| 1. |
- Moffett, Bianca D., et al.
(författare)
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Digital delivery of behavioural activation therapy to overcome depression and facilitate social and economic transitions of adolescents in South Africa (the DoBAt study) : protocol for a pilot randomised controlled trial
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:12
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Scalable psychological treatments to address depression among adolescents are urgently needed. This is particularly relevant to low-income and middle-income countries where 90% of the world's adolescents live. While digital delivery of behavioural activation (BA) presents a promising solution, its feasibility, acceptability and effectiveness among adolescents in an African context remain to be shown.METHODS AND ANALYSIS: This study is a two-arm single-blind individual-level randomised controlled pilot trial to assess the feasibility, acceptability and initial efficacy of digitally delivered BA therapy among adolescents with depression. The intervention has been coproduced with adolescents at the study site. The study is based in the rural northeast of South Africa in the Bushbuckridge subdistrict of Mpumalanga province. A total of 200 adolescents with symptoms of mild to moderately severe depression on the Patient Health Questionnaire Adolescent Version will be recruited (1:1 allocation ratio). The treatment group will receive BA therapy via a smartphone application (the Kuamsha app) supported by trained peer mentors. The control group will receive an enhanced standard of care. The feasibility and acceptability of the intervention will be evaluated using a mixed methods design, and signals of the initial efficacy of the intervention in reducing symptoms of depression will be determined on an intention-to-treat basis. Secondary objectives are to pilot a range of cognitive, mental health, risky behaviour and socioeconomic measures; and to collect descriptive data on the feasibility of trial procedures to inform the development of a further larger trial.ETHICS AND DISSEMINATION: This study has been approved by the University of the Witwatersrand Human Research Ethics Committee (MED20-05-011) and the Oxford Tropical Research Ethics Committee (OxTREC 34-20). Study findings will be published in scientific open access peer-reviewed journals, presented at scientific conferences and communicated to participants, their caregivers, public sector officials and other relevant stakeholders.TRIAL REGISTRATION NUMBERS: This trial was registered on 19 November 2020 with the South African National Clinical Trials Registry (DOH-27-112020-5741) and the Pan African Clinical Trials Registry (PACTR202206574814636).
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| 2. |
- O'Mahen, Heather A., et al.
(författare)
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Internet-based behavioral activation—Treatment for postnatal depression (Netmums): A randomized controlled trial
- 2013
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Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 150:3, s. 814-822
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the high prevalence of postnatal depression (PND), few women seek help. The internet may increase timely access to treatment. We report a randomized controlled trial of a minimal intervention internet Behavioral Activation (iBA) treatment modified to address postnatal specific concerns (Postnatal-iBA).Methods: Women (n=910) recruited via a popular UK parenting site, Netmums.com, scoring above 12 on the Edinburgh Postnatal Depression Scale (EPDS) were randomly assigned to receive either Postnatal-iBA delivered or treatment-as-usual (TAU). We investigated the feasibility (recruitment, trial and treatment adherence) and effectiveness (depression status EPDS >12) of the intervention.Results: Recruitment was excellent; 1261 women, 961 of whom met inclusion criteria, signed up to the trial within two 2-week recruitment periods. Thirty-eight percent (343/910) of women completed the 15-week outcome assessment. Of those who completed 15-week assessment, fewer exceeded the depression cutoff in the Postnatal-iBA group (n=66/181) compared to TAU (n=91/162). Assuming all non-respondents remained depressed, the Postnatal-iBA effect was reduced.Limitations: The study suffered from high attrition and future trials need to consider strategies for improving outcome completion. Some women reported struggles "keeping up" with the treatment.Conclusions: A minimal support, widely accessible internet Behavioral Activation program for PND is feasible to deliver to community populations when embedded within popular parenting sites. For women who provide outcome data, postnatal-iBA offers promise as an effective treatment for PND. The addition of support may reduce women's struggles to keep pace with the treatment.Keywords: Behavioral activation; Cognitive behavioral therapy; Depression; Online cbt; Postnatal depression; Randomized controlled trial.
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| 3. |
- O'Mahen, Heather A., et al.
(författare)
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Women's experiences of factors affecting treatment engagement and adherence in internet delivered Behavioural Activation for Postnatal Depression
- 2015
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 2:1, s. 84-90
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Women with postnatal depression (PND) face significant barriers to treatment that may be overcome by internet based delivery of treatment. Demand for a self-help internet postnatal treatment offered via a parenting site was high, but attrition rates were also high.Aims: To gain patient perspectives on engagement and barriers to the Netmums' “Helping with Depression” treatment.Method: Semi-structured interviews were conducted with 17 participants selected from the Netmums trial.Results: Thematic analysis revealed motivators and barriers to treatment. Women reported that the flexibility and anonymity of internet interventions fit with their postnatal circumstances. They identified that the relevance of the intervention to their personal circumstances, expectations of motherhood, stigma about depression and motherhood, hopelessness about their ability to improve, previous negative experiences with treatment and treatment seeking, and a lack of practical and emotional support contributed to feelings of being overwhelmed. Women who felt more overwhelmed were more likely to discontinue treatment. Women suggested that support would reduce the impact of barriers and improve adherence.Discussion: Open access, self-help internet interventions are acceptable to women with postnatal depression, but it is critical to provide tailoring and support to help overcome barriers and improve treatment adherence.
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| 4. |
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| 5. |
- Pettman, Danelle, et al.
(författare)
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Effectiveness and acceptability of cognitive behavioural therapy based interventions for maternal peripartum depression : A systematic review, meta-analysis and thematic synthesis protocol
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:12
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION:Peripartum depression is a common mental health difficulty associated with a range of negative impacts for the mother, infant and wider family. This review will examine the effectiveness of cognitive-behavioural therapy (CBT) based interventions for peripartum depression. Secondary aims are to explore the effect of CBT-based interventions targeted at peripartum depression on novel secondary outcomes and moderators potentially associated with effectiveness. To date, there has been little examination of effect on important secondary outcomes (eg, anxiety, stress and parenting), nor clinical and methodological moderators. Further, this review aims to explore the acceptability of CBT-based interventions for women with peripartum depression and examine important adaptations for this population.METHODS AND ANALYSIS:Electronic databases (e.g., MEDLINE; ISI Web of Science; CINAHL; CENTRAL; Prospero; EMBASE; ASSIA; PsychINFO; SCOPUS; And Swemed+) will be systematically searched. Database searches will be supplemented by expert contact, reference and citation checking, and grey literature. Primary outcomes of interest will be validated measures of symptoms of depression. A proposed meta-analysis will examine: (1) the overall effectiveness of psychological interventions in improving symptoms of depression (both self-reported and diagnosed major depression) in the peripartum period; (2) the impact of interventions on secondary outcomes (eg, anxiety, stress and parenting); (3) clinical and methodological moderators associated with effectiveness. A thematic synthesis will be conducted on qualitative data exploring the acceptability of CBT-based intervention for postpartum depression including participants' experience and perspectives of the interventions, satisfaction, barriers and facilitators to intervention use, intervention relevance to mothers' situations and suggestions for improvements to tailor interventions to the peripartum client group.ETHICS AND DISSEMINATION:Formal ethical approval is not required by the National Ethical Review Board in Sweden as primary data will not be collected. The results will be disseminated through a peer-reviewed publication and inform the development of a new psychological intervention for peripartum depression. This study including protocol development will run from March 2019 to March 2020.
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| 6. |
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| 7. |
- Pettman, Danelle, et al.
(författare)
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Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression : a systematic review and meta-analysis
- 2023
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDepression during the perinatal period (during pregnancy and the year after childbirth) is common and associated with a range of negative effects for mothers, infants, family members, and wider society. Although existing evidence suggests cognitive behavioral therapy (CBT) based interventions are effective for perinatal depression, less is known about the effect of CBT-based interventions on important secondary outcomes, and a number of potential clinical and methodological moderators have not been examined.MethodsA systematic review and meta-analysis primarily examined the effectiveness of CBT-based interventions for perinatal depression on symptoms of depression. Secondary aims examined the effectiveness of CBT-based interventions for perinatal depression on symptoms of anxiety, stress, parenting, perceived social support, and perceived parental competence; and explored clinical and methodological moderators potentially associated with effectiveness. A systematic search of electronic databases and other sources was performed up to November 2021. We included randomized controlled trials comparing CBT-based interventions for perinatal depression with control conditions allowing for the isolation of the effects of CBT.ResultsIn total, 31 studies (5291 participants) were included in the systematic review and 26 studies (4658 participants) were included in the meta-analysis. The overall effect size was medium (hedges g = − 0.53 [95% CI − 0.65 to − 0.40]); with high heterogeneity. Significant effects were also found for anxiety, individual stress, and perceived social support, however few studies examined secondary outcomes. Subgroup analysis identified type of control, type of CBT, and type of health professional as significant moderators of the main effect (symptoms of depression). Some concerns of risk of bias were present in the majority of studies and one study had a high risk of bias.ConclusionsCBT-based interventions for depression during the perinatal period appear effective, however results should be interpreted with caution given high levels of heterogeneity and low quality of included studies. There is a need to further investigate possibly important clinical moderators of effect, including the type of health professional delivering interventions. Further, results indicate a need to establish a minimum core data set to improve the consistency of secondary outcome collection across trials and to design and conduct trials with longer-term follow-up periods.
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| 8. |
- Pettman, Danelle, et al.
(författare)
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Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression : A systematic review and meta-analysis
- 2022
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Ingår i: BABCP 50th Annual Conference.
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Konferensbidrag (refereegranskat)abstract
- Background: Perinatal depression is prevalent condition which impact negatively upon mothers, infants, families and widersociety. The evidence based suggests that cognitive behavioral therapy (CBT) based interventions are effective for perinataldepression, however the effect upon important secondary outcomes, and a number of potential clinical andmethodological moderators has yet to be examined.Methods: A systematic review and meta-analysis was conducted to explore the effectiveness of CBT-based interventionsfor perinatal depression on symptoms of depression, anxiety, stress, parenting, perceived social support, and perceivedparental competence. Clinical and methodological moderators potentially associated with effectiveness were explored. Asystematic search was performed for randomized controlled trials (RCTs) of CBT-based interventions for perinataldepression. Searches were performed up until November 2021.Results: The systematic review included 31 studies (5,291 participants) and the meta-analysis included 26 studies (4,658participants). The overall effect size was medium (hedges g = -0.53 [95% CI -0.65 to -0.40]); with high heterogeneity.Significant effects were found for anxiety, individual stress, and perceived social support, however few studies includedthese secondary outcomes. In the subgroup analysis; type of control, type of cognitive behavioral therapy, and type ofhealth professional were significant moderators of the main effect (symptoms of depression). Some concerns of risk of biaswere present in many studies and one study had a high risk of bias.27Conclusions: CBT-based interventions for perinatal depression appear effective, however results should be cautiouslyinterpreted given high levels of heterogeneity and risk of bias presented in many studies. The moderating effect of the typeprofessional delivering interventions warrants further study. Additionally, the results indicate a need to improveconsistency of reporting across trials with the development of a minimum core data set and to design and conduct trialswith longer-term follow-up periods.PROSPERO registration: CRD42020152254.
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| 9. |
- Topooco, Naira, 1980-
(författare)
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Blended cognitive behavior therapy : efficacy and acceptability for treating depression in the adult and adolescent population
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depression is the most burdensome disorder worldwide in terms of health loss. The potential of internet and technologies to scale up psychological treatment resources is substantial. A blended treatment approach, reducing therapist time and combining sessions with online self-help components, could enhance availability of psychological treatment, while maintaining and possibly enhancing effect of treatment. The aim of this thesis was to develop and investigate the blended treatment approach, in terms of acceptance among key stakeholders, and clinical effect in treatment of depression in the adult and adolescent population.Study I investigated acceptance of the blended treatment approach among mental health care stakeholders by means of a European survey. The results demonstrated that the majority readily accepted blended treatment for management of mild and moderate depression.Study II evaluated blended treatment compared to standard face-toface psychotherapy in treatment of adult depression in a controlled non-inferiority trial. The results showed a similar decrease in depression from both interventions at post-treatment, with decreased levels maintained over six months. Non-inferiority for the blended treatment could not be statistically established.Study III was a controlled non-inferiority trial evaluating blended treatment compared to treatment as usual. The results indicated superiority for the blended treatment at post-treatment and partly at six months. After twelve months the outcomes in the two conditions were similar.Study IV evaluated blended treatment for adolescent depression in a controlled superiority trial, where the therapist time was not reduced, but sessions delivered via chat for improved reach and efficiency. Compared to attention control, the blended treatment significantly reduced depression symptoms, with effects indicated to be maintained over six months.Study V was a controlled superiority trial, evaluating an improved version of the blended treatment used in Study IV to similar methods and in a similar population. In comparison to minimal attention control, the blended treatment significantly reduced depression symptoms at post-treatment, corresponding to a large treatment effect.Across Study II to V, estimates indicated that the amount of therapist time that could be saved in blended treatment, compared to standard psychological treatment, was around 40%.In conclusion, a gradual, blended integration of technology into psychological treatment i) performed well in treatment of adult and adolescent populations, ii) could substantially reduce therapist time in comparison to standard face-to-face psychological treatment, and iii) was accepted by patients as well as other mental health care stakeholders.The thesis demonstrates the potentials of technology-assisted blended treatment models to deliver treatment of depression in the young and adult population in accordance with the current, urgent need to increase availability of psychological treatment as well as increase acceptance of technology-assisted mental health interventions.
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| 10. |
- Pettman, Danelle, et al.
(författare)
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- 2020
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Ingår i: 6th International Congress of Clinical Psychology and Health with Children and Adolescents. - : Ediciones Pirámide (Grupo Anaya, S. A.). ; , s. 84-84
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Postpartum depression (PPD) can interfere witha mother’s ability to engage in sensitive caregiving,however a recent systematic review and meta-analysisby our group (Pettman et al., 2020) revealed the majority of existing PPD interventions focus on the mothersmood alone, without additional support with parenting.Further, in a recent randomised controlled feasibilitytrial telephone supported internet-administered behavioural activation (BA) intervention for PPD demonstrated feasibility and acceptability with a large effectsize for depression at post-treatment (-0.87, 95% CI0.42-1.32), maintained at 6 months (O’Mahen et al.,2014). Attrition rates were low, with 10% attrition inthe BA group at post-treatment and 14% at 6-monthfollow-up. However, only small effect sizes were foundfor self-reported perception of relationship with infant(parental bonding). The purpose of this research is todevelop an accessible internet-based intervention thatintegrates BA treatment for PPD with parenting skillsand to adapt it to a Swedish population. Adopting theMedical Research Council (United Kingdom) phase I(development) framework, this qualitative study willuse a participatory action research (PAR) approach.Using PAR will place Swedish mothers with lived experience of PPD at the centre of the intervention development process. Through a series of iterative workshops,meetings and online feedback, a Mother ResearcherPartner Panel of mothers with lived experience ofPPD and Health Care Professional Advisory Group willassist the research team in iteratively developing theintegrated PPD and parenting intervention. Resultswill report mothers’ intervention design and deliverypreferences, including technical elements, visual andaudio elements, and amount and format of professional support. Results will also describe adaptations toimprove the cultural appropriateness, relevance, andacceptability of the intervention to Swedish mothers.
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