequate. 76.5 % of eligible patients participated in the study. Linear mixed-model analyses showed significantly reduced anxiety symptoms (p = .003), depressive symptoms (p = .017), and maladaptive ER (p = .014), and enhanced adaptive ER (p = .008) at six months follow-up in the CBT + ERT group compared to controls. Limitations: The sample size was small, and results regarding effectiveness remain preliminary. Data-collection took place during COVID-19, which may have influenced the results. Conclusions: Both the intervention and the study design were found to be feasible. In a larger RCT, however, improvement of recruitment strategy is necessary. Preliminary results indicate potential effectiveness in decreasing anxiety, depression, and emotion dysregulation in adolescents. The next step should be the development of an improved internet-based ERT and its evaluation in a larger RCT. Trial registration: Registered on January 14th, 2020 in The Netherlands Trial Register (NL8304)

Changes in Risk Perception After Sexual Victimization: Are We Following the Right Track?

Sexual abuse is a major public health concern with detrimental effects on both mental and physical health. Several studies have reported that victims of sexual abuse have a decreased ability to recognize risk in potentially threatening situations compared with nonvictims, although others were not able to replicate this finding. In addition, although emotion dysregulation has been linked to risk perception and sexual victimization, results have been contradictory. To strengthen the theoretical framework needed for the development of interventions to reduce women’s likelihood of sexual assault, it is crucial to further examine the role of emotion dysregulation in relation to sexual victimization history and risk perception. The aim of the current study was to examine cross-sectional associations between sexual victimization, emotion regulation difficulties, and risk perception. In our sample of 276 female college students, 40% reported lifetime sexual victimization, 14% reported recent sexual victimization, and 12% reported childhood sexual abuse. In contrast to our hypothesis, we did not find risk perception to be related to lifetime sexual victimization, childhood sexual victimization, or recent sexual victimization. In addition, we did not find evidence for the expected relationship between sexual victimization, risk perception, and emotion regulation difficulties. The discussion of the current study specifically highlights the need for a clear conceptualization of risk perception and provides recommendations for future studies. More sophisticated measurement methods could lead to a higher applicability of findings to real-life situations. The potential relationships between victimization, risk perception, and emotion dysregulation need further clarification to reach the ultimate goal of contributing to the prevention of victimization

Digital Interventions for People With Co-Occurring Depression and Problematic Alcohol Use: A Systematic Review and Meta-Analysis

AIMS: This systematic review and meta-analysis assessed the effectiveness of digital interventions addressing depressive symptoms and alcohol use simultaneously among people with co-occurring depression and problematic alcohol use. METHODS: Seven databases were searched for trials evaluating digital interventions aimed at depression and alcohol use. Random-effects meta-analyses were conducted to pool effects on depressive symptoms and alcohol use up to 3-month and 6-month follow-up. Overall quality for every outcome was assessed with GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS: The pooled effect of digital interventions compared to their comparators was in favour of digital interventions. Small but significant effects on depressive symptoms at 3-month follow-up were found (g = 0.34, 95% confidence interval (CI): 0.06-0.62, P = 0.02, k = 6) and non-significant effects at 6-month follow-up (g = 0.29, 95% CI: -0.16 to 0.73, P = 0.15, k = 5). For alcohol use, the pooled effect of digital interventions was small and non-significant at 3-month follow-up (g = 0.14, 95% CI: -0.02 to 0.30, P = 0.07, k = 6) and significant at 6-month follow-up (g = 0.14, 95% CI: 0.07-0.20, P = 0.005, k = 5). Sensitivity analysis indicated the latter finding to be sensitive to statistical estimator choice. Quality of evidence was moderate, except for depressive symptoms at 6-month follow-up for which it was low. CONCLUSION: Based on the literature, digital interventions are effective in reducing depressive symptoms at 3-month follow-up and alcohol use at 6-month follow-up among people with comorbid depression and problematic alcohol use. More high-quality trials are needed to confirm the current findings