Prioritising Targets for School-Based ADHD Interventions: A Delphi Survey

AbstractMany studies have investigated the effectiveness of school-based ADHD interventions at modifying different social, emotional and behavioural target outcomes. However, there is a lack of evidence about which targets stakeholders perceive to be most important. This study sought to obtain consensus on which outcomes are perceived to be most important. A total of 114 people with ADHD, educational professionals, parents of children with ADHD, clinicians and researchers participated in a Delphi survey with 3 rounds. The importance of 52 intervention targets was rated on a scale from 0 to 8 (8 being extremely important). Consensus was reached if &gt;70% of a stakeholder group rated a target as between 6–8 and &lt;15% rated it as 0–2. Targets were dropped from subsequent rounds if more than 50% of stakeholder groups rated it as 0–5. Targets that all four stakeholder groups reached consensus on in any round were automatically included in our final outcome set. Comments were analysed using Thematic Analysis. All four stakeholder groups reached consensus on the importance of seven targets: ability to pay attention, conflict with teachers and peers, executive functioning, global functioning and quality of life, inattention symptoms, organisation skills and self-esteem. Four overarching themes were identified: Complexity of ADHD, Relationships, School Context, and What ADHD means to me. School-based ADHD interventions should target outcomes identified as most important to those who stand to benefit from such interventions. Some outcomes prioritised by our participants have not yet been targeted in school-based ADHD interventions. Implications of our findings for intervention and research design are discussed.</jats:p

Adapted Behavioural Activation for Bipolar Depression: A Randomised Multiple Baseline Case Series

This is the final version. Available on open access from MDPI via the DOI in this recordData Availability Statement: The data presented in this study are available on request from the corresponding author provided that suitable approvals are in place and the data can be shared anonymously. The data are not publicly available due to the need to preserve the anonymity of participants.Behavioural Activation (BA) is associated with a substantial evidence base for treatment of acute unipolar depression, and has promise as an easily disseminable psychological intervention for bipolar depression. Using a randomised multiple baseline case series design we examined the feasibility and acceptability of an adapted version of BA in a U.K. outpatient sample of 12 adults with acute bipolar depression. Participants were allocated at random to a 3–8 week wait period before being offered up to 20 sessions of BA. They completed outcome measures at intake, pre- and post-treatment and weekly symptom measures across the study period. Retention in therapy was high (11/12 participants completed the target minimum number of sessions), and all participants returning acceptability measures reported high levels of satisfaction with the intervention. No therapy-related serious adverse events were reported, nor were there exacerbations in manic symptoms that were judged to be a result of the intervention. The pattern of change on outcome measures is consistent with the potential for clinical benefit; six of the nine participants with a stable baseline showed clinically significant improvement on the primary outcome measure. The findings suggest adapted BA for bipolar depression is a feasible and acceptable approach that merits further investigation

Usability, acceptability, and feasibility of two technology-based devices for mental health screening in perinatal care: A comparison of web versus app

The use of Information and Communication Technologies (web pages and apps) in mental health has boosted. However, it is unknown which of these two devices can be better in terms of feasibility and acceptability. Our aim is to compare the feasibility, usability, and user satisfaction of two devices (web vs mobile application) of an online program for perinatal depression screening called HappyMom. In total, 348 and 175 perinatal women registered into HappyMom web and app version, respectively. The assessment protocol included different biopsychosocial evaluations (twice during pregnancy and thrice in the postpartum) and a satisfaction questionnaire. Results showed that a higher percentage of women in the web sample (27.3–51.1%) responded to each assessment compared to the app sample (9.1–53.1%). A smaller proportion of women in web sample never responded to any assessments. By contrast, the percentage of women who responded to all assessments was higher in app sample (longitudinal retention sample was 4.6% of web users and 9.1% of app users). In general, high satisfaction was found in both web and app users. Our result showed that online assessment methods are feasible and acceptable by perinatal women. However, dropout rates are a real problem that urge a solution that will be discussed further in the paper. Web and App devices present different advantages and limitations. The choice of one of them must be made taking into account the study’s objective, the sample characteristics, and the dissemination possibilities

Listening to the voices of women suffering perinatal psychological distress

This article suggests that transactional analysis can be an effective treatment approach for women suffering from mental health conditions and the emotional and life disturbances that may occur during the perinatal period. It offers a brief introduction to perinatal psychological distress followed by a description of the use of transactional analysis psychotherapy for this condition. The article outlines a new model for a research project that aims to ascertain women’s views on the helpfulness of the treatment and to gain a better understanding of the stigma often associated with perinatal mental health issues. The author argues for the necessity of qualitative research to assess the efficacy of transactional-analysis-based treatment and to increase our knowledge about the change process in transactional analysis psychotherapy with this client population as well as to inform future transactional analysis treatment protocols

Prioritising Targets for School-Based ADHD Interventions: A Delphi Survey

AbstractMany studies have investigated the effectiveness of school-based ADHD interventions at modifying different social, emotional and behavioural target outcomes. However, there is a lack of evidence about which targets stakeholders perceive to be most important. This study sought to obtain consensus on which outcomes are perceived to be most important. A total of 114 people with ADHD, educational professionals, parents of children with ADHD, clinicians and researchers participated in a Delphi survey with 3 rounds. The importance of 52 intervention targets was rated on a scale from 0 to 8 (8 being extremely important). Consensus was reached if &gt;70% of a stakeholder group rated a target as between 6–8 and &lt;15% rated it as 0–2. Targets were dropped from subsequent rounds if more than 50% of stakeholder groups rated it as 0–5. Targets that all four stakeholder groups reached consensus on in any round were automatically included in our final outcome set. Comments were analysed using Thematic Analysis. All four stakeholder groups reached consensus on the importance of seven targets: ability to pay attention, conflict with teachers and peers, executive functioning, global functioning and quality of life, inattention symptoms, organisation skills and self-esteem. Four overarching themes were identified: Complexity of ADHD, Relationships, School Context, and What ADHD means to me. School-based ADHD interventions should target outcomes identified as most important to those who stand to benefit from such interventions. Some outcomes prioritised by our participants have not yet been targeted in school-based ADHD interventions. Implications of our findings for intervention and research design are discussed.</jats:p

Den motiverende endringen – livsstilsendringer for hjerteinfarktpasienter

Tittel: Den motiverende endringen – livsstilsendringer for hjerteinfarktpasienter Hensikt: Hensikten med oppgaven er å undersøke om sykepleiere kan bidra med å hjelpe pasienter som har gjennomgått et hjerteinfarkt, til å endre livsstil gjennom en metode som kalles motiverende intervju. Problemstilling: Hvordan kan sykepleier gjennom motiverende intervju bidra til livsstilsendringer hos pasienter som har gjennomgått sitt første hjerteinfarkt? Metode: Denne bacheloroppgaven er et litteraturstudium, hvor det er utført strukturerte og systematiske søk for å finne relevante forskningsartikler i ulike databaser for å belyse min problemstilling. Det er også foretatt en ressurssamtale med en fagperson relatert til motiverende intervju. Kunnskap er supplert med pensumbøker fra sykepleierstudiet og andre relevante fagbøker. Resultat: Motiverende intervju er en metode som kan benyttes til livsstilsendring for pasienter med behov for endring, og viser god effekt innen områder som fysisk aktivitet, røykeslutt og kolesterol. Behandlingshastighet for pasienter som har gjennomgått hjerteinfarkt, påvirker motivasjonen. Sosial støtte er også viktig i tiden etter et hjerteinfarkt. Konklusjon: Bruk av motiverende intervju må tilpasses pasientens endringsforberedthet i «Stages of Change». Mestringsforventning og indre motivasjon er viktig for endringen. Sykeleie fremheves som en god profesjon for å utøve MI angående livsstilsendringer, men likevel er det opp til pasienten om livsstilen vil bli endret eller ikke. Nøkkelord: Motiverende intervju, livsstilsendring, hjerteinfark

Radically open dialectical behaviour therapy for refractory depression: the RefraMED RCT

Background About one-third of patients who are depressed do not respond to antidepressant medication (ADM) and traditional psychotherapy shows limited benefits. However, most randomised trials have excluded the most sick patients, especially with comorbid personality disorder. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting emotionally overcontrolled personality, which is common in refractory depression. Objective To evaluate the efficacy, cost-effectiveness and therapeutic mechanisms of RO DBT for patients with refractory depression. Design The Refractory depression: Mechanisms and Efficacy of RO DBT (RefraMED) trial was a multicentre, parallel-group, randomised trial in which participants were randomised to receive either RO DBT plus treatment as usual (TAU) or TAU alone. Participants were assessed at 7, 12 and 18 months after randomisation. Therapeutic mechanisms were explored in causal analyses. Setting Participants were recruited from three secondary care NHS organisations in the UK: Dorset, Hampshire and North Wales. Participants Patients were eligible if they were aged ≥ 18 years, had a Hamilton Rating Scale for Depression (HRSD) score of at least 15, had a current diagnosis of major depressive disorder in the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I, were suffering either refractory or chronic depression and, in their current episode, had taken an adequate dose of ADM for at least 6 weeks without relief. Patients who met criteria for dramatic-erratic personality disorder (Cluster B), bipolar disorder or psychosis or who had a primary diagnosis of substance dependence or abuse were excluded. Interventions The intervention, RO DBT, comprised 29 weekly individual sessions lasting 1 hour and 27 weekly skills classes lasting 2.5 hours. Participants allocated to TAU could access any treatment offered by the NHS or privately. Main outcome measures The reported HRSD score 12 months after randomisation and cost per quality-adjusted life-year (QALY). Results A total of 250 participants were allocated at random: 162 (65%) participants were randomised to RO DBT plus TAU and 88 (35%) were randomised to TAU. The difference between RO DBT and TAU in the primary outcome at 12 months was not statistically significant. Nevertheless, after 7 months, participants randomised to RO DBT had substantially, and significantly, reduced depressive symptoms, relative to TAU, by 5.40 HRSD points [standardised mean difference 1.03 points, 95% confidence interval (CI) 0.94 to 9.85 points; p = 0.02]. Thereafter, RO DBT remained the better treatment with net, but non-significant, reductions of 2.15 HRSD points (standardised mean difference 0.41 points, 95% CI –2.28 to 6.59 points; p = 0.29) after 12 months and 1.69 points (standardised mean difference 0.32 points, 95% CI –2.84 to 6.22 points; p = 0.42) after 18 months. Participants allocated to TAU could access any treatment offered by the NHS or privately. Participants randomised to RO DBT reported significantly better psychological flexibility and emotional coping than TAU participants; these differences increased over time. From the perspective of the NHS and personal social services, RO DBT was not cost-effective; the incremental cost-effectiveness ratio was £220,000 per QALY, which is considerably above the willingness-to-pay threshold of £30,000 set by the National Institute for Health and Care Excellence (NICE). RO DBT participants reported eight possible serious adverse reactions compared with none by TAU participants; however, we believe that this imbalance was a result of major differences in reporting opportunities. The Data Monitoring and Ethics Committee agreed that there was no reason to suspect that RO DBT was harmful. Conclusions Although RO DBT achieved the target effect size (Cohen’s d) with a d of 0.4 at the primary end point of 12 months, this was not significant. RO DBT was not cost-effective by NICE criteria. Nevertheless, RO DBT enhanced psychological flexibility and emotional coping, which are potential mechanisms of change. Limitations Analysing only 190 participants, instead of the target of 245, reduced the statistical power of the trial. Future work Future studies should aim to refine RO DBT, by maintaining clinical effectiveness while reducing costs, and to evaluate it for a wider range of overcontrolled disorders over a longer period. Trial registration Current controlled trials ISRCTN85784627. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and NIHR partnership, and will be published in full in Efficacy and Mechanism Evaluation; Vol. 5, No. 7. See the NIHR Journals Library website for further project information. </jats:sec