American Journal of Psychiatry最新文献

{"title":"Randomized Controlled Trial of \"Bounce Back Now,\" a Mobile App to Reduce Post-Disaster Symptoms of Posttraumatic Stress, Depressed Mood, and Sleep Disturbance.","authors":"Kenneth J Ruggiero,Arthur Andrews,Tatiana M Davidson,Yulia Gavrilova,Brian E Bunnell,Jennifer Dahne,Matthew Price,Zoe M F Brier,Gregory Cohen,Dean Kilpatrick,Ron Acierno,Sandro Galea","doi":"10.1176/appi.ajp.20240232","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240232","url":null,"abstract":"OBJECTIVEThere is tremendous public health interest in cost-efficient, scalable interventions to improve post-disaster mental health. The authors examined the efficacy of Bounce Back Now (BBN), a mobile application, versus an enhanced usual care app (EUC).METHODSA population-based trial was conducted with a diverse sample of 1,357 adults affected by Hurricane Harvey, Irma, Maria, Florence, or Michael in 2017 and 2018. Participants were eligible if they were ≥18 years of age, had access to an Internet-accessible device, were English speaking, and lived in a hurricane-affected area. BBN is designed to address symptoms of posttraumatic stress, depression, and sleep disturbance using evidence-based techniques grounded in behavioral and cognitive principles. Depressive, posttraumatic stress, and sleep symptoms were measured.RESULTSParticipants' accessing of the BBN and EUC apps was similar. Active engagement was significantly greater among BBN users than EUC users (d=0.31), but BBN users engaged more actively in coping skills activities than in more time-intensive elements designed to promote behavior change. Moderate symptom reduction was observed in both conditions; Cohen's d values for the 3-month postbaseline assessment ranged from 0.49 to 0.60 in the BBN condition and from 0.36 to 0.41 in the EUC condition. Latent change models revealed that BBN users had significantly greater reductions in depression, sleep difficulty, and PTSD symptoms than EUC users, and these differences were maintained at the 6-month and 12-month postbaseline assessments.CONCLUSIONSPopulation impact is driven by reach and effectiveness. The potential reach of BBN is high, which heightens opportunity for population-level impact, but per-user symptom reduction was modest. Per-user impact may be improved by embedding digital health resources in the context of a broader health care strategy.","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"93 1","pages":"463-472"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Problems With Noninferiority Designs in PTSD Treatment Research: Losing Signal to Noise.","authors":"Sheila A M Rauch,H Myra Kim,Ron Acierno,Peter W Tuerk,Barbara O Rothbaum","doi":"10.1176/appi.ajp.20240567","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240567","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"48 1","pages":"421-423"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing Technology to Reimagine and Scale Support for Individual and Community Mental Health After Disaster.","authors":"Shannon Wiltsey Stirman,Adrienne Heinz","doi":"10.1176/appi.ajp.20250138","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250138","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"12 1","pages":"412-413"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychiatric Symptoms of Subacute and Chronic Long COVID.","authors":"Thida M Thant,Abhisek C Khandai,Aisha Gillan,Melissa Peace,Davin Quinn,John Levenson","doi":"10.1176/appi.ajp.25182003","DOIUrl":"https://doi.org/10.1176/appi.ajp.25182003","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"62 1","pages":"498-499"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemental Health Care for Children and Adolescents in the United States: Challenges and Opportunities.","authors":"Barbara J Coffey","doi":"10.1176/appi.ajp.20250141","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250141","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"48 1","pages":"419-420"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Either/Or: The Next Chapter in PTSD and Alcohol Use Disorder Treatment Research.","authors":"Denise Nguyen Hien,Teresa Lopez-Castro","doi":"10.1176/appi.ajp.20250120","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250120","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"90 1","pages":"408-411"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diverse Treatment Strategies and the Valuable Work That Brings Them Forward.","authors":"Ned H Kalin","doi":"10.1176/appi.ajp.20250299","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250299","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"36 1","pages":"403-407"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Two 90-Minute Workshops Reduce Risk of Substance Use Disorder for Vulnerable Seventh Graders? Results and Scalability From the Co-Venture Trial.","authors":"Brooke S G Molina","doi":"10.1176/appi.ajp.20250173","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250173","url":null,"abstract":"","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"15 1","pages":"414-416"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Update on Psychotherapy for the Treatment of PTSD.","authors":"Barbara Olasov Rothbaum,Laura E Watkins","doi":"10.1176/appi.ajp.20250110","DOIUrl":"https://doi.org/10.1176/appi.ajp.20250110","url":null,"abstract":"Posttraumatic stress disorder (PTSD) symptoms are part of the normal response to trauma. Most trauma survivors will recover over time without intervention, but a significant minority will develop chronic PTSD, which is unlikely to remit without intervention. Currently, only two medications, sertraline and paroxetine, are approved by the U.S. Food and Drug Administration to treat PTSD, and the combination of brexpiprazole and sertraline and MDMA-assisted therapy have FDA applications pending. These medications, and the combination of pharmacotherapy and psychotherapy, are not recommended as first-line treatments in any published PTSD treatment guidelines. The only interventions recommended as first-line treatments are trauma-focused psychotherapies; the U.S. Department of Veterans Affairs/Department of Defense PTSD treatment guideline recommends prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing, and the American Psychological Association PTSD treatment guideline recommends PE, CPT, cognitive therapy, and trauma-focused cognitive-behavioral therapy. Although published clinical trials of psychedelic-assisted psychotherapy have not incorporated evidence-based PTSD psychotherapies, they have achieved greater response rates than other trials of combination treatment, and there is some enthusiasm about combining psychedelic medications with evidence-based psychotherapies. The state-of-the-art PTSD psychotherapies are briefly reviewed here, including their effects on clinical and neurobiological measures.","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"27 1","pages":"424-437"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychotherapy Trends in the United States.","authors":"Mark Olfson,Chandler McClellan,Samuel H Zuvekas,Melanie Wall,Carlos Blanco","doi":"10.1176/appi.ajp.20240492","DOIUrl":"https://doi.org/10.1176/appi.ajp.20240492","url":null,"abstract":"OBJECTIVEThe authors investigated recent national trends in outpatient mental health care and psychotherapy.METHODService data from four representative surveys of the U.S. household population, the 2018-2021 Medical Expenditure Panel Survey, were analyzed focusing on adults with outpatient mental health visits (N=17,821) including psychotherapy visits (N=6,415). The authors present trends in age, sex, and Kessler-6 distress adjusted percentages of mental health patients receiving psychotherapy only, psychotropic medications, or their combination. They describe mean annual number of psychotherapy visits of persons receiving psychotherapy; providers delivering psychotherapy; psychotherapy expenditures; and other characteristics.RESULTSAmong adults receiving outpatient mental health care, an increase occurred in use of only psychotherapy (11.5% and 15.4% in 2018 and 2021, respectively; age, sex, and distress adjusted difference=2.8%, 95% CI=0.6, 5.0), but not in psychotherapy and psychotropic medication together (20.8% and 22.5%; adjusted difference=1.3%, 95% CI=-0.7, 3.4), while use of only psychotropic medication declined (67.6% and 62.1%; adjusted difference=-4.5%, 95% CI=-6.9, -2.1). Increases occurred in psychotherapy visits per psychotherapy patient (means, 9.8 and 11.8; adjusted difference=2.1, 95% CI=0.6, 3.7) and total national psychotherapy expenditures ($30.8 and $51.0 billion in constant 2021 dollars, trend, p=0.03) with a decrease in patients receiving psychotherapy from psychiatrists (41.2%-34.2%, adjusted difference=-6.7%, 95% CI=-11.0, -2.4).CONCLUSIONSBetween 2018 and 2021, psychotherapy assumed a larger role in outpatient mental health care while psychotropic medication without psychotherapy, though the modal treatment, became less common. Psychiatrists provided psychotherapy to a decreasing percentage of mental health outpatients, which may have increased the need for psychiatrists to refer patients to and collaborate with non-physician psychotherapists.","PeriodicalId":7656,"journal":{"name":"American Journal of Psychiatry","volume":"28 1","pages":"483-492"},"PeriodicalIF":17.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}