BMJ mental health最新文献

{"title":"Bidirectional associations between mental disorders, antidepressants and cardiovascular disease.","authors":"Hongbao Cao, Ancha Baranova, Qian Zhao, Fuquan Zhang","doi":"10.1136/bmjment-2023-300975","DOIUrl":"10.1136/bmjment-2023-300975","url":null,"abstract":"<p><strong>Background: </strong>Mental disorders have a high comorbidity with cardiovascular disease (CVD), but the causality between them has not been fully appreciated.</p><p><strong>Objective: </strong>This study aimed to systematically explore the bidirectional causality between the two broad categories of diseases.</p><p><strong>Methods: </strong>We conducted Mendelian randomisation (MR) and multivariable MR (MVMR) analyses to evaluate potential causal links between 10 mental disorders, the use of antidepressants and 7 CVDs.</p><p><strong>Findings: </strong>We discovered that major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD) and insomnia exhibit connections with elevated risks of two or more CVDs. Moreover, the use of antidepressants is linked to heightened risks of each CVD. Each distinct CVD is correlated with a greater probability of taking antidepressants. Our MVMR analysis demonstrated that the use of antidepressants is correlated with the elevation of respective risks across all cardiovascular conditions. This includes arrhythmias (OR: 1.28), atrial fibrillation (OR: 1.44), coronary artery disease (OR: 1.16), hypertension (OR: 1.16), heart failure (OR: 1.16), stroke (OR: 1.44) and entire CVD group (OR: 1.35). However, MDD itself was not linked to a heightened risk of any CVD.</p><p><strong>Conclusions: </strong>The findings of our study indicate that MDD, insomnia and ADHD may increase the risk of CVD. Our findings highlight the utilisation of antidepressants as an independent risk factor for CVD, thus explaining the influence of MDD on CVD through the mediating effects of antidepressants.</p><p><strong>Clinical implications: </strong>When treating patients with antidepressants, it is necessary to take into consideration the potential beneficial and detrimental effects of antidepressants.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11021753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological burden associated with incident persistent symptoms and their evolution during the COVID-19 pandemic: a prospective population-based study.","authors":"Baptiste Pignon, Joane Matta, Emmanuel Wiernik, Anne Toussaint, Bernd Loewe, Olivier Robineau, Fabrice Carrat, Gianluca Severi, Mathilde Touvier, Clement Gouraud, Charles Ouazana Vedrines, Victor Pitron, Brigitte Ranque, Nicolas Hoertel, Sofiane Kab, Marcel Goldberg, Marie Zins, Cédric Lemogne","doi":"10.1136/bmjment-2023-300907","DOIUrl":"10.1136/bmjment-2023-300907","url":null,"abstract":"<p><strong>Background: </strong>Identifying factors that predict the course of persistent symptoms that occurred during the COVID-19 pandemic is a public health issue. Modifiable factors could be targeted in therapeutic interventions.</p><p><strong>Objective: </strong>This prospective study based on the population-based CONSTANCES cohort examined whether the psychological burden associated with incident persistent symptoms (ie, that first occurred from March 2020) would predict having ≥1 persistent symptom 6-10 months later.</p><p><strong>Methods: </strong>A total of 8424 participants (mean age=54.6 years (SD=12.6), 57.2% women) having ≥1 incident persistent symptom at baseline (ie, between December 2020 and February 2021) were included. The psychological burden associated with these persistent symptoms was assessed with the Somatic Symptom Disorder-B Criteria Scale (SSD-12). The outcome was having ≥1 persistent symptom at follow-up. Adjusted binary logistic regression models examined the association between the SSD-12 score and the outcome.</p><p><strong>Findings: </strong>At follow-up, 1124 participants (13.3%) still had ≥1 persistent symptom. The SSD-12 score at baseline was associated with persistent symptoms at follow-up in both participants with (OR (95% CI) for one IQR increase: 1.42 (1.09 to 1.84)) and without SARS-CoV-2 infection prior to baseline (1.39 (1.25 to 1.55)). Female gender, older age, poorer self-rated health and infection prior to baseline were also associated with persistent symptoms at follow-up.</p><p><strong>Conclusions: </strong>The psychological burden associated with persistent symptoms at baseline predicted the presence of ≥1 persistent symptom at follow-up regardless of infection prior to baseline.</p><p><strong>Clinical implications: </strong>Intervention studies should test whether reducing the psychological burden associated with persistent symptoms could improve the course of these symptoms.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11021747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicide risk assessment tools and prediction models: new evidence, methodological innovations, outdated criticisms.","authors":"Aida Seyedsalehi, Seena Fazel","doi":"10.1136/bmjment-2024-300990","DOIUrl":"10.1136/bmjment-2024-300990","url":null,"abstract":"<p><p>The number of prediction models for suicide-related outcomes has grown substantially in recent years. These models aim to assist in stratifying risk, improve clinical decision-making, and facilitate a personalised medicine approach to the prevention of suicidal behaviour. However, there are contrasting views as to whether prediction models have potential to inform and improve assessment of suicide risk. In this perspective, we discuss common misconceptions that characterise criticisms of suicide risk prediction research. First, we discuss the limitations of a classification approach to risk assessment (eg, categorising individuals as low-risk vs high-risk), and highlight the benefits of probability estimation. Second, we argue that the preoccupation with classification measures (such as positive predictive value) when assessing a model's predictive performance is inappropriate, and discuss the importance of clinical context in determining the most appropriate risk threshold for a given model. Third, we highlight that adequate discriminative ability for a prediction model depends on the clinical area, and emphasise the importance of calibration, which is almost entirely overlooked in the suicide risk prediction literature. Finally, we point out that conclusions about the clinical utility and health-economic value of suicide prediction models should be based on appropriate measures (such as net benefit and decision-analytic modelling), and highlight the role of impact assessment studies. We conclude that the discussion around using suicide prediction models and risk assessment tools requires more nuance and statistical expertise, and that guidelines and suicide prevention strategies should be informed by the new and higher quality evidence in the field.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11021746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Work Engagement and Well-being Study (SWELL): a randomised controlled feasibility trial evaluating the effects of mindfulness versus light physical exercise at work.","authors":"Maris Vainre, Tim Dalgleish, Peter Watson, Christina Haag, Quentin Dercon, Julieta Galante, Caitlin Hitchcock","doi":"10.1136/bmjment-2023-300885","DOIUrl":"10.1136/bmjment-2023-300885","url":null,"abstract":"<p><strong>Background: </strong>Mindfulness-based programmes (MBPs) are increasingly offered at work, often in online self-guided format. However, the evidence on MBPs' effect on work performance (WP) is inconsistent.</p><p><strong>Objective: </strong>This pragmatic randomised controlled feasibility trial assessed procedural uncertainties, intervention acceptability and preliminary effect sizes of an MBP on WP, relative to an alternative intervention.</p><p><strong>Methods: </strong>241 employees from eight employers were randomised (1:1) to complete a 4-week, self-guided, online MBP or a light physical exercise programme (LE)(active control). Feasibility and acceptability measures were of primary interest. WP at postintervention (PostInt) was the primary outcome for preliminary assessment of effect sizes. Secondary outcomes assessed mental health (MH) and cognitive processes hypothesised to be targeted by the MBP. Outcomes were collected at baseline, PostInt and 12-week follow-up (12wFUP). Prospective trial protocol: NCT04631302.</p><p><strong>Findings: </strong>87% of randomised participants started the course. Courses had high acceptability. Retention rates were typical for online trials (64% PostInt; 30% 12wFUP). MBP, compared with the LE control, offered negligible benefits for WP (PostInt (<i>d</i>=0.06, 95% CI -0.19 to 0.32); 12wFUP (<i>d</i>=0.02, 95% CI -0.30 to 0.26)). Both interventions improved MH outcomes (<i>d</i>s=-0.40 to 0.58, 95% CI -0.32 to 0.18); between-group differences were small (<i>d</i>s=-0.09 to 0.04, 95% CI -0.15 to 0.17).</p><p><strong>Conclusion: </strong>The trial is feasible; interventions are acceptable. Results provide little support for a later phase trial comparing an MBP to a light exercise control. To inform future trials, we summarise procedural challenges.</p><p><strong>Clinical implications: </strong>Results suggest MBPs are unlikely to improve WP relative to light physical exercise. Although the MBP improved MH, other active interventions may be just as efficacious.</p><p><strong>Trial registration number: </strong>NCT04631302.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescriptions of antidepressants and anxiolytics in France 2012-2022 and changes with the COVID-19 pandemic: interrupted time series analysis.","authors":"David De Bandt, Sarah R Haile, Louise Devillers, Bastien Bourrion, Dominik Menges","doi":"10.1136/bmjment-2024-301026","DOIUrl":"10.1136/bmjment-2024-301026","url":null,"abstract":"<p><strong>Background: </strong>Depression and anxiety have increased in prevalence since the start of the COVID-19 pandemic.</p><p><strong>Objective: </strong>To evaluate the consumption of antidepressants and anxiolytics from 2012 to 2022 and the pandemic's potential impact in France.</p><p><strong>Methods: </strong>We conducted an interrupted time series analysis of routine drug sales data (Medic'AM) from all French outpatient pharmacies from 2012 to 2022. We investigated trends in defined daily doses of antidepressants and anxiolytics sold per 1000 inhabitants (DDD/TID) and related expenditures before and after pandemic onset and in relation with stringency of pandemic mitigation measures. Analyses were performed descriptively and using segmented linear regression, autoregressive and autoregressive integrated moving average models.</p><p><strong>Findings: </strong>From 2012 to 2019, overall monthly antidepressant sales increased (+0.02 DDD/TID) while monthly anxiolytic sales decreased (-0.07 DDD/TID). With pandemic onset, there was a relevant and persisting trend increase (+0.20 DDD/TID per month) for antidepressant sales overall, with an estimated excess of 112.6 DDD/TID sold from May 2020 until December 2022. Anxiolytic sales were elevated from February 2020 throughout the pandemic but returned to expected levels by December 2022, with an estimated excess of 33.8 DDD/TID. There was no evident association between stringency and antidepressant or anxiolytic sales.</p><p><strong>Conclusions: </strong>This study showed a protracted trend increase in the consumption of antidepressants since pandemic onset, while increases in anxiolytic consumption were temporary.</p><p><strong>Clinical implications: </strong>We provide evidence that the COVID-19 pandemic may have had long-lasting consequences on the prevalence and treatment of depression and anxiety disorders, requiring further actions by researchers and policy-makers to address this potential public mental health crisis.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding effect size: an international online survey among psychiatrists, psychologists, physicians from other medical specialities, dentists and other health professionals.","authors":"Ferdinand Heimke, Yuki Furukawa, Spyridon Siafis, Bradley C Johnston, Rolf R Engel, Toshi A Furukawa, Stefan Leucht","doi":"10.1136/bmjment-2023-300978","DOIUrl":"10.1136/bmjment-2023-300978","url":null,"abstract":"<p><strong>Background and objective: </strong>Various ways exist to display the effectiveness of medical treatment options. This study examined various psychiatric, medical and allied professionals' understanding and perceived usefulness of eight effect size indices for presenting both dichotomous and continuous outcome data.</p><p><strong>Methods: </strong>We surveyed 1316 participants from 13 countries using an online questionnaire. We presented hypothetical treatment effects of interventions versus placebo concerning chronic pain using eight different effect size measures. For each index, the participants had to judge the magnitude of the shown effect, to indicate how certain they felt about their own answer and how useful they found the given effect size index.</p><p><strong>Findings: </strong>Overall, 762 (57.9%) participants fully completed the questionnaire. In terms of understanding, the best results emerged when both the control event rate (CER) and the experimental event rate (EER) were presented. The difference in minimal importance difference units (MID unit) was understood worst. Respondents also found CER and EER to be the most useful presentation approach while they rated MID unit as the least useful. Confidence in the risk ratio ranked high, even though it was rather poorly understood.</p><p><strong>Conclusions and clinical implications: </strong>For dichotomous outcomes, presenting the effects in terms of the CER and EER could lead to the most correct interpretation. Relative measures including the risk ratio must be supplemented with absolute measures such as the CER and EER. Effects on continuous outcomes were better understood through standardised mean differences than mean differences. These can also be supplemented by dichotomised CER and EER.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internet-based behavioural activation therapy versus online psychoeducation for self-reported suicidal ideation in individuals with depression in Indonesia: a secondary analysis of an RCT.","authors":"Caroline B B C M Heuschen, Koen Bolhuis, Jasper B Zantvoord, Retha Arjadi, Damiaan A J P Denys, Maaike H Nauta, Anja Lok, Claudi L Bockting","doi":"10.1136/bmjment-2023-300918","DOIUrl":"10.1136/bmjment-2023-300918","url":null,"abstract":"<p><strong>Background: </strong>Southeast Asia has the highest suicide mortality worldwide. To improve our knowledge on the effectiveness of interventions for suicidal ideation (SI) in individuals with depression in Indonesia, we conducted a secondary analysis of a randomised controlled trial.</p><p><strong>Objective: </strong>We explored whether an internet-based behavioural activation (BA) intervention ('Guided Act and Feel Indonesia' (GAF-ID)) was superior in targeting SI compared with online-delivered psychoeducation (PE).</p><p><strong>Methods: </strong>In total, 313 participants were randomised between treatment allocation. The SI item of the Patient Health Questionnaire-9 was the primary outcome measure. Mediation analyses were conducted to identify if BA at week 10 mediated the relationship between intervention and SI at week 24.</p><p><strong>Findings: </strong>The GAF-ID intervention was not superior in reducing SI compared with online minimal PE at week 10 (OR 0.61, 95% CI (0.37 to 1.01)), nor at week 24 (OR 0.84, 95% CI (0.47 to 1.52)). SI at week 24 was not mediated by BA at week 10 (b=-0.03, 95% CI (-0.05 to 0.00), p=0.07).</p><p><strong>Conclusions: </strong>In individuals with depression in Indonesia, the GAF-ID intervention was not superior in reducing self-reported SI compared with PE. Also, the association between treatment condition and SI at week 24 was not mediated via BA at week 10.</p><p><strong>Clinical implications: </strong>This study supports the need for further research on the efficacy of psychological treatments targeting SI in the Southeast Asia context.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of increased affective symptoms and suicidal ideation during the COVID-19 pandemic: results from a large-scale study of 14 271 Thai adults.","authors":"Thitiporn Supasitthumrong, Michael Maes, Chavit Tunvirachaisakul, Teerayuth Rungnirundorn, Bo Zhou, Jing Li, Sorawit Wainipitapong, Anchalita Ratanajaruraks, Chaichana Nimnuan, Buranee Kanchanatawan, Trevor Thompson, Marco Solmi, Christoph Correll","doi":"10.1136/bmjment-2023-300982","DOIUrl":"10.1136/bmjment-2023-300982","url":null,"abstract":"<p><strong>Background: </strong>Increasing data suggest emergent affective symptoms during the COVID-19 pandemic.</p><p><strong>Objectives: </strong>To study the impact of the COVID-19 pandemic on affective symptoms and suicidal ideation in Thai adults.</p><p><strong>Methods: </strong>The Collaborative Outcomes Study on Health and Functioning during Infection Times uses non-probability sampling (chain referring and voluntary response sampling) and stratified probability sampling to identify risk factors of mental health problems and potential treatment targets to improve mental health outcomes during pandemics.</p><p><strong>Findings: </strong>Analysing 14 271 adult survey participants across all four waves of the COVID-19 pandemic in Thailand, covering all 77 provinces from 1 June 2020 to 30 April 2022, affective symptoms and suicidality increased during COVID-19 pandemic. Affective symptoms were strongly predicted by pandemic (feelings of isolation, fear of COVID-19, loss of social support, financial loss, lack of protective devices) and non-pandemic (female sex, non-binary individuals, adverse childhood experiences (ACEs), negative life events, student status, multiple mental health and medical conditions, physical pain) risk factors. ACEs, prior mental health conditions and physical pain were the top three risk factors associated with both increased affective symptoms and suicidal ideation during the COVID-19 pandemic. Partial least squares analysis showed that ACEs were the most important risk factor as they impacted most pandemic and non-pandemic risk factors.</p><p><strong>Clinical implications: </strong>Rational policymaking during a pandemic should aim to identify the groups at highest risk (those with ACEs, psychiatric and medical disease, women, non-binary individuals) and implement both immediate and long-term strategies to mitigate the impact of ACEs, while effectively addressing associated psychiatric and medical conditions.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10882356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996-2019: a register study.","authors":"Sami-Matti Ruuska, Katinka Tuisku, Timo Holttinen, Riittakerttu Kaltiala","doi":"10.1136/bmjment-2023-300940","DOIUrl":"10.1136/bmjment-2023-300940","url":null,"abstract":"<p><strong>Background: </strong>All-cause and suicide mortalities of gender-referred adolescents compared with matched controls have not been studied, and particularly the role of psychiatric morbidity in mortality is unknown.</p><p><strong>Objective: </strong>To examine all-cause and suicide mortalities in gender-referred adolescents and the impact of psychiatric morbidity on mortality.</p><p><strong>Methods: </strong>Finnish nationwide cohort of all <23 year-old gender-referred adolescents in 1996-2019 (n=2083) and 16 643 matched controls. Cox regression models with HRs and 95% CIs were used to analyse all-cause and suicide mortalities.</p><p><strong>Findings: </strong>Of the 55 deaths in the study population, 20 (36%) were suicides. In bivariate analyses, all-cause mortality did not statistically significantly differ between gender-referred adolescents and controls (0.5% vs 0.3%); however, the proportion of suicides was higher in the gender-referred group (0.3% vs 0.1%). The all-cause mortality rate among gender-referred adolescents (controls) was 0.81 per 1000 person-years (0.40 per 1000 person-years), and the suicide mortality rate was 0.51 per 1000 person-years (0.12 per 1000 person-years). However, when specialist-level psychiatric treatment was controlled for, neither all-cause nor suicide mortality differed between the two groups: HR for all-cause mortality among gender-referred adolescents was 1.0 (95% CI 0.5 to 2.0) and for suicide mortality was 1.8 (95% CI 0.6 to 4.8).</p><p><strong>Conclusions: </strong>Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for.</p><p><strong>Clinical implications: </strong>It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10875569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139898400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are web-based stress management interventions effective as an indirect treatment for depression? An individual participant data meta-analysis of six randomised trials.","authors":"Mathias Harrer, Patricia Nixon, Antonia A Sprenger, Elena Heber, Leif Boß, Hanna Heckendorf, Claudia Buntrock, David Daniel Ebert, Dirk Lehr","doi":"10.1136/bmjment-2023-300846","DOIUrl":"10.1136/bmjment-2023-300846","url":null,"abstract":"<p><strong>Question: </strong>Depression is highly prevalent and associated with numerous adverse consequences for both individuals and society. Due to low uptake of direct treatment, interventions that target related, but less stigmatising problems, such as perceived stress, have emerged as a new research paradigm.This individual participant data (IPD) meta-analysis examines if a web-based stress management intervention can be used as an 'indirect' treatment of depression.</p><p><strong>Study selection and analysis: </strong>Bayesian one-stage models were used to estimate pooled effects on depressive symptom severity, minimally important improvement and reliable deterioration. The dose-response relationship was examined using multilevel additive models, and IPD network meta-analysis was employed to estimate the effect of guidance.</p><p><strong>Findings: </strong>In total, N=1235 patients suffering from clinical-level depression from K=6 randomised trials were included. Moderate-to-large effects were found on depressive symptom severity at 7 weeks post-intervention (d=-0.65; 95% credibility interval (CrI): -0.84 to -0.48) as measured with the Center for Epidemiological Studies' Depression Scale. Effects were sustained at 3-month follow-up (d=-0.74; 95% CrI: -1.01 to -0.48). Post-intervention symptom severity was linearly related to the number of completed sessions. The incremental impact of guidance was estimated at d=-0.25 (95% CrI: -1.30 to 0.82), with a 35% posterior probability that guided and unguided formats produce equivalent effects.</p><p><strong>Conclusions: </strong>Our results indicate that web-based stress management can serve as an indirect treatment, yielding effects comparable with direct interventions for depression. Further research is needed to determine if such formats can indeed increase the utilisation of evidence-based treatment, and to corroborate the favourable effects for human guidance.</p><p><strong>Study registration: </strong>Open material repository: osf.io/dbjc8, osf.io/3qtbe.</p><p><strong>Trial registration number: </strong>German Clinical Trial Registration (DRKS): DRKS00004749, DRKS00005112, DRKS00005384, DRKS00005687, DRKS00005699, DRKS00005990.</p>","PeriodicalId":72434,"journal":{"name":"BMJ mental health","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10897957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139731185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}