Search

While many Chinese mental health professionals are familiar with modern psychotherapy, psychoanalysis, and cognitive behavioral therapy (CBT) are the mainstream therapy education and practice in today's China. Interpersonal psychotherapy (IPT) is a time-limited evidence-based psychotherapy that was originally developed for the treatment of depression. It has since been supported by over 250 randomized clinical trials in the treatment of various mental conditions including anxiety, and eating disorders. Despite good evidence for efficacy, IPT was not formally introduced to China until recently. This article describes a strategic plan for disseminating IPT knowledge in China and reports on current progress to date. We also summarize the discussion results from recent training lectures and workshops, and present suggestions for cultural adaptation per feedback from many enthusiastic trainees. Challenges and the future of promoting further integration of IPT as another effective psychotherapy option in China are discussed as well.

Introduction Therapies focused on exposure like prolonged exposure (PE) or Eye Movement Desensitization and Reprocessing (EMDR) dominate the treatment of posttraumatic stress disorder (PTSD). There are many patients with PTSD who are not fully responding with exposure-therapies. or don’t want exposure therapies at all. Many patients don’t like to be confronted with elements of their traumatic experience. IPT has proven to be highly efficient in e.g. depression and bulimia and is promising as a treatment for PTSD while NOT using exposure. IPT aims to repair the damage trauma does to interpersonal trust and social functioning. Objectives Learn more about IPT. Learn more about the way IPT is used in the treatment for patients with PTSD (adaptations). Methods Literature review focused on IPT for PTSD. Results Among the consequences of PTSD are affective numbing, interpersonal hypervigilance, and social withdrawal (1). Numbness, an avoidance particularly of negative affect, makes it hard to read one’s interpersonal environment. Thus in adapting IPT for PTSD, we devote the early part of treatment to affective reattunement: helping patients to identify their emotions and to recognize them as helpful social signals. Once patients can read their feelings, they can put them to use to handle relationships better, deciding whom they can trust and whom they can’t. IPT for PTSD tends to focus on role transitions, which are usually inherent having been traumatized (2). Conclusions In the past there has been several kinds of research that show that group IPT and individual IPT reduce PTSD and depression in traumatized patients with PTSD. Disclosure No significant relationships.

BackgroundChildren of parents with a mental illness are at higher risk for various psychiatric problems and adaptive difficulties compared to those of parents without mental health problems. Certain preventive psychoeducational interventions target these children to promote their well-being and resilience and prevent the emergence of adaptive difficulties. However, few such interventions have been developed and evaluated specifically for elementary school-aged children of parents with a mental illness.ObjectivesThis study aims to evaluate an interpersonal psychotherapy-based book targeting children living with a parent with a mental illness.MethodsThe study examines children, parents and psychosocial workers' perception of the acceptability, appropriateness and utility of the book. In total, 22 participants answered online open-ended questions after reading the book.ResultsThe book was highly appreciated and positively perceived by the families and psychosocial workers. Results suggest that children, parents and psychosocial workers viewed it as an appropriate and useful tool for supporting children with a parent with a mental illness. The present study reveals that the bibliotherapy appears well adapted to the developmental level of school-age children.DiscussionThis study presents a book that shows promise for supporting the resilience of elementary school-aged children having a parent with a mental illness. Results highlight the importance of tailoring the content and modalities of interventions to the developmental level, needs and preferences of elementary school-aged children. The relevance of a collaborative method is also discussed, thus providing knowledge regarding this type of approach for the development of interventions targeting children.

We examine the efficacy of nonspecialists delivering interpersonal psychotherapy (IPT) to HIV-positive (HIV+) women. We describe a case in which local personnel without prior mental health training delivered IPT for the treatment of depression and posttraumatic stress disorder in an HIV+ woman who reported experiencing gender-based violence and was enrolled in HIV care at the Family AIDS, Care, Education and Services program in Kisumu, Kenya.

Despite established knowledge that Low and Middle Income Countries (LMICs) bear the majority of the worlds burden of mental disorders, and more than a decade of efficacy research showing that the most common disorders, such as depression and anxiety, can be treated using readily available local personnel in LMICs to apply evidence-based treatments, there remains a massive mental health treatment gap, such that 75 % of those in LMICs never receive care. Here, we discuss the use of a new type of implementation science study design, the effectiveness-implementation hybrids, to speed the translation and scale up of mental health care in LMICs. We use our current study of Interpersonal Psychotherapy (IPT) delivered by local personnel for depression and trauma-related disorders among HIV+ women in Kenya as an example of effectiveness-implementation hybrid design for mental health services research in LMICs.

Background: This study describes adaptation and modification of World Health Organization (WHO) recommended group interpersonal psychotherapy (IPT-G) for depressed peripartum adolescents. The adaptation process includes accommodating contextual factors and strategies to address intervention implementation barriers, such as engagement problems with adolescents, caregivers, and providers, and stigma and dearth of mental health specialists. The modifications include and adolescent relevant iterations to the therapy format and content. Methods: A multi-stakeholder led two-stage intervention adaptation and modification process integrating mixed qualitative methods were used with pregnant and parenting adolescents, their partners, and health care workers. In-depth interviews focusing on personal, relationship, social, and cultural barriers experienced by adolescents were carried out modeled on the Consolidated Framework for Implementation Research. Focus group discussions with depressed adolescents on their experiences, feedback from caregivers, partners, health workers inform focused modifications. An IPT expert committee of three practitioners, along with UNICEF adolescent officer, and mental health policy expert from Ministry of Health and representative community advisory body reviewed the adaptations and modifications made to the WHO IPT-G manual. Discussion: Integration of mental health needs of peripartum adolescents as demonstrated in the stakeholder engagement process, adaptation of key terms into locally relevant language, determination of number of sessions, and user-centric design modifications to digitize a brief version of group interpersonal psychotherapy are presented. [ABSTRACT FROM AUTHOR]

Background: Lay Health Workers (LHW) are important providers of community mental health services and help mitigate access and treatment gaps in Africa. However, there is a paucity of knowledge about the role and performance of these workers, as well as about the extent to which the interventions delivered are culturally adapted to the African context. Aims: This scoping review aimed to explore the content and aspects concerning the cultural adaptation and sustainability of psychological interventions delivered by LHW to people with mental disorders in Africa. Methods: We conducted a scoping review of the peer-reviewed literature published from January 2000 to December 2018 to identify psychological interventions delivered by LHW for people with mental disorders in Africa. We systematically searched PubMed, Google scholar and Hinari to select relevant publications. The articles were evaluated for risk of bias according to study design with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. Expert consultation was performed according to Arksey & O'Malley framework and cultural adaptation analysis was performed according to Bernal framework. Results: Out of 14,549 retrieved records, we identified ten peer-reviewed articles conducted in Zimbabwe, Uganda, South Africa and Zambia describing four distinct interventions. Six were randomized controlled trials; none addressed implementation outcomes. Group-based interpersonal therapy (n = 5), trauma-focused cognitive behaviour therapy (n = 1), problem solving therapy (n = 3) and narrative exposure therapy (n = 1) emerged as psychological interventions delivered by LHW for people with depression, anxiety, trauma and suicidal behavior. Psychological interventions delivered by LHW in Africa were all culturally adapted to meet the competence of LHW. All the interventions were associated with symptom improvement, but the quality of this evidence varied widely with study design. Conclusion: Task-shifting psychological interventions delivered by LHW after appropriate cultural adaptation show promise for addressing unmet mental health care needs in Africa. More effectiveness and implementation evidence is needed, especially with regard to psychological interventions delivered by LHW for adolescence, older people and those with severe mental disorders and suicidal behaviors. [ABSTRACT FROM AUTHOR]

To initially assess psychometric properties of two abbreviated versions of the Geriatric Suicide Ideation Scale (GSIS): a 10-item Brief Geriatric Suicide Ideation Scale (BGSIS), and a 5-item Geriatric Suicide Ideation Scale-Screen (GSIS-Screen). A series of psychometric analyses was conducted, assessing the internal consistency, test–retest reliability, construct and predictive validity of the abbreviated GSIS scales. This was done by selecting-out GSIS items from a combined dataset of studies on suicide ideation in older adults: 1) The GSIS scale development study (n = 107); 2) A clinical trial of Interpersonal Psychotherapy (IPT) modified for suicidal older adults(n = 25); 3) A longitudinal study of risk and resiliency to suicide ideation in community-residing older adults (n = 173). Overall findings demonstrated strong internal consistency, test–retest reliability, concurrent and predictive validity for the BGSIS and GSIS-Screen with older adults across community, clinical, and residential settings. Study findings support the use of the abbreviated GSIS scales when conducting research on suicide risk identification among older adults. Future research is recommended testing these scales prospectively in public health, residential, and clinical settings, in research and healthcare delivery contexts. [ABSTRACT FROM AUTHOR]

Background: Adolescents with depression need access to culturally relevant psychological treatment. In many low- and middle-income countries treatments are only accessible to a minority. We adapted group interpersonal therapy (IPT) for adolescents to be delivered through schools in Nepal. Here we report IPT's feasibility, acceptability, and cost. Methods: We recruited 32 boys and 30 girls (aged 13–19) who screened positive for depression. IPT comprised of two individual and 12 group sessions facilitated by nurses or lay workers. Using a pre-post design we assessed adolescents at baseline, post-treatment (0–2 weeks after IPT), and follow-up (8–10 weeks after IPT). We measured depressive symptoms with the Depression Self-Rating Scale (DSRS), and functional impairment with a local tool. To assess intervention fidelity supervisors rated facilitators' IPT skills across 27/90 sessions using a standardised checklist. We conducted qualitative interviews with 16 adolescents and six facilitators post-intervention, and an activity-based cost analysis from the provider perspective. Results: Adolescents attended 82.3% (standard deviation 18.9) of group sessions. All were followed up. Depression and functional impairment improved between baseline and follow-up: DSRS score decreased by 81% (95% confidence interval 70–95); functional impairment decreased by 288% (249–351). In total, 95.3% of facilitator IPT skills were rated superior/satisfactory. Adolescents found the intervention useful and acceptable, although some had concerns about privacy in schools. The estimate of intervention unit cost was US $96.9 with facilitators operating at capacity. Conclusions: School-based group IPT is feasible and acceptable in Nepal. Findings support progression to a randomised controlled trial to assess effectiveness and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Perinatal depression and anxiety account for a high burden of perinatal morbidity and poor psychosocial functioning. There is a growing interest among mental health professionals, to devise interventions to prevent this condition. This review synthesizes evidence for the effectiveness of psychological and psychosocial interventions aimed at the prevention of perinatal depression and anxiety. We also explore qualitative evidence to understand the acceptability and feasibility of these interventions. Using a mixed-methods approach, data from a total of 21 studies were collated to inform the evidence for preventive interventions for perinatal depression and anxiety. Based on their theoretical orientations, these interventions were described by authors as cognitive-behavioral (n = 7); psychoeducational (n = 6); mindfulness (n = 2); and interpersonal psychotherapy (n = 2). These also included psychosocial approaches such as social support (n = 1) and multicomponent interventions (n = 3). For depressive symptoms, these interventions yielded moderate to strong effect sizes in favor of the intervention group [standardized mean difference (SMD) = −0.59; 95% confidence interval (CI) −0.95 to −0.23]. For anxiety symptoms, a strong effect size was estimated in favor of the intervention group (SMD = −1.43, 95% CI −2.22 to −0.65). Preventive interventions significantly reduce the severity of perinatal depressive and anxiety symptoms. These interventions are also acceptable and feasible in many settings. [ABSTRACT FROM AUTHOR]

Objective: The Personalized Advantage Index (PAI) is a method to guide treatment selection by investigating which of two or more treatments is optimal for a given individual. Recently, it was shown that, on average, twice-weekly sessions of psychotherapy for depression lead to better outcomes compared to once-weekly sessions. The present study applied the PAI method to assess if subgroups of patients may have a differential response to psychotherapy frequency. Method: Data came from a clinical trial (n = 200) randomizing depressed patients into different session frequencies: weekly sessions versus twice-weekly sessions. Machine-learning techniques were used to select pretreatment variables and develop a multivariable prediction model that calculated each patient's PAI. Differences in observed depression post-treatment scores (Beck Depression Inventory-II [BDI-II]) were tested between patients that received their PAI-indicated versus non-indicated session frequency. Between-group effect sizes (Cohen's d) were reported. Results: We identified prognostic indicators generally associated with lower post-treatment BDI-II regardless of treatment assignment. In addition, we identified specific demographic and psychometric features associated with differential response to weekly- versus twice-weekly therapy sessions. Observed post-treatment BDI-II scores were significantly different between individuals receiving the PAI-indicated versus non-indicated session frequency (d =.37). Conclusions: Although a higher session frequency is more effective on average, different session frequencies seem beneficial for different patients. Future studies should externally validate these findings before they can be generalized to other settings. What is the public health significance of this article?: Although a higher session frequency is more effective for depression on average, different session frequencies might be beneficial for different patients. Results in the present sample indicated that a higher session frequency might be most beneficial for patients with less than two earlier treatments, low-reported happiness, males, with higher behavioral activation, lower physical functioning, better general health, a longer duration of symptoms considered as untenable, better perceived health change in the past year, and low-working memory. Furthermore, patients with more previous treatments, worse general health, higher working memory, and higher reported happiness may benefit more from the once-weekly sessions. These findings require external validation before they can be generalized to other settings. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effect of interpersonal psychotherapy on anxiety, depression, and quality of life among breast cancer patients with mental health disorders at Tikur Anbessa Specialized Hospital, Ethiopia. Methods: A two-arm parallel randomized controlled trial study was conducted among 114 (n = 57 intervention, and n = 57 control group) breast cancer patients with common mental health disorder at the oncology center of Tikur Anbessa Specialized Hospital. The hospital anxiety and depression measurement scale was used to assess depression and anxiety disorder and a 30-item quality of life questionnaire was used to assess the quality of life. General linear model analysis was done, confounding factors were controlled, and p < 0.05 was used to declare statistical significance. Results: Patients in the intervention group showed a significant improvement in the anxiety (coefficient − 3.68; 95% CI − 5.67, − 1.69; p < 0.001), depression (coefficient − 3.22; 95% CI − 4.7, − 1.69; p < 0.001), physical functioning (coefficient 10.55; 95% CI 3.13, 17.98; p = 0.006), health-related quality of life (coefficient 21.85; 95% CI 14.1, 29.59; p < 0.001), insomnia (coefficient − 19.56; 95% CI − 31.87, − 7.25; p = 0.002), and fatigue (coefficient − 11.37; 95% CI − 21.49, − 1.24; p = 0.028) respectively. Conclusions: The adapted Ethiopian version of interpersonal psychotherapy had improved anxiety, depression, and some domains of health-related quality of life. Hence, health programmers should consider incorporating it as a treatment option in oncology centers. Trial registration number: PACTR202011629348967 granted on 20 November 2020 which was retrospectively registered. [ABSTRACT FROM AUTHOR]

Hua Xu,1,2 Diana Koszycki2,3 1Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Faculty of Education and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 3Institut du Savoir Montfort, Hôpital Montfort, Ottawa, Ontario, CanadaCorrespondence: Hua Xu; Diana Koszycki Email xuhuaemail@126.com; dkoszyck@uottawa.caAbstract: Interpersonal psychotherapy (IPT) is a time-limited, structured, interpersonally oriented psychotherapy, with demonstrated efficacy for the treatment of major depression across the lifespan. IPT uses a medical model of illness and links depressed mood to four research-informed interpersonal problem areas: complicated grief, role transitions, role disputes, and interpersonal deficits/sensitivity. The IPT model of vulnerability to depression nicely dovetails with interpersonal issues that are faced by older adults, and this article focuses on the application of IPT for late-life depression in China. The group format of IPT may be a practical and efficient method of improving access to an established depression-focused treatment for China’s rapidly aging population and has the advantage of providing important social support for patients who feel lonely, isolated, and stigmatized. Short-term interventions like IPT are more cost-effective from a public health perspective and can easily be delivered in primary care facilities, where many elderly patients receive care. IPT is effective in different cultures, and possible cultural adaptations of IPT for older adults in China are discussed herein.Keywords: interpersonal psychotherapy, late-life depression, cultural adaptation, China

Abstract Background Interpersonal psychotherapy (IPT) can be effective for both Bulimia Nervosa (BN) and co-occurring depression. While changes in symptoms of Eating disorder (ED) and depression have been found to correlate, it is unclear how they interact during treatment and in which order the symptoms decrease. Methods Thirty-one patients with BN and depressive symptoms received IPT using the manual IPT-BNm in a naturalistic design. The outcome was measured with the Eating Disorder Examination Questionnaire (EDE-Q) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Symptom improvement at each session was measured with Repeated Evaluation of Eating Disorder Symptoms (REDS) and the Patient Health Questionnaire-9 (PHQ-9). Results Significant improvements with large effect sizes were found on both ED symptoms and depression. The rates of change were linear for both BN and depression. A strong correlation between reduction of depressive symptoms and ED symptoms was found. Depressive symptom reduction at one session predicted improvement of ED symptoms at the next session. Conclusions IPT-BNm had an effect on both BN and co-occurring depressive symptoms. The analyses indicated that reduction in depressive symptoms preceded reduction in bulimic symptoms.

Abstract Background Excess gestational weight gain (GWG) in pregnant adolescents is a major public health concern. Excess GWG increases risk of pregnancy complications as well as postpartum and offspring obesity and cardiometabolic disease. Prevention interventions for pregnant adults that target lifestyle modification (i.e., healthy eating/physical activity) show insufficient effectiveness. Pregnant adolescents have distinct social-emotional needs, which may contribute to excess GWG. From an interpersonal theoretical framework, conflict and low social support increase negative emotions, which in turn promote excess GWG through mechanisms such as overeating and physical inactivity. Methods The current manuscript describes the design of a pilot randomized controlled feasibility trial of adolescent interpersonal psychotherapy (IPT) to address social-emotional needs and prevent excess GWG. Up to 50 pregnant, healthy adolescents 13-19y, 12-18 weeks gestation are recruited from an interdisciplinary adolescent maternity hospital clinic and randomized to IPT + usual care or usual care alone. IPT involves 6 individual 60-minute sessions delivered by a trained behavioral health clinician during 12-30 weeks gestation. Sessions include relationship psychoeducation, emotion identification and expression, and teaching/role-playing communication skills. Between sessions, adolescents are instructed to complete a daily journal and to have conversations to work on relationship goals. Outcomes are assessed at baseline, mid-program, post-program, and 3-months postpartum. Primary outcomes are feasibility and acceptability based upon rate of recruitment, session attendance, program acceptability ratings, and follow-up retention. Secondary outcomes are perinatal social functioning, stress, depression, and eating behaviors assessed with validated surveys and interviews; perinatal physical activity and sleep measured via accelerometer; GWG from measured weights; and at 3-months postpartum only, maternal adiposity by dual energy x-ray absorptiometry, maternal insulin sensitivity derived from 2-hour oral glucose tolerance testing, and infant adiposity by air displacement plethysmography. Discussion This pilot trial will address a key gap in extant understanding of excess GWG prevention for a high-risk population of adolescents. If feasible and acceptable, brief psychotherapy to address social-emotional needs should be tested for its effectiveness to address excess GWG and postpartum maternal/infant health. If effective, such an approach has potential to interrupt an adverse, intergenerational cycle of social-emotional distress, obesity, and cardiometabolic disease among young mothers and their offspring. Trial registration ClinicalTrials.gov NCT03086161 , retrospectively registered

Background: People with Major Depressive Disorder (MDD) are far more likely to suffer from Early Life Stress (ELS) than the average population. This typically increases severity of symptoms, and often leads to treatment resistance. This study set out to examine which treatments work best to treat depression in patients who have suffered from ELS, as well as possible interactions between ELS and antidepressant effects in therapies., Method: A literature review was conducted in July 2020 using the databases Embase, PsychInfo, and MEDLINE. The search looked for clinical trials treating MDD with psychotherapies and pharmacotherapies with patients who suffered from ELS. Data regarding demographics, comorbidities, measurement tools, and outcomes (generally response rates and remission) were extracted. The data was compared according to treatment types., Results: Cognitive Behavioural Therapy (CBT) had the best evidence for treating MDD in people with ELS. There was some mixed evidence for Interpersonal Therapy, SSRIs, and SNRIs as suitable treatments for MDD. There was also very promising but limited evidence for Cognitive Behavioural Analysis of System Therapy and combination treatments (pharmacotherapy and psychotherapy together). Nefazodone (a SARI) had the weakest evidence., Conclusions: CBT was the most effective treatment for MDD with ELS. However, more research needs to be conducted to ascertain a proper hierarchy of treatments, particularly with combination treatments.

Background: The dissolution of the Soviet Union brought economic instability and variety of social changes, resulting in fluctuating suicide rates and highlighting the national phenomenon of a melancholy cultural trait across the general population. The socio-political changes in Russia post-1991 led to increased rates of depressive and stress-related disorders, as well as opening avenues for integrating foreign psychotherapeutic methods, including Interpersonal Psychotherapy (Klerman-Weissman IPT), into the treatment of mental disorders. This narrative review explores the adaptation and efficacy of IPT in Russia, particularly for depressive and stress-related disorders., Material and Methods: We assembled key PhD theses related to the topic of IPT use in Russia. One such study involved 120 female patients aged 23-45 years with adjustment disorders, treated at the Omsk Rehabilitation Treatment Hospital. Participants were divided into an IPT group (n=80) and a control group (n=40) receiving treatment as usual (TAU). The IPT group underwent 12-16 individual sessions, each lasting 60 minutes, held twice a week. The main study group was further divided into four sub-groups based on specific interpersonal problems: loss of loved ones, interpersonal conflicts, social role changes, and social isolation., Results: Both groups showed improvement in anxiety, dyssomnia, and motor retardation, with the IPT group demonstrating more sustained improvement. At the 8-week endpoint, full recovery from depression was observed in 50% of the IPT group, compared to only 20% in the TAU group. The IPT group also showed significant improvements in coping strategies, with a notable decrease in avoidance behaviors and an increase in problem-solving strategies, also targeting melancholy national phenomenon via training acceptance skills and practicing an active life position to aware the self-responisbility and achieve a of well-being state of emotional balance. The group IPT method was also experimentally combined with the person-oriented (reconstructive) psychotherapy, which has a long and successful history of within the group format, and has enabled shortening of the standard course of person-oriented reconstructive treatment., Conclusions: IPT method has proven efficacy in treating depressive and stress-related disorders in Russia, by addressing deeper pathogenetic levels of mental and behavioral formations. The Russian Society of Psychiatrists and Russian Psychotherapy Association have recommended its broader implementation in Russian mental health institutions, and has included IPT in the Russian National Guidelines for Psychiatry.

Objective: To test potential cognitive and interpersonal moderators of two evidence-based youth depression prevention programs., Method: Two hundred four adolescents ( M age = 1.65; 56% female; 71% White, 11% Black, 11% multiracial, 5% Asian, 2% other races, 18% Hispanic/Latinx) were randomized to either a cognitive-behavioral (Coping With Stress [CWS]) or interpersonal (Interpersonal Psychotherapy-Adolescent Skills Training [IPT-AST]) prevention program. Potential moderators, selected based on theory and research, included rumination, negative cognitive style, dysfunctional attitudes, hopelessness, parent-adolescent conflict, negative interactions with parents and friends, and social support from parents and friends. Depression symptoms were assessed repeatedly through 18 months postintervention.SD = 1.65; 56% female; 71% White, 11% Black, 11% multiracial, 5% Asian, 2% other races, 18% Hispanic/Latinx) were randomized to either a cognitive-behavioral (Coping With Stress [CWS]) or interpersonal (Interpersonal Psychotherapy-Adolescent Skills Training [IPT-AST]) prevention program. Potential moderators, selected based on theory and research, included rumination, negative cognitive style, dysfunctional attitudes, hopelessness, parent-adolescent conflict, negative interactions with parents and friends, and social support from parents and friends. Depression symptoms were assessed repeatedly through 18 months postintervention., Results: After adjusting for multiple comparisons, rumination ( B = -2.02, SE = .61, p = .001, d = .47), hopelessness ( B = -2.03, SE = .72, p = .005, d = .41), and conflict with father ( B = 1.68, SE = .74, p = .02, d = .32) moderated intervention effects on change in depression symptoms from postintervention through 18-month follow-up. For example, at high levels of conflict with father, youth in IPT-AST reported a significant decrease in symptoms during follow-up, whereas youth in CWS reported a nonsignificant change in symptoms. At low levels of conflict with father, youth in IPT-AST reported a significant increase in symptoms during follow-up, whereas youth in CWS reported a nonsignificant change in symptoms., Conclusions: These exploratory secondary analyses of Personalized Depression Prevention study data highlight specific cognitive and interpersonal risk factors that could be considered when determining which prevention program may be most effective for a given adolescent. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This study examined patients with binge-eating disorder (BED) subtyped by dietary restraint (DR) and the negative affect (NA) dimension of depression, anxiety, hostility, and self-esteem, comparing clinical features and outcome of evidence-based psychological treatments. It was hypothesized that individuals with DR and high NA (DR–HNA) would have lower functioning and poorer immediate and long-term BED treatment outcomes compared to those with DR and low NA (DR–LNA). Method: Cluster analysis was conducted (n = 159) as a secondary analysis of data from a randomized group cognitive–behavioral therapy and interpersonal psychotherapy trial of women and men with BED. Results: At pretreatment, participants with DR–HNA were higher in eating disorder and general psychopathology, emotional eating, and poor social adjustment. At post-treatment, differences in binge days between cluster groups were small and statistically nonsignificant, and differences in rates of binge-eating abstinence were only marginally significant. However, by 1-year follow-up, patients with DR–HNA had a greater increase in binge days, less abstinence from binge eating, a higher risk for relapse, and were significantly less likely to be in BED remission than those with DR–LNA. Conclusions: DR–HNA served as a predictor of poorer maintenance of BED therapeutic improvement. Future directions to better sustain outcomes among patients with DR–HNA include developing a brief measure to assess for the full construct of NA prior to and throughout treatment, enhancing BED interventions by focusing more on NA, and augmenting treatment dose. What is the public health significance of this article?: Binge-eating disorder (BED) is often associated with significant impairment in physical and mental health as well as quality of life, and following evidence-based psychological treatment, some individuals with BED may fail to achieve abstinence or maintain their treatment gains in the long term. This research extends the subtyping literature, suggesting that individuals with BED and dietary restraint (DR) who have high levels of negative affect (NA) at pretreatment have less abstinence and poorer maintenance of treatment gains in the long term, highlighting the need for a screening tool and interventions tailored to reducing NA within the context of DR. [ABSTRACT FROM AUTHOR]

Objective: The authors compared maintenance of training outcomes for two approaches to training college therapists in interpersonal psychotherapy (IPT): train the trainer versus expert training.Methods: A cluster-randomized trial was conducted in 24 college counseling centers. Therapists were recruited from enrolled centers, and the therapists enrolled students with depression and eating disorder symptoms. The therapists (N=184) provided data during baseline, posttraining (during the 12 months of expert consultation offered to the expert training group), and maintenance (approximately 7 months after the expert consultation ended). Outcomes were therapist fidelity (i.e., adherence and competence) and IPT knowledge.Results: Both groups showed within-group improvement from baseline to the maintenance period for adherence, competence, and IPT knowledge; however, the train-the-trainer group had greater improvement over time in adherence and competence.Conclusions: Given that the effects of the train-the-trainer approach were better maintained, and this model's potential to train more therapists over time, the train-the-trainer approach may help increase dissemination of evidence-based treatments such as IPT. [ABSTRACT FROM AUTHOR]

Although experts have suggested ways that cognitive behavioral therapy (CBT) of depression might be personalized for individual clients, there has been little empirical examination of this issue. We examine cognitive behavioral skills and vulnerabilities (i.e., dysfunctional thinking, behavioral inactivation, and avoidance) as potential prescriptive predictors to cognitive vs. behavioral interventions. Forty-two adults with major depressive disorder were randomized to eight weeks of cognitive-only (n = 21) or behavioral-only (n = 21) individual psychotherapy. Clients completed pre-treatment measures of cognitive and behavioral skills and vulnerabilities. Dropout rates were comparable across treatments (21% overall). Treatment outcomes did not differ significantly between treatments (g = .13). Cognitive skills were associated with superior outcomes in the behavioral-only treatment, but additional analyses suggested general skillfulness (i.e., the tendency to have high scores across cognitive and behavioral assessments), rather than cognitive skills per se, predicted a larger response to behavioral interventions. Similarly, behavioral avoidance of social and non-social domains were associated with worse outcomes in the behavioral-only treatment, indicating that behavioral approaches yield less positive outcomes for clients high in behavioral avoidance. If replicated, the results of this pilot study suggest ways that a cognitive behavioral therapist could select intervention strategies to suit individual clients and thereby improve treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Frequent exposure to antibiotic treatments may increase the risk of antibiotic resistance, which may threaten the effectiveness of future antibiotic treatments. Thus, it is important to identify the preventable risks in terms of antibiotic use. This study assessed the association between major depressive disorder (MDD) and antibiotic use by comparing the likelihood and extent of antibiotic use between patients with and without MDD. Methods: This retrospective cross-sectional study utilized the National Patients Sample data from the 2017 Health Insurance Review and Assessment Service. We analyzed 16,950 patients with MDD, defined as those with at least two claims records stating a primary diagnosis of MDD (International Classification of Diseases, 10th revision codes F32–33) and 67,800 patients without MDD (1:4 propensity-score matched control group). Antibiotic use was compared between the patients with and without MDD based on three variables: the presence of antibiotic prescriptions, total prescription days of antibiotics per year, and total medication costs of antibiotics per year. Results: The adjusted odds ratio obtained by multivariate regression analysis for the presence of prescription of antibiotics was 1.31 (95% confidence interval [CI]: 1.25–1.36). In the negative binomial model, the number of prescription days was 1.25 times (95% CI: 1.23–1.28) higher in patients with MDD than in those without MDD. Generalized linear model analysis showed a 1.39-fold (95% CI: 1.36–1.43) higher cost of antibiotic prescription in patients with MDD than in those without MDD. Conclusions: Our results suggest a potential association between MDD and the prescription of antibiotics, implying that patients with MDD are relatively vulnerable to infections. It is important to prevent as well as closely monitor the occurrence of infections when managing patients with MDD. [ABSTRACT FROM AUTHOR]

Background: Up to one in eight women experience depression during pregnancy. In the UK, low intensity cognitive behavioural therapy (CBT) is the main psychological treatment offered for those with mild or moderate depression and is recommended during the perinatal period, however referral by midwives and take up of treatment by pregnant women is extremely low. Interpersonal Counselling (IPC) is a brief, low-intensity form of Interpersonal Psychotherapy (IPT) that focuses on areas of concern to service users during pregnancy. To improve psychological treatment for depression during pregnancy, the study aimed to assess the feasibility and acceptability of a trial of IPC for antenatal depression in routine NHS services compared to low intensity perinatal specific CBT. Methods: We conducted a small randomised controlled trial in two centres. A total of 52 pregnant women with mild or moderate depression were randomised to receive 6 sessions of IPC or perinatal specific CBT. Treatment was provided by 12 junior mental health workers (jMHW). The primary outcome was the number of women recruited to the point of randomisation. Secondary outcomes included maternal mood, couple functioning, attachment, functioning, treatment adherence, and participant and staff acceptability. Results: The study was feasible and acceptable. Recruitment was successful through scanning clinics, only 6 of the 52 women were recruited through midwives. 71% of women in IPC completed treatment. Women reported IPC was acceptable, and supervisors reported high treatment competence in IPC arm by jMHWs. Outcome measures indicated there was improvement in mood in both groups (Change in EPDS score IPC 4.4 (s.d. 5.1) and CBT 4.0 (s.d. 4.8). Conclusions: This was a feasibility study and was not large enough to detect important differences between IPC and perinatal specific CBT. A full-scale trial of IPC for antenatal depression in routine IAPT services is feasible. Trial registration: This study has been registered with ISRCTN registry 11513120. – date of registration 05/04/2018. [ABSTRACT FROM AUTHOR]

Perinatal depression is an important public health problem. Psychological interventions play an essential role in the treatment of depression. In the current paper, we will present the results of a series of meta-analyses on psychological treatments of perinatal depression. We report the results of a series of meta-analyses on psychological treatments of depression, including perinatal depression. The meta-analyses are based on a database of randomized trials on psychotherapies for depression that has been systematically developed and updated every year. Psychological interventions are effective in the treatment of perinatal depression with a moderate effect size of g = 0.67, corresponding with a NNT of about 4. These effects were still significant at 12 months after the start of the treatment. These interventions also have significant effects on social support, anxiety, functional impairment, parental stress, and marital stress. Possibly the effects are overestimated because of the use of waiting list control groups, the low quality of the majority of trials and publication bias. Research on psychotherapies for depression in general has shown that there are no significant differences between the major types of therapy, except for non-directive counseling that may have somewhat smaller effects. CBT can also be delivered in individual, group, telephone, and guided self-help format. Interventions in subthreshold depression are also effective and may prevent the onset of a full-blown depressive disorder, while therapies may be less effective in chronic depression. Psychological interventions are effective and deserve their place as first-line treatment of perinatal depression. [ABSTRACT FROM AUTHOR]

Background: It is widely accepted that adversities during development may impact depression in adulthood, but its relations with current depression triggers are unclear. The present research aimed to explore the association between self-reported adverse childhood and adolescent experiences with self-reported depressive triggers, according to interpersonal classification, in depressed women. Methods: The sample consisted of 822 women with Depressive Disorders, who attended Psychotherapy at a Central Hospital in Lisbon (Portugal). Problems in childhood and adolescence and triggering factors were obtained through open-ended questions from a psychotherapy screening questionnaire. Descriptive statistics and Pearson´s correlation coefficients were calculated. Results: The most commonly reported adversities in childhood and adolescence took place in the family context, namely and in order of frequency, family conflicts, relational difficulties between parents and children and family violence. Higher reports of significant problems at an early age were associated with higher reports across development. Higher reports of interpersonal disputes as depressive triggers were associated with higher reports of interpersonal disputes problems during childhood and adolescence. Conclusion: Interpersonal disputes seem a major precursor of depressive symptomatology in women later in life. The classification of childhood and adolescent problems and depression triggers according to interpersonal theory proved to be a consistent association criterion and allowed us to assess priority intervention areas in depressed patients, such as interpersonal disputes and role transitions. This study highlights the unmet needs of families, that could be a target for conflict management and interpersonal communication intervention programs early in parental-child relationships. This is an important contribute to the development of family-friendly public policies and action plans.

Despite many theoretical and clinical writings, the theorized connection between defense mechanisms and adult attachment in depressed patients has received little empirical attention. This is the first study to examine patients' defense mechanisms in relation to their attachment in a clinical sample of depressed patients and also the first to use observer-rated measures for assessing both defense mechanisms and attachment. In this pilot study, we aimed to investigate the relationship between patients' attachment and their use of defense mechanisms in psychotherapy sessions, as well as patterns of change over treatment. We conducted a secondary analysis of data from a randomized controlled trial of 30 patients receiving psychotherapy for major depression. Session transcripts were previously coded for defense mechanisms using the Defense Mechanisms Rating Scales, and depression severity data were collected by the clinician-rated HRSD-17 and the self-report BDI-II. Patients' attachment was assessed in two transcripts, one in an early session and a second in a late session, using the novel observer-rated Patient Attachment Coding System. In contrast with expectations, in the early phase of therapy, preoccupied attachment-related characteristics were significantly positively related to overall defensive functioning and negatively related to Depressive immature defenses. In the late phase of treatment, preoccupied attachment-related characteristics were negatively correlated with Non-depressive immature defenses. Moreover, as expected, early-phase defense use was related to late phase attachment; specifically, early neurotic and immature Depressive and Non-depressive defenses predicted an increase in avoidant, whereas immature Non-depressive defenses predicted a decrease in preoccupied attachment-related characteristics over the course of treatment, after controlling for early attachment effects. The results imply a longitudinal relationship between defenses and change in attachment-related characteristics over the course of treatment in a depressed sample and warrant further research about the relationship between defenses and attachment during psychotherapy. [ABSTRACT FROM AUTHOR]

Background: Depression is a heterogeneous condition, with multiple possible symptom‐profiles leading to the same diagnosis. Descriptive depression subtypes based on observation and theory have so far proven to have limited clinical utility. Aim: To identify depression subtypes and to examine their time‐course and prognosis using data‐driven methods. Methods: Latent transition analysis was applied to a large (N = 8380) multi‐service sample of depressed patients treated with cognitive behavioral therapy (CBT) in outpatient clinics. Patients were classed into initial latent states based on their responses to the Patient Health Questionnaire‐9 of depression symptoms, and transition probabilities to other states during treatment were quantified. Qualitatively similar states were clustered into overarching depression subtypes and we statistically compared indices of treatment engagement and outcomes between subtypes using post hoc analyses. Results: Fourteen latent states were clustered into five depression subtypes: mild (2.7%), severe (9.8%), cognitive‐affective (23.7%), somatic (21.4%), and typical (42.4%). These subtypes had high temporal stability, and the most common transitions during treatment were from severe toward milder states within the same subtype. Differential response to treatment was evident, with the highest improvement rate (63.6%) observed in the cognitive‐affective subtype. Conclusion: Replicated evidence indicates that depression subtypes are temporally stable and associated with differential response to CBT. [ABSTRACT FROM AUTHOR]

Background: Clinical guidelines suggest that psychological interventions specifically aimed at reducing suicidality may be beneficial. We examined the impact of two depression treatments, cognitive therapy (CT) and interpersonal psychotherapy (IPT) on suicidal ideation (SI) and explored the temporal associations between depression and SI over the course of therapy. Methods: Ninety‐one adult (18–65) depressed outpatients from a large randomized controlled trial who were treated with CT (n = 37) and IPT (n = 54) and scored at least ≥1 on the Beck Depression Inventory II (BDI‐II) suicide item were included. Linear (two‐level) mixed effects models were used to evaluate the impact of depression treatments on SI. Mixed‐effects time‐lagged models were applied to examine temporal relations between the change in depressive symptoms and the change in SI. Results: SI decreased significantly during treatment and there were no differential effects between the two intervention groups (B = −0.007, p =.35). Depressive symptoms at the previous session did not predict higher levels of SI at the current session (B = 0.016, p =.16). However, SI measured at the previous session significantly predicted depressive symptoms at the current session (B = 2.06, p <.001). Conclusions: Both depression treatments seemed to have a direct association with SI. The temporal association between SI and depression was unidirectional with SI predicting future depressive symptoms during treatment. Our findings suggest that it may be most beneficial to treat SI first. [ABSTRACT FROM AUTHOR]

Introduction: Chronic loneliness has been linked to many adverse outcomes, including mental health problems. Psychological treatment of loneliness can be effective, but the evidence base is limited.Objective: To investigate the efficacy of 2 internet-based interventions based on cognitive behavioral therapy (ICBT) and interpersonal psychotherapy (IIPT) relative to a wait-list control group and each other.Methods: A total of 170 participants were recruited and randomized to either 9 weeks of ICBT (n = 68), IIPT (n = 68), or a wait-list condition (n = 34). The primary outcome was loneliness, measured using the UCLA Loneliness Scale before, during, and after treatment. Secondary measures of psychiatric disorders and quality of life were administered before and after treatment. Follow-up was conducted 4 months after the treatment had ended. Primary outcome data were analyzed using growth curve modeling. Secondary outcomes were analyzed using robust regression models. The trial was preregistered (ClinicalTrials.gov ID: NCT03807154).Results: The ICBT condition had a significantly greater impact on loneliness compared to the wait-list and IIPT conditions. Effect sizes were moderate to large (Cohen d = 0.71) compared to the wait-list and moderate (d = 0.53) compared to IIPT. The IIPT condition did not differ significantly from the wait-list. Both active treatments led to significant increases in quality of life. Only the ICBT group had significantly lower symptoms of depression and generalized anxiety compared to the wait-list group. Treatment gains were maintained but not improved at follow-up.Conclusions: ICBT can be an efficacious option for alleviating loneliness. The IIPT intervention was not as effective. [ABSTRACT FROM AUTHOR]

Postnatal depression (PND) is a mood disorder with potentially devastating effects to the individual on many levels. It can affect cognitive functioning, motivation, and self-esteem. The person can socially withdraw from their immediate familial or social circle. It can affect bonding and quality time between the mother and baby. There are many effective therapeutic treatments used for the treatment of PND such as cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT). This study using a single-case study trial with 15 participants investigates the clinical usefulness of combining CBT with virtual reality (VR). Results show that the combination of CBT with VR is an effective treatment for PND. In addition, VR can enhance awareness, decision-making, and self-appreciation within the individual and can also have real-life applications. This study also shows that the combination of VR and CBT is feasible, while the use of such a technology is well accepted. [ABSTRACT FROM AUTHOR]