Evidence Based Mental Health最新文献

{"title":"Linking the Mini-Mental State Examination, the Alzheimer's Disease Assessment Scale-Cognitive Subscale and the Severe Impairment Battery: evidence from individual participant data from five randomised clinical trials of donepezil.","authors":"Stephen Z Levine,&nbsp;Kazufumi Yoshida,&nbsp;Yair Goldberg,&nbsp;Myrto Samara,&nbsp;Andrea Cipriani,&nbsp;Orestis Efthimiou,&nbsp;Takeshi Iwatsubo,&nbsp;Stefan Leucht,&nbsp;Toshi A Furukawa","doi":"10.1136/ebmental-2020-300184","DOIUrl":"https://doi.org/10.1136/ebmental-2020-300184","url":null,"abstract":"<p><strong>Background: </strong>The Mini-Mental State Examination (MMSE), the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and the Severe Impairment Battery (SIB) are widely used rating scales to assess cognition in Alzheimer's disease.</p><p><strong>Objective: </strong>To understand the correspondence between these rating scales, we aimed to examine the linkage of MMSE with the ADAS-Cog and SIB total and change scores.</p><p><strong>Methods: </strong>We used individual-level data on participants with Alzheimer's disease (n=2925) from five pivotal clinical trials of donepezil. Data were collected at baseline and scheduled visits for up to 6 months. We used equipercentile linking to identify the correspondence between simultaneous measurements of MMSE with ADAS-Cog, and SIB total and change ratings.</p><p><strong>Findings: </strong>Spearman's correlation coefficients were of strong magnitude between the MMSE total score and the ADAS-Cog (rs from -0.82 to -0.87; p<0.05) and SIB total scores (rs from 0.70 to 0.75; p<0.05). Weaker correlations between the change scores were observed between the MMSE change score and the ADAS-Cog (week 1: r=-0.11, p=0.18; rs thereafter: -0.28 to -0.45; p<0.05) and SIB change scores (rs from 0.31 to 0.44; p<0.05). Linking suggested that the MMSE total scores were sensitive to moderate and severe cognitive impairment levels. Despite weak to moderate correlations for the change scores, moderate change levels linked well, indicating ceiling and floor effects.</p><p><strong>Conclusions: </strong>The current results can be used in meta-analyses, data harmonisation and may contribute to increasing statistical power when pooling data from multiple sources.</p><p><strong>Clinical implications: </strong>The current study results help clinicians to understand these cognitive rating scale scores.</p>","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231617/pdf/ebmental-2020-300184.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10217163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact.","authors":"Roxanne Keynejad, Jessica Spagnolo, Graham Thornicroft","doi":"10.1136/ebmental-2021-300254","DOIUrl":"10.1136/ebmental-2021-300254","url":null,"abstract":"<p><strong>Question: </strong>There is a large worldwide gap between the service need and provision for mental, neurological and substance use disorders. WHO's Mental Health Gap Action Programme (mhGAP) intervention guide (IG), provides evidence-based guidance and tools for assessment and integrated management of priority disorders. Our 2017 systematic review identified 33 peer-reviewed studies describing mhGAP-IG implementation in low-income and middle-income countries.</p><p><strong>Study selection and analysis: </strong>We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, 3ie, Google Scholar and citations of our review, on 24 November 2020. We sought evidence, experience and evaluations of the mhGAP-IG, app or mhGAP Humanitarian IG, from any country, in any language. We extracted data from included papers, but heterogeneity prevented meta-analysis.</p><p><strong>Findings: </strong>Of 2621 results, 162 new papers reported applications of the mhGAP-IG. They described mhGAP training courses (59 references), clinical applications (n=49), research uses (n=27), contextual adaptations (n=13), economic studies (n=7) and other educational applications (n=7). Most were conducted in the African region (40%) and South-East Asia (25%). Studies demonstrated improved knowledge, attitudes and confidence post-training and improved symptoms and engagement with care, post-implementation. Research studies compared mhGAP-IG-enhanced usual care with task-shared psychological interventions and adaptation studies optimised mhGAP-IG implementation for different contexts. Economic studies calculated human resource requirements of scaling up mhGAP-IG implementation and other educational studies explored its potential for repurposing.</p><p><strong>Conclusions: </strong>The diverse, expanding global mhGAP-IG literature demonstrates substantial impact on training, patient care, research and practice. Priorities for future research should be less-studied regions, severe mental illness and contextual adaptation of brief psychological interventions.</p>","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2021-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38910494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnitude and variability of structural brain abnormalities in neuropsychiatric disease: protocol for a network meta-analysis of MRI studies.","authors":"Robert McCutcheon, Toby Pillinger, George Welby, Luke Vano, Connor Cummings, Xin Guo, Toni Ann Heron, Orestis Efthimiou, Andrea Cipriani, Oliver Howes","doi":"10.1136/ebmental-2020-300229","DOIUrl":"10.1136/ebmental-2020-300229","url":null,"abstract":"<p><strong>Introduction: </strong>Structural MRI is the most frequently used method to investigate brain volume alterations in neuropsychiatric disease. Previous meta-analyses have typically focused on a single diagnosis, thereby precluding transdiagnostic comparisons.</p><p><strong>Methods and analysis: </strong>We will include all structural MRI studies of adults that report brain volumes for participants from at least two of the following diagnostic groups: healthy controls, schizophrenia, schizoaffective disorder, delusional disorder, psychotic depression, clinical high risk for psychosis, schizotypal personality disorder, psychosis unspecified, bipolar disorder, autism spectrum disorder, major depressive disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, post-traumatic stress disorder, emotionally unstable personality disorder, 22q11 deletion syndrome, generalised anxiety disorder, social anxiety disorder, panic disorder, mixed anxiety and depression. Network meta-analysis will be used to synthesise eligible studies. The primary analysis will examine standardised mean difference in average volume, a secondary analysis will examine differences in variability of volumes.</p><p><strong>Discussion: </strong>This network meta-analysis will provide a transdiagnostic integration of structural neuroimaging studies, providing researchers with a valuable summary of a large literature.</p><p><strong>Prospero registration number: </strong>CRD42020221143.</p>","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2021-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9113326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of depression and anxiety in people with inflammatory bowel disease and associated healthcare use: population-based cohort study.","authors":"Peter Irving, Kevin Barrett, Monica Nijher, Simon de Lusignan","doi":"10.1136/ebmental-2020-300223","DOIUrl":"10.1136/ebmental-2020-300223","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) has a significant impact on quality of life for many people.</p><p><strong>Objective: </strong>To assess the prevalence of common mental health conditions in IBD and the combined impact of IBD and mental health conditions on healthcare use and time off work.</p><p><strong>Methods: </strong>A UK population-based primary care database (Royal College of General Practitioners Research and Surveillance Centre) was used to identify adults with IBD (n=19 011) (Crohn's disease (CD) or ulcerative colitis (UC)), and matched controls (n=76 044). Prevalences of anxiety, depressive episodes and depressive disorder recorded in primary care were assessed between 2016 and 2018. Outcomes comprised of rates of primary care visits, emergency secondary care visits, certificates for time off work, antidepressant and anxiolytic prescriptions.</p><p><strong>Findings: </strong>Mental health conditions were more common in people with CD than controls: anxiety episodes (3.5% vs 3.0%; p=0.02), depressive episodes (5.7% vs 4.1%; p<0.001) and depressive disorder (17.5% vs 12.9%; p<0.001), and people with UC versus controls: depressive episodes (4.4% vs 3.6%; p<0.001) and depressive disorder (14.2% vs 12.4%; p<0.001). Healthcare utilisation rates were higher in people with IBD than controls (primary care visits incidence rate ratio 1.47 (95% CI 1.43 to 1.51); emergency secondary care visits 1.87 (1.79 to 1.95); fitness for work certificates 1.53 (1.44 to 1.62); antidepressant use 1.22 (1.13 to 1.32); anxiolytic use 1.20 (1.01 to 1.41)). In people with IBD, mental health conditions were associated with additional increases in healthcare use and time off work.</p><p><strong>Conclusion: </strong>Depression and anxiety are more common in people with IBD than matched controls. Healthcare utilisation and prescribing of psychotropic medications are also higher in people with IBD. Mental health conditions in people with IBD are associated with additional healthcare use and time off work.</p><p><strong>Clinical implications: </strong>Evidence-based mental health support programmes, including psychological treatments, are needed for people with IBD.</p>","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9d/80/ebmental-2020-300223.PMC8311072.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10217677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How can we estimate QALYs based on PHQ-9 scores? Equipercentile linking analysis of PHQ-9 and EQ-5D.","authors":"Toshi A Furukawa, Stephen Z Levine, Claudia Buntrock, David D Ebert, Simon Gilbody, Sally Brabyn, David Kessler, Cecilia Björkelund, Maria Eriksson, Annet Kleiboer, Annemieke van Straten, Heleen Riper, Jesus Montero-Marin, Javier Garcia-Campayo, Rachel Phillips, Justine Schneider, Pim Cuijpers, Eirini Karyotaki","doi":"10.1136/ebmental-2020-300240","DOIUrl":"10.1136/ebmental-2020-300240","url":null,"abstract":"<p><strong>Background: </strong>Quality-adjusted life years (QALYs) are widely used to measure the impact of various diseases on both the quality and quantity of life and in their economic valuations. It will be clinically important and informative if we can estimate QALYs based on measurements of depression severity.</p><p><strong>Objective: </strong>To construct a conversion table from the Patient Health Questionnaire-9 (PHQ-9), the most frequently used depression scale in recent years, to the Euro-Qol Five Dimensions Three Levels (EQ-5D-3L), one of the most commonly used instruments to assess QALYs.</p><p><strong>Methods: </strong>We obtained individual participant data of randomised controlled trials of internet cognitive-behavioural therapy which had administered depression severity scales and the EQ-5D-3L at baseline and at end of treatment. Scores from depression scales were all converted into the PHQ-9 according to the validated algorithms. We used equipercentile linking to establish correspondences between the PHQ-9 and the EQ-5D-3L.</p><p><strong>Findings: </strong>Individual-level data from five trials (total N=2457) were available. Subthreshold depression (PHQ-9 scores between 5 and 10) corresponded with EQ-5D-3L index values of 0.9-0.8, mild major depression (10-15) with 0.8-0.7, moderate depression (15-20) with 0.7-0.5 and severe depression (20 or higher) with 0.6-0.0. A five-point improvement in PHQ-9 corresponded approximately with an increase in EQ-5D-3L score by 0.03 and a ten-point improvement by approximately 0.25.</p><p><strong>Conclusions and clinical implications: </strong>The conversion table between the PHQ-9 and the EQ-5D-3L scores will enable fine-grained assessment of burden of depression at its various levels of severity and of impacts of its various treatments.</p>","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"PeriodicalIF":6.6,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/13/cb/ebmental-2020-300240.PMC8311092.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25429798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creating a prepared mental health workforce: comparative illustrations of implementation strategies.","authors":"Bruce F Chorpita,&nbsp;Eric L Daleiden,&nbsp;Juan Diego Vera,&nbsp;Karen Guan","doi":"10.1136/ebmental-2020-300203","DOIUrl":"https://doi.org/10.1136/ebmental-2020-300203","url":null,"abstract":"<p><strong>Background: </strong>Psychotherapy implementation must contend with the task of preparing a mental health workforce to provide the highest quality services to as much of a service population as possible, in high-income as well as low-to-middle income countries.</p><p><strong>Objective: </strong>We outline general challenges and solutions and investigate how well various implementation strategies would fit a clinical population.</p><p><strong>Methods: </strong>Using a data set from a prior cluster randomised trial with a clinically diverse population and 33 intervention practices, we presented multiple illustrations comparing the ability of different implementation strategies to serve youth and families with procedures in which service providers were trained.</p><p><strong>Findings: </strong>A series of survival functions demonstrated that many common implementation strategies are unlikely to create a prepared workforce, given the large and diverse number of practices needed to be mastered by providers.</p><p><strong>Clinical implications: </strong>'Benchmark' solutions that afforded superior coverage of the service population could be supported through paced learning approaches (ie, training interventions a little at a time) using extensible, modular intervention designs.</p>","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231619/pdf/ebmental-2020-300203.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10215557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time for a paradigm shift for psychotherapies?","authors":"Elisabeth Schramm,&nbsp;Ron Rapee,&nbsp;Toshi A Furukawa","doi":"10.1136/ebmental-2020-300239","DOIUrl":"https://doi.org/10.1136/ebmental-2020-300239","url":null,"abstract":"Schramm E, et al. Evid Based Ment Health Month 2021 Vol 0 No 0 Time for a paradigm shift for psychotherapies? Elisabeth Schramm, Ron Rapee, Toshi A Furukawa 3 Almost 70 years ago, Eysenck stirred up the community of psychotherapists by postulating that psychotherapies—at that time predominantly psychoanalytic—are not effective in the treatment of psychological disorders. This led to a massive surge of empirically evaluated psychotherapy research and promoted particularly the rise of cognitive behavioural therapy. Today, we know that a range of psychotherapies work across a wide variety of mental disorders and numerous metaanalyses of randomised controlled trials prove that Eysenck’s conclusion is no longer relevant. However, despite ample evidence that psychotherapy is generally efficacious, only 30% of patients achieve remission while as many as 65% leave treatment without a measurable benefit or even with deterioration. Therefore, psychotherapy researchers face the challenge to improve the effectiveness of their interventions. In order to solve Gordon Paul’s fundamental question—‘What treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances?’—we have to ask: What is hindering the development of the field of psychotherapy and how can it move forward? Until today, categorical thinking still informs treatment selection and led to the development of intervention guilds and psychotherapy schools, which has retarded our progress in understanding and treating mental disorders. Mostly in absence of any empirical evidence, psychotherapy schools are usually based on plausible, yet unproven theories and on commercial and status interests of the representatives. Moreover, strong identification with one’s own school and its superiority over other schools reflects drastic allegiance effects and high risks of bias in research. As Marvin Goldfried, one of the pioneers of psychotherapy research, prominently calls out, the lack of consensus and disparate languages across theoretical orientations means that identifying the core factors that may underlie the effectiveness of psychotherapy is difficult if not impossible and holds back progress in the science and practice of psychotherapy. In more recent times, a trend is emerging to move away from nosology and a strictly categorical diagnostic approach to dimensional, functionoriented, mechanistic constructs used as specific therapy targets. Abandoning the dichotomies, categorical approaches and guilds as well as overcoming mere ‘horse races’ in efficacy research may help us to understand mechanisms and to move towards a contextual model of psychotherapy. This coincides with an increasing interest in medicine and psychology to develop individualised precision therapy. By identifying the key elements that may be driving an intervention’s effect, transdiagnosticmodularised approaches can be developed addressing pathological mechanisms such as difficult","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231498/pdf/ebmental-2020-300239.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10217663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technology and implementation science to forge the future of evidence-based psychotherapies: the PRIDE scale-up study.","authors":"Milton L Wainberg,&nbsp;Maria Lídia Gouveia,&nbsp;Melissa Ann Stockton,&nbsp;Paulino Feliciano,&nbsp;Antonio Suleman,&nbsp;Jennifer J Mootz,&nbsp;Milena Mello,&nbsp;Andre Fiks Salem,&nbsp;M Claire Greene,&nbsp;Charl Bezuidenhout,&nbsp;Phuti Ngwepe,&nbsp;Kathryn L Lovero,&nbsp;Palmira Fortunato Dos Santos,&nbsp;Simone H Schriger,&nbsp;David S Mandell,&nbsp;Rogerio Mulumba,&nbsp;Anibal Neves Anube,&nbsp;Dirceu Mabunda,&nbsp;Flavio Mandlate,&nbsp;Francine Cournos,&nbsp;Jean-Marie Alves-Bradford,&nbsp;Terriann Nicholson,&nbsp;Bianca Kann,&nbsp;Wilza Fumo,&nbsp;Cristiane S Duarte,&nbsp;Jair de Jesus Mari,&nbsp;Marcelo F Mello,&nbsp;Ana O Mocumbi,&nbsp;Maria A Oquendo,&nbsp;Myrna M Weissman","doi":"10.1136/ebmental-2020-300199","DOIUrl":"https://doi.org/10.1136/ebmental-2020-300199","url":null,"abstract":"<p><strong>Objective: </strong>To report the interim results from the training of providers inevidence-based psychotherapies (EBPs) and use of mobile applications.</p><p><strong>Design and setting: </strong>The Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence (PRIDE) study is a cluster-randomised hybrid effectiveness-implementation trial comparing three delivery pathways for integrating comprehensive mental healthcare into primary care in Mozambique. Innovations include the use of EBPs and scaling-up of task-shifted mental health services using mobile applications.</p><p><strong>Main outcome measures: </strong>We examined EBP training attendance, certification, knowledge and intentions to deliver each component. We collected qualitative data through rapid ethnography and focus groups. We tracked the use of the mobile applications to investigate early reach of a valid screening tool (Electronic Mental Wellness Tool) and the roll out of the EBPs PARTICIPANTS: Psychiatric technicians and primary care providers trained in the EBPs.</p><p><strong>Results: </strong>PRIDE has trained 110 EBP providers, supervisors and trainers and will train 279 community health workers in upcoming months. The trainings improved knowledge about the EBPs and trainees indicated strong intentions to deliver the EBP core components. Trained providers began using the mobile applications and appear to identify cases and provide appropriate treatment.</p><p><strong>Conclusions: </strong>The future of EBPs requires implementation within existing systems of care with fidelity to their core evidence-based components. To sustainably address the vast mental health treatment gap globally, EBP implementation demands: expanding the mental health workforce by training existing human resources; sequential use of EBPs to comprehensively treat mental disorders and their comorbid presentations and leveraging digital screening and treatment applications.</p>","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmental-2020-300199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10565562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten-week Intensive Group Program (IGP) for borderline personality disorder: making the case for more accessible and affordable psychotherapy.","authors":"Dervila Gec,&nbsp;Jillian Helen Broadbear,&nbsp;David Bourton,&nbsp;Sathya Rao","doi":"10.1136/ebmental-2020-300195","DOIUrl":"https://doi.org/10.1136/ebmental-2020-300195","url":null,"abstract":"<p><strong>Background: </strong>The availability of specialist psychotherapies for treating borderline personality disorder (BPD) is limited by costs associated with training, resourcing and treatment duration. Developing a programme that incorporates effective strategies from a range of evidence-based specialist treatments, concentrates their delivery and uses a group-based format will improve treatment access.</p><p><strong>Objective: </strong>To assess the short-term clinical efficacy, acceptability and feasibility of a bespoke manualised programme for the treatment of BPD. This 10-week group-based outpatient programme was delivered 2 days per week in 4 hour sessions; participants received 80 hours of treatment in total.</p><p><strong>Methods: </strong>Forty-three participants, many having severe BPD symptomatology, were assessed before and after the 10-week programme using a range of validated self-report questionnaires and a self-appraisal feedback form. The primary outcome measured was BPD symptom severity.</p><p><strong>Findings: </strong>Statistically significant improvements were measured in BPD symptom severity, depression, trait anxiety, emotional regulation, general health, hopefulness, self-compassion and anger, several with moderate to large effect sizes. Many of these improvements remained at 4-6 months post treatment. More than 90% of surveyed participants expressed a moderate or high level of satisfaction with the programme.</p><p><strong>Conclusions: </strong>This integrated treatment programme delivered in a highly concentrated format demonstrated short-term efficacy across many BPD-relevant endpoints; its acceptability was endorsed by most clients.</p><p><strong>Clinical implications: </strong>Incorporation of key aspects of evidence-based treatment using a time-intensive group format could greatly enhance the capacity of mental health services to meet the needs of people who experience BPD within a population-based mental health service framework.</p>","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231581/pdf/ebmental-2020-300195.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10212207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design of a brief psychological intervention for youth who self-harm: a formative study in India.","authors":"Shilpa Aggarwal,&nbsp;George Patton,&nbsp;Michael Berk,&nbsp;Vikram Patel","doi":"10.1136/ebmental-2020-300188","DOIUrl":"https://doi.org/10.1136/ebmental-2020-300188","url":null,"abstract":"<p><strong>Background: </strong>There is an urgent need for context-specific research leading to development of scalable interventions to address self-harm and suicide in low and middle-income countries (LMICs).</p><p><strong>Objective: </strong>The current study was conducted to determine the contents of a psychological intervention to reduce recurrence of self-harm and improve functioning in youth who self-harm in India and finalise its delivery mechanisms.</p><p><strong>Methods: </strong>A systematic, sequential approach was used to integrate available scientific evidence, expert service providers' knowledge and experience, and service users' lived experiences in the codesigning and development of a psychological intervention. The steps included: identifying prioritised outcomes for youth who self-harm as well as a selection of feasible and acceptable elements from self-harm interventions that have been trialled in LMICs, intervention development workshops with mental health professionals and youth to finalise elements, a review of relevant treatment manuals to decide on the treatment framework, and finalising the treatment structure and schedule in the second round of intervention development workshops.</p><p><strong>Findings: </strong>We developed ATMAN treatment with three key elements; problem solving, emotion regulation and social network strengthening skills. The delivery schedule emphasises on the engagement elements, and allows for involvement of other stakeholders such as family members when acceptable to the clients.</p><p><strong>Conclusion and clinical implications: </strong>ATMAN treatment could prove to be especially effective in reducing self-harm recurrence in youth in India due to its brief schedule, elements that have been selected in collaboration with the service users and its potential to be scaled up for delivery by non-specialist treatment providers.</p>","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"PeriodicalIF":5.2,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmental-2020-300188","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38617517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}