REACHING PEOPLE IN NEED OF MENTAL HEALTH SERVICES THROUGH NOVEL MODELS OF INTERVENTION DELIVERY

The treatment gap refers to the difference in the proportion of people who have disorders and the proportion of those individuals who receive treatment. In developing and developed countries, the gap is enormous, i.e., most individuals in need of mental health services receive no treatment. Among the many barriers is the dominant model of delivering psychosocial interventions. That model includes one-to-one, in-person treatment, with a trained mental health professional, provided in clinical setting (e.g., clinic, private practice office, health-care facility). That model greatly limits the scale and reach of psychosocial interventions. The article discusses many novel models of delivering interventions that permit scaling treatment to reach people who are not likely to receiveservices. Four models (task shifting, best-buy, disruptive interventions, and Entertainment Education) are illustrated. These and other models are readily available, most have evidence in their behalf, but are still not sufficiently exploited to close the treatment gap. The article argues for the need for multiple models to optimize reaching the many diverse groups in need of care

LLEGANDO A LAS PERSONAS QUE NECESITAN SERVICIOS DE SALUD MENTAL A TRAVÉS DE NOVEDOSOS MODELOS DE PRESTACIÓN DE INTERVENCIONES

La brecha de tratamiento se refiere a la diferencia en la proporción de personas que tienen trastornos y la proporción de personas que reciben tratamiento. En los países desarrollados y en desarrollo, la brecha es enorme; es decir, la mayoría de las personas que necesitan servicios de salud mental no recibe tratamiento. Entre las muchas barreras, se encuentra el modelo dominante de realizar intervenciones psicosociales. Ese modelo incluye tratamiento individualizado en persona, con un profesional de salud mental capacitado, proporcionado en un entorno clínico (por ejemplo, clínica, consultorio privado, centro de atención médica). Ese modelo limita en gran medida la escala y el alcance de las intervenciones psicosociales. El artículo analiza muchos modelos novedosos de prestación de intervenciones que permiten ampliar el tratamiento para llegar a las personas que probablemente no recibirán servicios. Se ilustran cuatro modelos (cambio de tareas, mejor compra, intervenciones disruptivas y educación en entretenimiento). Estos y otros modelos están fácilmente disponibles, la mayoría tiene evidencia a su favor, pero aún no se explotan lo suficiente como para cerrar la brecha de tratamiento. El artículo sostiene la necesidad de múltiples modelos para optimizar llegar a los diversos grupos que necesitan atención

Identifying evidence-based interventions for children and adolescents using the range of possible changes model: A meta-analytic illustration

We are very grateful to Kelly D. Brownell, Julia Kim-Cohen, Susan Nolen-Hoeksema, and Peter Salovey for extremely insightful discussions and commentaries on previous versions of this manuscript. We also thank Jennifer Thomas, Jessica Cronce, and Amelia Aldao for their careful and diligent participation as coders for this study. Please address correspondence to Andres De Los Reyes, Department of Psychology, University of Maryland at College Park, Biology/Psychology Building, Room 3123H, College Park, MD 20742; office: 301-405-7049; e-mail: [email protected] article discusses a study involving a framework (range of possible changes [RPC] Model) developed and applied to identify patterns in consistent and inconsistent intervention outcomes effects by informant, measurement method, and method of statistical analysis to the meta-analytic study of trials testing two evidence-based interventions for children and adolescents (youth-focused cognitive-behavioral treatment for child anxiety problems; parent-focused behavioral parent training for childhood conduct problems). This article illustrates how findings gleaned from applying the RPC Model allow for unique opportunities for hypothesis generation based on the patterns of consistent outcomes effects. Based on the RPC Model, studies can be closely examined to identify the specific instances in which interventions yield robust effects, and the authors illustrate how examining effects in this way can lead to new understandings of interventions and the outcomes they produce. Findings suggest that researchers can employ previously underutilized patterns of consistencies and inconsistencies in outcomes effects as new resources for identifying evidence-based interventions.This work was supported, in part, by National Institute of Mental Health Grant MH67540 (Andres De Los Reyes). This work was also supported by National Institute of Mental Health Grant MH59029 (Alan E. Kazdin)

Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication

Background Prior research indicates that conduct disorder (CD) is associated with a range of comorbid mental disorders. However, the actual prevalence, subtypes, and patterns of comorbidity of DSM-IV defined CD in the general U.S. population remains unknown. Method Retrospective assessment of CD and other DSM-IV disorders was conducted using fully structured diagnostic interviews among a nationally representative sample of respondents (n = 3,199) in the National Comorbidity Survey Replication. Results The estimated lifetime prevalence of CD in the U.S. is 9.5% (males = 12.0%, females = 7.1%), with a median age-of-onset of 11.6 (0.2) years. Latent class analysis identified five CD subtypes characterized by rule violations, deceit/theft, aggression, severe covert behaviors, and pervasive CD symptoms. A dose-response relationship was revealed between CD subtype severity and risk of subsequent disorders. Results also indicated that CD typically precedes mood and substance use disorders, but most often occurs after impulse control and anxiety disorders. Although both active and remitted CD is associated with increased risk of the subsequent first onset of other mental disorders, remitted CD is associated with significantly lower risk of subsequent disorders. Conclusions CD is prevalent and heterogeneous in the U.S. population, and more severe subtypes and the presence of active CD are associated with higher risk of comorbid disorders. Future prospective studies using general population samples will further inform the nature and course of this disorder.Psycholog

Initial risk matrix, home resources, ability development and children’s achievement

This paper investigates the development of basic cognitive, motor and noncognitive abilities from infancy to adolescence. We analyse the predictive power of these abilities, initial risk conditions and home resources for children’s achievement. Our data are taken from the Mannheim Study of Children at Risk (MARS), an epidemiological cohort study, which follows the long-term outcome of early risk factors. Results indicate that differences in abilities increase during childhood, while there is a remarkable stability in the distribution of the economic and socio-emotional home resources during childhood. Initial risk conditions trigger a cumulative effect. Cognitive, motor and noncognitive abilities acquired during preschool age contribute to the prediction of children’s achievement at school age

Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students:A randomized clinical trial

OBJECTIVE: Untreated mental disorders are important among low- and middle-income country (LMIC) university students in Latin America, where barriers to treatment are high. Scalable interventions are needed. This study compared transdiagnostic self-guided and guided internet-delivered cognitive behavioral therapy (i-CBT) with treatment as usual (TAU) for clinically significant anxiety and depression among undergraduates in Colombia and Mexico. METHOD: 1,319 anxious, as determined by the Generalized Anxiety Disorder-7 (GAD-7) = 10+ and/or depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) = 10+, undergraduates (mean [SD] age = 21.4 [3.2]); 78.7% female; 55.9% first-generation university student) from seven universities in Colombia and Mexico were randomized to culturally adapted versions of self-guided i-CBT (n = 439), guided i-CBT (n = 445), or treatment as usual (TAU; n = 435). All randomized participants were reassessed 3 months after randomization. The primary outcome was remission of both anxiety (GAD-7 = 0-4) and depression (PHQ-9 = 0-4). We hypothesized that remission would be higher with guided i-CBT than with the other interventions. RESULTS: Intent-to-treat analysis found significantly higher adjusted (for university and loss to follow-up) remission rates (ARD) among participants randomized to guided i-CBT than either self-guided i-CBT (ARD = 13.1%, χ12 = 10.4, p = .001) or TAU (ARD = 11.2%, χ12 = 8.4, p = .004), but no significant difference between self-guided i-CBT and TAU (ARD = -1.9%, χ12 = 0.2, p = .63). Per-protocol sensitivity analyses and analyses of dimensional outcomes yielded similar results. CONCLUSIONS: Significant reductions in anxiety and depression among LMIC university students could be achieved with guided i-CBT, although further research is needed to determine which students would most likely benefit from this intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).</p

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression among University Students:A Secondary Analysis of a Randomized Clinical Trial

Importance: Guided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT. Objective: To develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors. Design, Setting, and Participants: This prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022. Interventions: Participants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435). Main Outcomes and Measures: Remission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline. Results: The study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P =.003) or treatment as usual (40.0% [2.7%]; P =.001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P =.007; self-guided i-CBT: 25.4% [8.8%]; P =.004; treatment as usual: 31.0% [9.4%]; P =.001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P =.14; treatment as usual: 53.0% [6.0%]; P =.25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P =.001; treatment as usual: 41.8% [3.2%]; P &lt;.001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P =.07). Conclusions and Relevance: Guided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings. Trial Registration: ClinicalTrials.gov Identifier: NCT04780542.</p

Informant discrepancies in assessing child dysfunction relate to dysfunction within mother-child interactions.

We examined whether mother-child discrepancies in perceived child behavior problems relate to dysfunctional interactions between mother and child and stress in the mother. Participants included 239 children (6–16 years old; 58 girls, 181 boys) referred for oppositional, aggressive, and antisocial behavior, and their mothers. Mother-child discrepancies in perceived child behavior problems were related to mother-child conflict. Moreover, maternal stress mediated this relationship. The findings suggest that discrepancies among mother and child evaluations of child functioning are not merely reflections of different perspectives or artifacts of the assessment process, but can form components of conceptual models that can be developed and tested to examine the interrelations among critical domains of child, parent, and family functioning.This work was supported, in part, by a grant from the National Institute of Mental Health (MH67540) awarded to the first author and by grants from the Leon Lowenstein Foundation, the William T. Grant Foundation (98-1872-98), and the National Institute of Mental Health (MH59029) awarded to the second author