| 1. |
- Akram, AJ, et al.
(author)
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Development of a condition-specific measure to assess quality of life in patients with hypodontia
- 2011
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In: Orthodontics & craniofacial research. - : John Wiley & Sons. - 1601-6335 .- 1601-6343. ; 14:3, s. 160-167
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Journal article (peer-reviewed)abstract
- Objectives: To develop a measure to assess quality of life in patients with hypodontia.Setting and sample population: Royal Devon and Exeter NHS Foundation Trust.Materials and methods: The study was divided into two parts. The first phase involved developing a patient-specific questionnaire using 22 patients with hypodontia in five focus groups. The transcripts from these groups were analysed thematically, and emerging themes used to direct the remaining focus groups. When no new themes were identified, it was assumed that data saturation was reached and no further focus groups were organised. In the second phase of the study, a health-related quality of life questionnaire was developed.Results: Analysis of transcripts revealed four themes: treatment, effect on daily activities, appearance and other peoples' reactions. These themes were incorporated into a questionnaire. The readability, ease of administration, face and content validity of the questionnaire were tested.Conclusions: A new measure for assessment of quality of life in patients with hypodontia is presented.
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| 2. |
- Ander, Malin, 1983-, et al.
(author)
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A preliminary open trial of individualised cognitive behavioural therapy for young survivors of cancer during adolescence: initial findings and conceptualisation of distress
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Other publication (other academic/artistic)abstract
- Objective: A subgroup of adolescent and young adult (AYA) survivors of cancer in adolescence report high levels of psychological distress. Empirically-supported treatments tailored to the concerns experienced by this population are lacking. The aims of this study were to (1) conduct a preliminary evaluation of an individualised cognitive behavioural therapy (CBT) intervention for adolescent and young adult (AYA) survivors of cancer during adolescence and (2) identify and conceptualise cancer-related psychological concerns using cognitive-behavioural theory.Methods: A single-arm trial in which ten AYA (17-25 years) survivors of cancer during adolescence were offered up to 15 sessions of individualised CBT guided by behavioural case formulations was undertaken. Clinical outcomes were assessed at baseline, post-treatment, and three months follow-up. Before commencing treatment, two individual qualitative interviews were conducted with each participant. Analysis of cancer-related concerns was guided by qualitative framework analysis and theoretical thematic analysis, and cognitive-behavioural theory was used to inform identification of themes.Results: Ten of 201 potential participants invited to participate were included resulting in an overall participation rate of 5%. Nine participants completed treatment and eight completed the follow-up assessment. The majority of concerns reported were cancer-related and conceptualised as social avoidance, fear and avoidance of emotions and bodily symptoms, low mood and unbalance in activity, and worry and rumination.Conclusions: Given significant difficulties with recruitment, further research is needed to examine barriers and the impact of mental health literacy and stigma on help seeking in the AYA cancer survivor population. Internet-administered CBT self-help tailored towards the main presenting concerns of AYA cancer survivors may be a promising solution.
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| 3. |
- Ander, Malin, et al.
(author)
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Guided Internet-Administered Self-Help to Reduce Symptoms Of Anxiety and Depression Among Adolescents and Young Adults Diagnosed With Cancer During Adolescence (U-CARE: YoungCan) : study protocol for a feasibility trial
- 2017
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In: BMJ Open. - : BMJ. - 2044-6055. ; 7:1
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Journal article (peer-reviewed)abstract
- Introduction A subgroup of adolescents and young adults diagnosed with cancer during adolescence reports elevated levels of anxiety and depressive symptoms and unmet needs for psychological support. Evidence-based psychological treatments tailored for this population are lacking. This protocol describes a feasibility study of a guided-internet-administered self-help programme (YoungCan) primarily targeting symptoms of anxiety and depression among young persons diagnosed with cancer during adolescence and of the planned study procedures for a future controlled trial. Methods/analysis The study is an uncontrolled feasibility trial with a pre-post and 3-month follow-up design. Potential participants aged 15-25years, diagnosed with cancer during adolescence, will be identified via the Swedish Childhood Cancer Registry. 30 participants will be included. Participants will receive YoungCan, a 12-week therapist-guided, internet-administered self-help programme consisting primarily of cognitive-behavioural therapy organised into individually assigned modules targeting depressive symptoms, worry and anxiety, body dissatisfaction and post-traumatic stress. Interactive peer support and psychoeducative functions are also available. Feasibility outcomes include: recruitment and eligibility criteria; data collection; attrition; resources needed to complete the study and programme; safety procedures; participants' and therapists' adherence to the programme; and participants' acceptability of the programme and study methodology. Additionally, mechanisms of impact will be explored and data regarding symptoms of anxiety, depression, post-traumatic stress, body dissatisfaction, reactions to social interactions, quality of life, axis I diagnoses according to the Mini International Neuropsychiatric Interview and healthcare service use will be collected. Exploratory analyses of changes in targeted outcomes will be conducted. Ethics/dissemination This feasibility protocol was approved by the Regional Ethical Review Board in Uppsala, Sweden (ref: 2016/210). Findings will be disseminated to relevant research, clinical, health service and patient communities through publications in peer-reviewed and popular science journals and presentations at scientific and clinical conferences.
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| 4. |
- Awortwe, Victoria, et al.
(author)
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Prevalence and social determinants of anxiety and depression among adults in Ghana : a systematic review and meta-analysis protocol
- 2024
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 14:4, s. e081927-e081927
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Research review (peer-reviewed)abstract
- Introduction Anxiety and depression pose a significant global health challenge, especially affecting adults in low-income and middle-income countries. In many low-income and middle-income countries, including those in sub-Saharan Africa, social determinants such as access to affordable health services, conflict, food insecurity, and poverty may be associated with the prevalence of anxiety and depression, further contributing to health disparities. To mitigate the burden of anxiety and depression in sub-Saharan Africa, it is essential to develop country-level tailored mental health policies and strategies. For example, Ghana is working towards improving mental health via its 12 year Mental Health policy launched in 2021. However, the prevalence of anxiety and depression among adults in Ghana, along with associated social determinants remains largely unknown, posing challenges for mental health planning, resource allocation and developing targeted interventions. This systematic review seeks to (1) examine the prevalence of anxiety and depression among adults in Ghana and (2) explore social determinants potentially associated with anxiety and depression.Methods and analysis Electronic databases (eg, African Index Medicus, CINAHL, EMBASE, MEDLINE, and PsycINFO) will be searched with all screening steps conducted by two independent reviewers. Secondary search strategies, including grey literature searches, will be used. Studies reporting on the prevalence of anxiety, depression and/or a combined symptom measure (ie, psychological distress) among adults in Ghana, using validated instruments will be included. If data allows, random-effects-meta-analyses will be performed to estimate pooled prevalence rates of anxiety and depression. Potential clinical and methodological moderators will be examined using subgroup analyses and meta-regression. A narrative synthesis will explore social determinants potentially associated with anxiety and depression among adults in Ghana.Ethics and dissemination Ethical approval is not required as no primary data will be collected. Results will be disseminated via a peer-reviewed publication and presentations at academic conferences. Plain language summaries will be provided to relevant non-governmental organisations working in Ghana.
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| 5. |
- Blomberg, Oscar, et al.
(author)
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Adaptation of a guided low-intensity behavioral activation intervention for people with dementia in Sweden : a qualitative study exploring the needs and preferences of key stakeholders
- 2024
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In: BMC Geriatrics. - : Springer. - 1471-2318. ; 24:113
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Journal article (peer-reviewed)abstract
- BackgroundDespite depression being prevalent in people with dementia, contributing to negative health outcomes and placing increased burden on individuals and family members, access to psychological interventions is limited. A potential solution is guided low-intensity behavioral activation, supported by informal caregivers and guided by healthcare professionals. However, it is necessary to adapt interventions to meet the needs and preferences of key stakeholders to enhance acceptability and relevance. Study objectives were to: (1) explore needs and preferences concerning the content and delivery model of the guided low-intensity behavioral activation intervention; and (2) adapt the intervention to ensure cultural appropriateness, relevancy, and acceptability to people with dementia and their caregivers in Sweden.MethodsSemi-structured interviews and focus group discussions were conducted with key stakeholders, including healthcare professionals (n = 18), community stakeholders (n = 7), people with dementia (n = 8), and informal caregivers (n = 19). A draft of the written low-intensity behavioral activation intervention and a description of the proposed intervention delivery model were provided to participants. Open-ended questions explored the perceived relevance of the intervention, alongside needs and preferences concerning content and delivery. A manifest content analysis approach was adopted.ResultsContent analysis resulted in three categories: Content, Delivery procedures, and Illness trajectory. Results highlighted a need to consider the intervention Content via increased cultural adaptation to the Swedish context, and increasing the inclusiveness of intervention content. Delivery procedures were identified as needing to be flexible given the unpredictable nature of caring for people with dementia, with the provision of additional guidance to informal caregivers supporting the intervention. Illness trajectory was viewed as essential to consider, with the intervention regarded as suitable for those early in the dementia trajectory, alongside a need to reduce workbook text to minimize burden given dementia symptomology.ConclusionsThe intervention and proposed delivery model were generally well received by all stakeholders. We were able to identify key adaptations to enhance cultural appropriateness, relevancy, and acceptability for a currently neglected population. Results will inform a feasibility study to explore the feasibility and acceptability of the intervention and study procedures to inform the design of a future superiority randomized controlled trial.
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| 6. |
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| 7. |
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| 8. |
- Brantnell, Anders, 1983-, et al.
(author)
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Barriers to and Facilitators of the Implementation of Digital Mental Health Interventions as Perceived by Primary Care Decision Makers : Content Analysis of Structured Open-Ended Survey Data
- 2023
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In: JMIR Human Factors. - : JMIR Publications. - 2292-9495. ; 10
-
Journal article (peer-reviewed)abstract
- Background: Digital mental health represents a way to increase access to evidence-based psychological support. However, the implementation of digital mental health in routine health care practice is limited, with few studies focusing on implementation. Accordingly, there is a need to better understand the barriers to and facilitators of implementing digital mental health. Existing studies have mainly focused on the viewpoints of patients and health professionals. Currently, there are few studies about barriers and facilitators from the perspective of primary care decision makers, that is, the persons responsible for deciding whether a given digital mental health intervention should be implemented in a primary care organization.Objective: The objectives were to identify and describe barriers to and facilitators of the implementation of digital mental health as perceived by primary care decision makers, evaluate the relative importance of different barriers and facilitators, and compare barriers and facilitators reported by primary care decision makers who have versus have not implemented digital mental health interventions.Methods: A web-based self-report survey was conducted with primary care decision makers responsible for the implementation of digital mental health in primary care organizations in Sweden. Answers to 2 open-ended questions about barriers and facilitators were analyzed through summative and deductive content analysis.Results: The survey was completed by 284 primary care decision makers—59 (20.8%) decision makers representing implementers (ie, organizations that offered digital mental health interventions) and 225 (79.2%) respondents representing nonimplementers (ie, organizations that did not offer digital mental health interventions). Overall, 90% (53/59) of the implementers and 98.7% (222/225) of the nonimplementers identified barriers, and 97% (57/59) of the implementers and 93.3% (210/225) of the nonimplementers identified facilitators. Altogether, 29 barriers and 20 facilitators of implementation were identified related to guidelines; patients; health professionals; incentives and resources; capacity for organizational change; and social, political, and legal factors. The most prevalent barriers were related to incentives and resources, whereas the most prevalent facilitators were related to the capacity for organizational change.Conclusions: A number of barriers and facilitators were identified that could influence the implementation of digital mental health from the perspective of primary care decision makers. Implementers and nonimplementers identified many common barriers and facilitators, but they differ in terms of certain barriers and facilitators. Common and differing barriers and facilitators identified by implementers and nonimplementers may be important to address when planning for the implementation of digital mental health interventions. For instance, financial incentives and disincentives (eg, increased costs) are the most frequently mentioned barrier and facilitator, respectively, by nonimplementers, but not by implementers. One way to facilitate implementation could be to provide more information to nonimplementers about the actual costs related to the implementation of digital mental health.
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| 9. |
- Brantnell, Anders, 1983-, et al.
(author)
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Views of Implementers and Nonimplementers of Internet-Administered Cognitive Behavioral Therapy for Depression and Anxiety : Survey of Primary Care Decision Makers in Sweden
- 2020
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In: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 22:8
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Internet-administered cognitive behavioral therapy (ICBT) has been demonstrated to be an effective intervention for adults with depression and/or anxiety and is recommended in national guidelines for provision within Swedish primary care. However, the number and type of organizations that have implemented ICBT within primary care in Sweden is currently unclear. Further, there is a lack of knowledge concerning barriers and facilitators to ICBT implementation.OBJECTIVE: The two primary objectives were to identify and describe primary care organizations providing ICBT in Sweden and compare decision makers' (ie, directors of primary care organizations) views on barriers and facilitators to implementation of ICBT among ICBT implementers (ie, organizations that offered ICBT) and nonimplementers (ie, organizations that did not offer ICBT).METHODS: An online survey based on a checklist for identifying barriers and facilitators to implementation was developed and made accessible to decision makers from all primary care organizations in Sweden. The survey consisted of background questions (eg, provision of ICBT and number of persons working with ICBT) and barriers and facilitators relating to the following categories: users, therapists, ICBT programs, organizations, and wider society.RESULTS: The participation rate was 35.75% (404/1130). The majority (250/404, 61.8%) of participants were health care center directors and had backgrounds in nursing. Altogether, 89.8% (363/404) of the participating organizations provided CBT. A minority (83/404, 20.5%) of organizations offered ICBT. Most professionals delivering ICBT were psychologists (67/83, 80%) and social workers (31/83, 37%). The majority (61/83, 73%) of organizations had 1 to 2 persons delivering ICBT interventions. The number of patients treated with ICBT during the last 12 months was 1 to 10 in 65% (54/83) of the organizations, ranging between 1 and 400 treated patients across the whole sample. There were 9 significant (P<.05) differences out of 37 possible between implementers and nonimplementers. For example, more implementers (48/51, 94%) than nonimplementers (107/139, 76.9%) perceived few technical problems (P<.001), and more implementers (53/77, 68%) than nonimplementers (103/215, 47.9%) considered that their organization has resources to offer ICBT programs (P<.001).CONCLUSIONS: Despite research demonstrating the effectiveness of ICBT for depression and anxiety and national guidelines recommending its use, ICBT is implemented in few primary care organizations in Sweden. Several interesting differences between implementers and nonimplementers were identified, which may help inform interventions focusing on facilitating the implementation of ICBT.
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| 10. |
- Chiwanga, Faraja S., et al.
(author)
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An mHealth Intervention to Improve Guardians' Adherence to Children's Follow-Up Care for Acute Lymphoblastic Leukemia in Tanzania (GuardiansCan Project) : Protocol for a Development and Feasibility Study
- 2023
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In: JMIR Research Protocols. - : JMIR Publications. - 1929-0748. ; 12
-
Journal article (peer-reviewed)abstract
- Background: Cancer is a leading cause of death during childhood and in low- and middle-income countries survival rates can be as low as 20%. A leading reason for low childhood cancer survival rates in low- and middle-income countries such as Tanzania is treatment abandonment. Contributing factors include poor communication between health care providers and children's guardians, insufficient cancer knowledge, and psychological distress.Objective: Our aim is to respond to Tanzanian guardians' poor adherence to children's follow-up care after treatment for acute lymphoblastic leukemia with the help of mobile health (mHealth) technology. Our goal is to increase guardians' adherence to children's medications and follow-up visits and to decrease their psychological distress.Methods: Following the Medical Research Council framework for developing and evaluating complex interventions, we will undertake the GuardiansCan project in an iterative phased approach to develop an mHealth intervention for subsequent testing. Public contribution activities will be implemented throughout via the establishment of a Guardians Advisory Board consisting of guardians of children with acute lymphoblastic leukemia. We will examine the acceptability, feasibility, and perceived impact of Guardians Advisory Board activities via an impact log and semistructured interviews (study I). In phase 1 (intervention development) we will explore guardians' needs and preferences for the provision of follow-up care reminders, information, and emotional support using focus group discussions and photovoice (study II). We will then co-design the mHealth intervention with guardians, health care professionals, and technology experts using participatory action research (study III). In phase 2 (feasibility), we will examine clinical, methodological, and procedural uncertainties associated with the intervention and study procedures to prepare for the design and conduct of a future definitive randomized controlled trial using a single-arm pre-post mixed methods feasibility study (study IV).Results: Data collection for the GuardiansCan project is anticipated to take 3 years. We plan to commence study I by recruiting Guardians Advisory Board members in the autumn of 2023.Conclusions: By systematically following the intervention development and feasibility phases of the Medical Research Council Framework, and working alongside an advisory board of guardians, we intend to develop an acceptable, culturally appropriate, feasible, and relevant mHealth intervention with the potential to increase guardians' adherence to children's follow-up care after treatment of acute lymphoblastic leukemia, leading to a positive impact on children's health and chances to survive, and reducing distress for guardians.
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| 11. |
- Coumoundouros, Chelsea, et al.
(author)
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Barriers and facilitators to implementing e-mental health interventions – a systematic review focusing in on interventions for informal cancer and dementia caregivers
- 2021
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Conference paper (peer-reviewed)abstract
- ObjectivesThis systematic review aimed to identify barriers and facilitators to implementing e-mental health interventions for informal caregivers.Methods Electronic databases were searched for studies published since 2007 reporting on implementation of e-mental health interventions for caregivers of adults with chronic diseases. A thematic synthesis using the Consolidated Framework for Implementation Research (CFIR) was used to identify implementation barriers and facilitators.ResultsImplementation barriers and facilitators were reported for 15 unique interventions designed for cancer (n=8) or dementia (n=7) caregivers. Intervention and individual characteristics were the most commonly addressed CFIR domains. Facilitators related to intervention’s easy-to-use design and presentation of tailored materials. Barriers included a lack of intervention support and difficulty identifying with materials due to low diversity in caregiver demographics and dyad types presented. Perspectives from stakeholders other than caregivers were infrequently reported, however challenges finding resources and financing interventions posed a barrier to real-world implementation. Themes for cancer and dementia caregiver interventions were similar, however a specific dimension related to cancer caregiver interventions was the (un)desirability of dyadic interventions. Conclusion and clinical implicationsE-mental health interventions for caregivers tend to be well-designed, however many dimensions of implementing these interventions remain largely unexplored. Future intervention development and evaluations should include feedback from stakeholders such as clinicians and care organizations to create a more complete picture of important factors for real-world intervention implementation. Review findings are part of a programme of research aiming to develop an implementation ready e-mental health intervention for cancer caregivers which will also be briefly discussed.
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| 12. |
- Coumoundouros, Chelsea, et al.
(author)
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Cognitive behavioural therapy self-help intervention preferences among informal caregivers of adults with chronic kidney disease : an online cross-sectional survey
- 2023
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In: BMC Nephrology. - : BioMed Central (BMC). - 1471-2369. ; 24:1
-
Journal article (peer-reviewed)abstract
- Background: Informal caregivers (i.e. family and friends) provide essential support to people with chronic kidney disease (CKD). Many informal caregivers experience mental health problems such as anxiety and depression due to the caregiving role, and commonly have unmet psychological support needs. One potential solution is cognitive behavioural therapy (CBT) self-help interventions that are less reliant on extensive involvement of healthcare professionals, which may increase access. Within the intervention development phase of the MRC framework, the study's primary objective was to examine informal caregivers' self-help intervention preferences (e.g. delivery format, content). Secondary objectives were to describe the informal caregiver's situation (e.g. type of care activities) and mental health (symptoms of depression, anxiety, and stress).Methods: An online cross-sectional survey conducted in the United Kingdom. Informal caregivers of adults living with CKD were recruited via social media, websites, newsletters, magazine articles, a podcast episode, and paid Facebook advertisements. The survey examined: informal caregiver characteristics; care recipient characteristics; self-help intervention preferences; and informal caregiver's mental health using the DASS-21. Data were analysed using descriptive statistics.Results: Sixty-five informal caregivers participated. The majority (85%) were female, caring for a male (77%) spouse/partner (74%). Responses indicated 58% of informal caregivers were experiencing at least mild depression. In total, 48% indicated they were likely to use a CBT self-help intervention, preferring an intervention provided via internet (e.g. website) (64%), workbook (56%), or individually in-person (54%). Regarding content, interventions should cover a wide range of topics including living with CKD, support services, informal caregiver's physical health, and diet. Overall, 48% reported a preference for a supported intervention, with support delivered in-person or via email by a trained professional at a community organisation.Conclusions: Results suggest CBT self-help interventions may be an acceptable way to provide psychological support to informal caregivers, however the study is limited by the small sample size. A wide range of intervention preferences were identified indicating a need to tailor intervention content and delivery to enhance acceptability and engagement. Results will inform development of a CBT self-help intervention for informal caregivers of people with CKD.
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| 13. |
- Coumoundouros, Chelsea
(author)
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E-mental health interventions for informal caregivers : Development with a focus on implementation
- 2023
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Doctoral thesis (other academic/artistic)abstract
- The four studies within this thesis contributed to the identification of key factors to be considered when designing and implementing e-mental health (e-MH) interventions for informal caregivers. Study I was a mixed-methods systematic review to examine factors related to the effectiveness and implementation of e-MH interventions for informal caregivers of adults with chronic diseases. A thematic synthesis with deductive coding using the Consolidated Framework for Implementation Research (CFIR) identified 152 implementation barriers and facilitators. Barriers and facilitators primarily related to intervention and user characteristics. Exploration of barriers and facilitators related to the implementation setting or wider context was limited.Study II was a cross-sectional survey to examine contextual factors related to informal caregivers (e.g. intervention preferences, caregiving situation) to inform the development of a cognitive behavioural therapy (CBT) self-help intervention to support the mental health of informal caregivers of people living with chronic kidney disease (CKD). The majority of participants were caring for a male spouse or partner living with CKD, and over half were experiencing at least mild depressive symptoms. Informal caregivers reported preferences for CBT self-help interventions to be delivered via the internet, a workbook, or individually in-person, with additional support provided in-person or via email by a trained professional at a non-profit organisation.Study III was a qualitative study to explore the perspectives of professionals (i.e. potential implementers) anticipated to play key roles in the future implementation of an e-MH intervention for informal caregivers of people living with CKD regarding the intervention’s design, delivery, and implementation. Manifest content analysis with primarily deductive coding using the CFIR led to identification of 29 generic categories representing implementation determinants. Potential implementers considered an e-MH intervention as fitting within some existing healthcare delivery models and work routines, however, capacity to be involved with intervention delivery was low. Equitable support access was important to ensure intervention acceptability.Study IV was a qualitative study to explore informal caregivers’ experiences of accessing and receiving support while caring for someone living with CKD. Reflexive thematic analysis generated three themes: (1) “Systems seem to get in the way” – challenges within support systems, describing challenges encountered when navigating complex systems; (2) Relying on yourself, describing how informal caregivers relied on their own skills and networks to find support; and (3) Support systems can “take the pressure off”, describing how support systems were perceived as supportive when empathetic and reliable.
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| 14. |
- Coumoundouros, Chelsea, et al.
(author)
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Implementation of e-mental health interventions for informal caregivers: a systematic review
- 2021
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Conference paper (peer-reviewed)abstract
- Background:Informal caregivers of people with chronic health conditions can experience anxiety, distress, depression, and other mental health difficulties as a result of their caregiving role. E-mental health interventions present a way to provide effective and accessible mental health support to informal caregivers, however implementation of e-mental health interventions can be challenging. A systematic review was conducted aiming to (1) examine implementation barriers and facilitators, and (2) identify implementation and intervention features associated with intervention effectiveness, to inform the design and implementation of e-mental health interventions for informal caregivers of adults with chronic diseases. Methods:Studies published since 2007 were searched for in six electronic databases, clinical trial registries and OpenGrey. Eligible studies reported on the implementation and/or effectiveness of e-mental health interventions for informal caregivers of adults with chronic diseases. Studies reporting on implementation were included in a thematic synthesis using the Consolidated Framework for Implementation Research (CFIR) to identify implementation barriers and facilitators. Randomized controlled trials reporting on intervention effectiveness were included in a qualitative comparative analysis to determine conditions related to implementation (e.g. interventionist training) and intervention characteristics (e.g. presence of support) sufficient for an intervention to be effective. Findings: A total of 34 studies have been included, representing 18 unique interventions for informal cancer (n=8), dementia (n=9) or stroke (n=1) caregivers. The majority of interventions were self-administered, and were either based on cognitive behavioral therapy or stress and coping frameworks. Aim 1: Implementation data were identified in 27 studies, representing 15 interventions. Intervention and individual (primarily informal caregiver) characteristics were the domains of the CFIR most commonly addressed. A barrier to implementation was lack of diversity among the informal care situations presented in interventions (e.g. not showing informal caregivers of different ages, ethnicities and care dyad types). Lack of support provided to informal caregivers was an additional barrier to implementation, however not all types of support are equally desirable (e.g. peer discussion forums). Implementation facilitators included intervention’s user-friendly designs and use of materials that informal caregivers could apply to their daily lives and routines. Perspectives from stakeholders at implementing organizations were not often explored, however, resource constraints (e.g. time) was one barrier to implementing e-mental health programs for informal caregivers.Aim 2: The qualitative comparative analysis included 8 randomized controlled trials and explored conditions such as the presence of peer support, professional support and the type of intervention theory. However, the analysis could not be conducted as the consistency level across the included studies was too low. Discussion: A variety of implementation barriers and facilitators were identified that can be used to inform future intervention development and implementation planning. Few studies were included in the qualitative comparative analysis, however there was low consistency in conditions sufficient for intervention effectiveness. Future research about e-mental health interventions for informal caregivers should seek out perspectives from a broader group of stakeholders, such as clinicians and care organizations, to gain further insight into implementation barriers and facilitators at different organizational levels.
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| 15. |
- Coumoundouros, Chelsea, et al.
(author)
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Implementation of e-mental health interventions for informal caregivers – a systematic review of what we know and where to go next
- 2023
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Conference paper (peer-reviewed)abstract
- Introduction: E-mental health interventions have the potential to provide accessible mental health support to informal caregivers who commonly experience mental health problems. However, e-mental health interventions for informal caregivers are frequently not implemented. Methods: A mixed-methods systematic review was undertaken to explore what factors impact the implementation of e-mental health interventions for informal caregivers. Within the review, a thematic synthesis utilizing primarily deductive coding based on the Consolidated Framework for Implementation Research was used to identify implementation barriers and facilitators.Results: The thematic synthesis included 44 reports resulting in identification of 152 barriers and facilitators. Barriers and facilitators were commonly related to the intervention and individual characteristic domains of the framework, including barriers such as lack of diversity in informal care scenarios included in the intervention and lack of support, and facilitators such as user-friendly design and providing benefits to informal caregivers (e.g. improved wellbeing). Barriers and facilitators related to the outer and inner setting, and the implementation process were less commonly explored but included lack of resources as a barrier, and alignment between the intervention and organizational goals as a facilitator. Conclusions: Implementation barriers and facilitators identified in this review can be used to inform future intervention development and implementation strategy development and planning. Future research should focus on exploring the perspectives of professionals who may be involved in implementation of e-mental health interventions for informal caregivers to improve our understanding of factors that influence e-mental health implementation within implementing organisations.
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| 16. |
- Coumoundouros, Chelsea, et al.
(author)
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Implementation of e-mental health interventions for informal caregivers of adults with chronic diseases : a protocol for a mixed-methods systematic review with a qualitative comparative analysis
- 2020
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In: BMJ Open. - : BMJ. - 2044-6055. ; 10:6
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Research review (peer-reviewed)abstract
- INTRODUCTION: Informal caregivers provide the majority of care to individuals with chronic health conditions, benefiting the care recipient and reducing use of formal care services. However, providing informal care negatively impacts the mental health of many caregivers. E-mental health interventions have emerged as a way to provide accessible mental healthcare to caregivers. Much attention has been given to reviewing the effectiveness and efficacy of such interventions, however, factors related to implementation have received less consideration. Therefore, this mixed-methods systematic review will aim to examine factors associated with the effectiveness and implementation of e-mental health interventions for caregivers.METHODS AND ANALYSIS: Eligible studies published since 1 January 2007 will be searched for in several electronic databases (CINAHL Plus with Full Text, the Cochrane Library, EMBASE, PsycINFO, PubMed and Web of Science), clinical trial registries and OpenGrey, with all screening steps conducted by two independent reviewers. Studies will be included if they focus on the implementation or effectiveness of e-mental health interventions designed for informal adult caregivers of adults with cancer, heart disease, stroke, diabetes, dementia or chronic obstructive pulmonary disease. Pragmatic randomised controlled trials quantitatively reporting on caregiver anxiety, depression, psychological distress or stress will be used for a qualitative comparative analysis to identify combinations of conditions that result in effective interventions. Qualitative and quantitative data on implementation of e-mental health interventions for caregivers will be integrated in a thematic synthesis to identify barriers and facilitators to implementation. These results will inform future development and implementation planning of e-mental health interventions for caregivers.ETHICS AND DISSEMINATION: Ethical approval is not required for this study as no primary data will be collected. Results will be disseminated in the form of a scientific publication and presentations at academic conferences and plain language summaries for various stakeholders.PROSPERO REGISTRATION NUMBER: CRD42020155727.
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| 17. |
- Coumoundouros, Chelsea, et al.
(author)
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Implementation of e-mental health interventions for informal caregivers of adults with chronic diseases : a systematic review
- 2020
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In: Implementation Science. - : Springer Science and Business Media LLC. - 1748-5908. ; 15, s. P10-P10
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Journal article (peer-reviewed)abstract
- Background:Many informal caregivers experience mental health difficulties. E-mental health interventions offer effective and accessible mental health support; however, these interventions are often not implemented. To explore implementation of e-mental health interventions for informal caregivers, a systematic review was conducted to (1) examine implementation barriers and facilitators, and (2) identify implementation and intervention features associated with intervention effectiveness.Method:Multiple electronic databases were searched for studies published since 2007 reporting on the implementation and/or effectiveness of e-mental health interventions for informal caregivers of adults with chronic diseases. A thematic synthesis of data related to implementation will be used to identify implementation barriers and facilitators. A qualitative comparative analysis, using data from pragmatic randomized controlled trials, will be used to determine combinations of conditions related to an intervention’s implementation or program features, sufficient for intervention effectiveness.Results:Electronic database searches yielded 9248 unique records to undergo title/abstract screening. The literature screening process is currently underway to identify full-texts eligible for inclusion in the analysis. Preliminary findings will be presented. Implementation barriers and facilitators identified in the thematic synthesis will be presented. These barriers and facilitators will be linked to initial results from the qualitative comparative analysis, as barriers and facilitators may relate to conditions important for intervention effectiveness. Practical applications of these findings will be discussed. If a qualitative comparative analysis cannot be completed prior to the conference, pragmatic trials reporting on intervention effectiveness will be descriptively summarized and analysis plans discussed.Conclusions:This review will identify key factors to consider during implementation of e-mental health interventions for informal caregivers and present potential solutions to overcome implementation barriers. These findings can be used to inform intervention design and implementation strategies to facilitate the implementation of e-mental health services for informal caregivers.Acknowledgements:This work was supported by the European Union’s Horizon 2020 research and innovation program under the Marie-Sklodowska Curie grant agreement No 814072.
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| 18. |
- Coumoundouros, Chelsea, et al.
(author)
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Implementation of e–Mental Health Interventions for Informal Caregivers of Adults With Chronic Diseases : Mixed Methods Systematic Review With a Qualitative Comparative Analysis and Thematic Synthesis
- 2022
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In: JMIR Mental Health. - : JMIR Publications Inc.. - 2368-7959. ; 9:11
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Research review (peer-reviewed)abstract
- Background: Informal caregivers commonly experience mental health difficulties related to their caregiving role. e–Mental health interventions provide mental health support in a format that may be more accessible to informal caregivers. However, e–mental health interventions are seldom implemented in real-world practice.Objective: This mixed methods systematic review aimed to examine factors associated with the effectiveness and implementation of e–mental health interventions for informal caregivers of adults with chronic diseases. To achieve this aim, two approaches were adopted: combinations of implementation and intervention characteristics sufficient for intervention effectiveness were explored using qualitative comparative analysis, and barriers to and facilitators of implementation of e–mental health interventions for informal caregivers were explored using thematic synthesis.Methods: We identified relevant studies published from January 1, 2007, to July 6, 2022, by systematically searching 6 electronic databases and various secondary search strategies. Included studies reported on the effectiveness or implementation of e–mental health interventions for informal caregivers of adults with cancer, chronic obstructive pulmonary disease, dementia, diabetes, heart disease, or stroke. Randomized controlled trials reporting on caregivers’ mental health outcomes were included in a crisp-set qualitative comparative analysis. We assessed randomized controlled trials for bias using the Risk of Bias 2.0 tool, and we assessed how pragmatic or explanatory their trial design was using the Pragmatic Explanatory Continuum Indicator Summary 2 tool. Studies of any design reporting on implementation were included in a thematic synthesis using the Consolidated Framework for Implementation Research to identify barriers to and facilitators of implementation.Results: Overall, 53 reports, representing 29 interventions, were included in the review. Most interventions (27/29, 93%) focused on informal cancer or dementia caregivers. In total, 14 reports were included in the qualitative comparative analysis, exploring conditions including the presence of peer or professional support and key persuasive design features. Low consistency and coverage prevented the determination of condition sets sufficient for intervention effectiveness. Overall, 44 reports were included in the thematic synthesis, and 152 barriers and facilitators were identified, with the majority related to the intervention and individual characteristic domains of the Consolidated Framework for Implementation Research. Implementation barriers and facilitators in the inner setting (eg, organizational culture) and outer setting (eg, external policies and resources) domains were largely unexplored.Conclusions: e–Mental health interventions for informal caregivers tend to be well-designed, with several barriers to and facilitators of implementation identified related to the intervention and individual user characteristics. Future work should focus on exploring the views of stakeholders involved in implementation to determine barriers to and facilitators of implementing e–mental health interventions for informal caregivers, focusing on inner and outer setting barriers and facilitators.Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42020155727; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020155727
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| 19. |
- Coumoundouros, Chelsea, et al.
(author)
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Potential Implementers’ Perspectives on the Development and Implementation of an e–Mental Health Intervention for Caregivers of Adults With Chronic Kidney Disease : Qualitative Interview Study
- 2023
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In: JMIR Human Factors. - : JMIR Publications. - 2292-9495. ; 10
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Journal article (peer-reviewed)abstract
- Background: e–Mental health interventions can improve access to mental health support for caregivers of people living with chronic kidney disease (CKD). However, implementation challenges often prevent effective interventions from being put into practice. To develop an e–mental health intervention for caregivers of people living with CKD that is optimized for future implementation, it is important to engage professionals that may endorse or deliver the intervention (ie, potential implementers) during intervention development.Objective: This study aims to explore the perspectives of potential implementers working in kidney care, in mental health care, or at nonprofit organizations regarding the design and implementation of an e–mental health intervention for caregivers of people living with CKD.Methods: Potential implementers (N=18) were recruited via National Health Service Trusts, email, and social media advertisements to participate in semistructured video interviews. Interview questions were informed by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using a deductive analysis approach using the CFIR, with inductive coding applied to relevant data not captured by the framework.Results: A total of 29 generic categories, related to 17 CFIR constructs, were identified. The perceived fit between the intervention and implementation context (ie, existing service delivery models and work routines) and existing social networks among potential implementers were perceived as important factors in enhancing implementation potential. However, a need for capacity building among potential implementers to create systems to support the identification and referral of caregivers to an e–mental health intervention was identified. Equity concerns were raised regarding the intervention, highlighting the importance of incorporating an equity lens during intervention design to enhance accessibility and adoption.Conclusions: Potential implementers provided valuable insights into key design and implementation factors to help inform the development of an e–mental health intervention for caregivers of people living with CKD. Incorporating their feedback can help ensure the intervention is acceptable and inform the selection of future implementation strategies to enhance the implementation potential of the intervention. Potential implementers should continue to be engaged throughout intervention development.
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| 20. |
- Coumoundouros, Chelsea, et al.
(author)
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Self-help intervention preferences among informal caregivers of adults with kidney conditions: an online cross-sectional survey
- 2022
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Conference paper (peer-reviewed)abstract
- Introduction: Informal caregivers provide important help and support to people with kidney conditions. However, informal caregivers often experience common mental health difficulties, such as depression and anxiety, while in the caregiving role. Informal caregiver’s mental health negatively impacts their own wellbeing, and can also impact the wellbeing of the person they care for. One potential solution to address informal caregivers’ need for psychological support is the development of cognitive behavioural therapy self-help (CBT-SH) interventions. CBT-SH interventions can increase access to psychological support as they are less reliant on extensive involvement of healthcare professionals, and can be delivered in a variety of formats. However, there is a lack of research exploring CBT-SH intervention preferences among informal caregivers of adults with kidney conditions. Following the development phrase of the Medical Research Council framework for developing and evaluating complex interventions, we aim to explore CBT-SH intervention preferences among informal caregivers of adults with kidney conditions to inform the development of an intervention that is acceptable to users and optimised for implementation into routine practice. Methods: Informal caregivers’ self-help intervention preferences were explored using an online cross-sectional survey. Adults living in the UK who were providing unpaid care to an adult with a kidney condition were eligible to participate. Participants were recruited via social media, websites, newsletters, and/or magazines of non-profit organisations for people with kidney conditions and/or informal caregivers. The survey contained questions related to (1) characteristics of the informal caregiver; (2) characteristics of the person with a kidney condition; (3) self-help intervention preferences (e.g. content, delivery format); and (4) informal caregiver’s mental health. Study materials were reviewed by two public contributors, informing the appearance of recruitment materials, and content of the participant information sheet and survey. Quantitative data analysis using descriptive statistics will be used to analyse survey responses. Results: Participants are currently being recruited, with data collection projected to end in May 2022. We aim to recruit approximately 150 participants, with 15 participants recruited as of mid-February 2022. Preliminary results describing participants’ sociodemographic background, caregiving situation (e.g. condition of the person they care for, relationship to the person they care for), and current mental health status will be presented. Intervention content and delivery (e.g. intervention format; where, when, and by whom the intervention is delivered) preferences identified as most important by informal caregivers will be reported. Findings will be used to guide development of a CBT-SH intervention for informal caregivers of people with kidney conditions and will inform upcoming qualitative research with informal caregivers and health and social care professionals to continue the intervention development process. Discussion: To our knowledge, this is the first study focused on the development of a CBT-SH intervention to support informal caregivers of people with kidney conditions. By incorporating informal caregiver’s intervention preferences during intervention development, we aim to ensure the intervention meets their needs and preferences, and will be acceptable when implemented into practice. Results reflect the first step towards the development of a CBT-SH intervention for informal caregivers of people with kidney conditions.
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| 21. |
- Coumoundouros, Chelsea, et al.
(author)
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Sources of support and views of e-mental health among caregivers of adults with kidney conditions
- 2023
-
Conference paper (peer-reviewed)abstract
- Background: Caregivers of adults with kidney conditions often experience mental health difficulties such as anxiety and depression. E-mental health interventions may help improve access to mental health support. To inform intervention development, this study aimed to explore caregivers’ experiences of receiving support and views of e-mental health interventions. Methods: Semi-structured interviews are being conducted with adults providing unpaid care to an adult with a kidney condition in the United Kingdom. Interviews explore topics such as experiences of receiving support, barriers and facilitators to accessing support, and views on the design and implementation of e-mental health interventions. Interviews are being analysed using reflexive thematic analysis.Expected results: Preliminary findings highlight that caregivers’ situations are complex, challenging, and unpredictable. Informal sources of support (i.e., family, friends and community/social media groups) provide valued support. Support from healthcare professionals is minimal and varied across kidney care units. Limited time and competing responsibilities are major barriers to accessing support, and the flexibility of e-mental health interventions can facilitate access. Incorporating practical tools and activities caregivers could apply to their daily lives are important design considerations. Current stage of work: Nine interviews have been conducted, transcribed, and are being analysed. Recruitment and analysis are ongoing. Discussion: By understanding caregivers’ caring contexts, we can enhance our knowledge of caregivers’ needs, and identify factors to consider during intervention development to design e-mental health interventions tailored to caregivers’ needs and inform future implementation planning. Careful consideration of caregivers’ needs may also increase the acceptability and relevancy of the intervention.
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| 22. |
- Coumoundouros, Chelsea, et al.
(author)
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Stakeholder perspectives on implementation of e-mental health interventions for caregivers of adults with kidney conditions
- 2023
-
Conference paper (peer-reviewed)abstract
- Background: E-mental health interventions for caregivers can be effective, but implementation challenges often prevent implementation into real-world practice. To understand these challenges, this study aimed to explore stakeholders’ views on the implementation and design of e-mental health interventions for caregivers of adults with kidney conditions to inform initial intervention development and future implementation planning.Methods: Semi-structured interviews with 18 professional stakeholders working with caregivers and/or people with kidney conditions in healthcare and community settings in the United Kingdom were conducted. Interviews explored topics including the implementation setting, barriers and facilitators to implementation, and intervention design. Interview transcripts were analysed using content analysis with deductive coding using the Consolidated Framework for Implementation Research, and inductive coding.Findings: Stakeholders acknowledged the importance of providing mental health support to caregivers, however, at a societal level (e.g. policy) caregivers tend to be undervalued and are a low priority. Stakeholders expressed equity and safeguarding concerns regarding e-mental health interventions, desiring an intervention accessible to people with different health and digital literacy levels at no cost. Building awareness and knowledge about the intervention among many professionals and having simple intervention referral pathways were important implementation facilitators. Discussion: Provision of mental health support for caregivers is endorsed by stakeholders, however involving stakeholders in implementation beyond promoting and referral of caregivers to the intervention would be challenging without additional resources. Intervention design and implementation factors identified by stakeholders must be considered during intervention development to design e-mental health interventions optimized for implementation into real-world practice.
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| 23. |
- Coumoundouros, Chelsea, et al.
(author)
-
"Systems seem to get in the way" : a qualitative study exploring experiences of accessing and receiving support among informal caregivers of people living with chronic kidney disease
- 2024
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In: BMC Nephrology. - : BioMed Central (BMC). - 1471-2369. ; 25:1
-
Journal article (peer-reviewed)abstract
- Background: The well-being of informal caregivers of people living with chronic kidney disease is influenced by their experiences with support, however, few studies have focused on exploring these experiences. This study aimed to explore informal caregivers' experiences accessing and receiving support while caring for someone living with chronic kidney disease.Methods: Informal caregivers of people living with chronic kidney disease (n = 13) in the United Kingdom were primarily recruited via community organisations and social media adverts to participate in semi-structured interviews. Interviews explored support needs, experiences of receiving support from different groups (e.g. healthcare professionals, family/friends), and barriers and facilitators to accessing support. Support was understood as including emotional, practical, and informational support. Data were analysed using reflexive thematic analysis.Results: Three themes were generated: (1) "Systems seem to get in the way" - challenges within support systems, illustrating the challenges informal caregivers encountered when navigating complex support systems; (2) Relying on yourself, describing how informal caregivers leveraged their existing skills and networks to access support independently, while recognising the limitations of having to rely on yourself to find support; and (3) Support systems can "take the pressure off", showing how support systems were able to help informal caregivers cope with the challenges they experienced if certain conditions were met.Conclusions: In response to the challenges informal caregivers experienced when seeking support, improvements are needed to better consider informal caregiver needs within healthcare systems, and to develop interventions tailored to informal caregiver needs and context. Within the healthcare system, informal caregivers may benefit from system navigation support and better integration within healthcare teams to ensure their informational support needs are met. New interventions developed to support informal caregivers should fit within their existing support systems and incorporate the qualities of support, such as empathy, that were valued. Additionally, use of an equity framework and user-centered design approaches during intervention development could help ensure interventions are accessible and acceptable.
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| 24. |
- Farrand, Paul, et al.
(author)
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Behavioural activation self-help to improve depression in people living with dementia: The PROMOTE treatment protocol.
- 2017
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In: New Zealand Journal of Psychology. ; 46:2, s. 51-62
-
Journal article (peer-reviewed)abstract
- There is an increasing number of people living with dementia and depression, with support for people to live well with dementia becoming a global healthcare priority and seminal to the New Zealand Framework for Dementia Care (Ministry of Health, 2013). This paper overviews the clinical protocol for the PROMOTE self-help programme to inform the delivery of a written low intensity intervention based on behavioural activation for the treatment of depression and low mood in people with dementia. The primary aim of the programme is to decrease symptoms of depression and improve quality of life in people living with dementia. Support to the person living with dementia in the use of the PROMOTE programme is provided by an informal caregiver, who themselves receive guidance over the telephone by an appropriately trained mental health professional. This model of support and guidance represents a novel feature of the intervention, and one that potentially helps to increase access within the community. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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| 25. |
- Farrand, Paul, et al.
(author)
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Behavioural activation written self-help to improve mood, wellbeing and quality of life in people with dementia supported by informal carers (PROMOTE) : a study protocol for a single-arm feasibility study.
- 2016
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In: Pilot and feasibility studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 2
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Increases in life expectancy have resulted in a global rise in dementia prevalence. Dementia is associated with poor wellbeing, low quality of life and increased incidence of mental health difficulties such as low mood or depression. However, currently, there is limited access to evidence-based psychological interventions for people with dementia experiencing low mood and poor wellbeing. Behavioural activation-based self-help, supported by informal carers and guided by mental health professionals, may represent an effective and acceptable solution.METHODS/DESIGN: The present study is a phase II (feasibility) single-arm trial informed by the Medical Research Council complex interventions research methods framework. Up to 50 dementia participant/informal carer dyads will be recruited from a variety of settings including primary care, dementia-specific health settings and community outreach. People living with dementia will receive behavioural activation-based self-help and be supported by their informal carer who has received training in the skills required to support the self-help approach. In turn, during the use of the intervention, the informal carer will be guided by mental health professionals to help them work through the materials and problem solve any difficulties. Consistent with the objectives of feasibility studies, outcomes relating to recruitment from different settings, employment of different recruitment methods, attrition, data collection procedures, clinical delivery and acceptability of the intervention will be examined. Clinical outcomes for people with dementia (symptoms of depression and quality of life) and informal carers (symptoms of depression and anxiety, carer burden and quality of life) will be measured pre-treatment and at 3 months post-treatment allocation.DISCUSSION: This study will examine the feasibility and acceptability of a novel behavioural activation-based self-help intervention designed to promote wellbeing and improve low mood in people living with dementia, alongside methodological and procedural uncertainties associated with research-related procedures. As determined by pre-specified progression criteria, if research procedures and the new intervention demonstrate feasibility and acceptability, results will then be used to inform the design of a pilot randomised controlled trial (RCT) to specifically examine remaining methodological uncertainties associated with recruitment into a randomised controlled design.TRIAL REGISTRATION: Current Controlled Trials ISRCTN42017211.
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| 26. |
- Farrand, Paul, et al.
(author)
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Effectiveness of Cognitive Behavioural Self-Help for the Treatment of Depression and Anxiety in People with Long-Term Physical Health Conditions : a Systematic Review and Meta-Analysis of Randomised Controlled Trials
- 2015
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In: Annals of Behavioral Medicine. - : Oxford University Press. - 0883-6612 .- 1532-4796. ; 49:4, s. 579-593
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Depression and anxiety are prevalent comorbidities in people with long-term physical health conditions; however, there is limited access to evidence-based treatments for comorbid mental health difficulties.PURPOSE: This study is a meta-analysis examining the effectiveness of cognitive behavioural self-help for physical symptoms, depression and anxiety in people with long-term conditions.METHODS: This study involves a systematic search of electronic databases supplemented by expert contact, reference and citation checking and grey literature.RESULTS: The meta-analysis yielded a small effect size for 11 studies reporting primary outcomes of depression (g = -0.20) and 8 studies anxiety (g = -0.21) with a large effect size (g = -1.14) for 1 study examining physical health symptoms. There were no significant moderators of the main effect.CONCLUSIONS: Limited evidence supports cognitive behavioural self-help for depression, anxiety and physical symptoms in people with long-term conditions. Small effect sizes for depression and anxiety may result from failure to recruit participants with clinical levels of these difficulties at baseline.
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| 27. |
- Farrand, Paul, et al.
(author)
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Impact of support on the effectiveness of written cognitive behavioural self-help : a systematic review and meta-analysis of randomised controlled trials
- 2013
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In: Clinical Psychology Review. - : Elsevier. - 0272-7358 .- 1873-7811. ; 33:1, s. 182-195
-
Journal article (peer-reviewed)abstract
- Cognitive behavioural therapy self-help is an effective intervention for a range of common mental health difficulties. However the extent to which effectiveness may vary by type of support--guided, minimal contact, self-administered--has not been extensively considered. This review identifies the impact of support on the effectiveness of written cognitive behavioural self-help and further explores the extent to which effectiveness varies across mental health condition by type of support provided. Randomised controlled trials were identified by searching relevant bibliographic databases, clinical trials registers, conference proceedings and expert contact. 38 studies were included in the meta-analysis yielding a statistically significant overall mean effect size (Hedges' g=-0.49). Overall effect size did not significantly differ by type of support (Q=0.85, df=2, p=0.65) (guided: Hedges' g=-0.53; minimal contact: Hedges' g=-0.55; self-administered: Hedges' g=-0.42). For guided and self-administered types of support, planned comparisons revealed a trend for effect size to vary by mental health condition and for guided CBT self-help the modality of support was significant (Q=6.32, df=2, p=0.04), with the largest effect size associated with telephone delivery (Hedges' g=-0.91). Additional moderator analysis was undertaken for depression given the number of available studies. Regardless of higher baseline levels of severity the effect size for minimal contact was greater than for guided support. Greater consideration should be given to the potential that type of support may be related to the effectiveness of written cognitive behavioural self-help and that this may vary across mental health condition. Findings from this systematic review make several recommendations to inform future research.
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| 28. |
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| 29. |
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| 30. |
- Farrand, Paul, et al.
(author)
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Measurement of individualised quality of life amongst young people with indicated personality disorder during emerging adulthood using the SEIQoL-DW
- 2012
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In: Quality of Life Research. - : Springer Science and Business Media LLC. - 0962-9343 .- 1573-2649. ; 22:4, s. 829-838
-
Journal article (peer-reviewed)abstract
- Purpose: To examine both the feasibility of applying the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting procedure (SEIQoL-DW) as a routine outcome measure within an early intervention service for young people with indicated personality disorder and the overall quality of life (QoL) in this population.Methods: SEIQoL-DW was administered alongside the Standardised Assessment of Personality-Abbreviated Scale-Self-Report (SAPAS-SR), Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Scale (GAD-7) and the Post-Traumatic Stress Disorder-Primary Care (PTSD-PC) as part of routine service evaluation over a 16-month period. Descriptive statistics were calculated for data reflecting use of the SEIQoL-DW alongside demographic and outcome variables.Results: The SEIQoL-DW was administered to 52 young adults with indicated personality disorder, with 47 completing the measure, taking an average time of 27 min. Individual QoL was poor with a mean global index score of 55.07 (SD = 22.34). Individual QoL areas formed five main domains-'Aspects of Daily Living', 'Relationships', 'Social Life and Leisure', 'Family' and 'Emotional and Physical Wellbeing'.Conclusion: This study further extends the application of the SEIQoL-DW for use as a routine outcome measure within a busy service setting, although ways to accommodate administration time need to be considered. Poor QoL highlights the need for continued development of services to meet the needs of young adults with indicated personality disorder.
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| 31. |
- Farrand, Paul, et al.
(author)
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Psychological interventions to improve psychological well-being in people with dementia or mild cognitive impairment : systematic review and meta-analysis protocol
- 2016
-
In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 6:1
-
Journal article (peer-reviewed)abstract
- Introduction: Dementia and mild cognitive impairment are associated with an increased risk of depression, anxiety, psychological distress and poor mental health-related quality of life. However, there is a lack of research examining the evidence base for psychological interventions targeting general psychological well-being within this population. Furthermore, there is little research relating to the design of randomised controlled trials examining psychological interventions for dementia and mild cognitive impairment, such as effective recruitment techniques, trial eligibility and appropriate comparators.Methods and analysis: Systematic review of electronic databases (CINAHL; EMBASE; PsychInfo; MEDLINE; ASSIA and CENTRAL), supplemented by expert contact, reference and citation checking, and grey literature searches. Published and unpublished studies will be eligible for inclusion with no limitations placed on year of publication. Primary outcomes of interest will be standardised measurements of depression, anxiety, psychological distress or mental health-related quality of life. Eligibility and randomisation proportions will be calculated as secondary outcomes. If data permits, meta-analytical techniques will examine: (1) overall effectiveness of psychological interventions for people with dementia or mild cognitive impairment in relation to outcomes of depression, anxiety, psychological distress or mental health-related quality of life; (2) clinical and methodological moderators associated with effectiveness; (3) proportions eligible, recruited and randomised.Ethics and dissemination: Ethical approval is not required for the present systematic review. Results will inform the design of a feasibility study examining a new psychological intervention for people with dementia and depression, with dissemination through publication in peer-reviewed journals and presentations at relevant conferences.
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| 32. |
- Farrand, Paul, et al.
(author)
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Supported cognitive-behavioural therapy self-help versus treatment-as-usual for depressed informal caregivers of stroke survivors (CEDArS) : feasibility randomised controlled trial
- 2020
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In: The Cognitive Behaviour Therapist. - 1754-470X. ; 13
-
Journal article (peer-reviewed)abstract
- Demands placed on informal caregivers can result in an increased likelihood of experiencing common mental health difficulties that may affect their ability to undertake the caring role. Currently, however, few evidence-based interventions have been specifically developed for informal caregivers and available interventions are difficult to access. The Improving Access to Psychological Therapies (IAPT) programme aims to improve access to evidence-based psychological therapies for all groups and may therefore present an opportunity to meet informal caregiver needs. Located within the MRC Complex Intervention Framework, a Phase II feasibility randomised controlled trial (RCT) examines key methodological, procedural and clinical uncertainties associated with running a definitive Phase III RCT of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors. Recruitment was low despite different recruitment strategies being adopted, highlighting significant challenges moving towards a Phase III RCT until resolved. Difficulties with study recruitment may reflect wider challenges engaging informal caregivers in psychological interventions and may have implications for IAPT services seeking to improve access for this group. Further attempts to develop a successful recruitment protocol to progress to a Phase III RCT examining effectiveness of the adapted CBT self-help intervention should be encouraged.
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| 33. |
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| 34. |
- Ferraris, Giulia, et al.
(author)
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Dyadic Interdependence in Non-spousal Caregiving Dyads’ Wellbeing : A Systematic Review
- 2022
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In: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 13
-
Research review (peer-reviewed)abstract
- Caregiving dyads (i.e., an informal caregiver and a care recipient) work as an interdependent emotional system, whereby it is assumed that what happens to one member of the dyad essentially happens to the other. For example, both members of the dyad are involved in care giving and care receiving experiences and therefore major life events, such as a serious illness affect the dyad and not only the individual. Consequently, informal caregiving may be considered an example of dyadic interdependence, which is “the process by which interacting people influence one another’s experience.” This systematic review aimed to synthesize studies of dyadic interdependence, specifically in non-spousal caregiving dyads (e.g., adult children—parents, siblings, other relatives, or friends). Electronic databases (PsycINFO, Pubmed, and CINAHL) were systematically searched for dyadic studies reporting on interdependence in the emotional and relational wellbeing of non-spousal caregiving dyads. A total of 239 full-text studies were reviewed, of which 14 quantitative and qualitative studies met the inclusion criteria with a majority of dyads consisting of adult daughters caring for their older mothers. A narrative synthesis suggested mutual influences between non-spousal caregiving dyad members based on: (1) associations between intrapersonal (e.g., psychological functioning) and interpersonal (e.g., relationship processes) variables and emotional and relational wellbeing of the dyad; (2) associations between care context variables (e.g., socio-demographics and care tasks) and emotional and relational wellbeing of the dyad; and (3) patterns of covariation between caregivers’ and care recipients’ wellbeing. Evidence supporting dyadic interdependence among non-spousal caregiving dyads shed light on the ways dyad members influence each other’s wellbeing while providing and receiving care (e.g., via the exchange of support). Future studies investigating mutual influences in dyads, should differentiate subsamples of caregivers based on relationship type, and adopt dyadic and longitudinal designs.
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| 35. |
- Ferraris, Giulia, et al.
(author)
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The interpersonal process model of intimacy, burden and communal motivation to care in a multinational group of informal caregivers
- 2023
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In: Journal of Social and Personal Relationships. - : Sage Publications. - 0265-4075 .- 1460-3608.
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Journal article (peer-reviewed)abstract
- The interpersonal process model of intimacy suggests that intimacy within dyads develops when open communication from one dyad member is met with validating, understanding and caring responses from the other dyad member. Little is known about interpersonal processes between informal caregivers and care recipients in different illness contexts (i.e., coping with neurological, physical or other impairments/comorbidities) and relationship types (i.e., spouses, adult children and others), and how interpersonal processes are linked to the caregivers’ wellbeing. In this cross-sectional study, caregivers (N = 882) from nine countries reported on their open communication with care recipients, care recipients’ responsiveness, and caregivers’ wellbeing (i.e., intimacy, burden and communal motivation to care). Although caregivers of care recipients with neurological impairments and adult child caregivers reported lower mean levels of open communication and perceived responsiveness, similar mediating effects of perceived responsiveness between open communication and intimacy (effect = 0.05; CI95 = [0.04, 0.06]), burden (effect = −0.42; CI95 = [−0.49, −0.35]), and communal motivation to care (effect = 0.28; CI95 = [0.21, 0.36]) were reported across different illness contexts and relationship types. Only the negative relationship between perceived responsiveness and burden was stronger for spouses (b = −0.23, CI95 = [-0.26, −0.19]) than for adult children and others. Results suggest the interpersonal process model of intimacy may be used to identify caregivers at risk of poor wellbeing in different illness contexts and with different relationships with their care recipients. Lack of open communication and caregivers’ misperceptions of care recipients’ responsiveness may represent opportunities to intervene to enhance caregivers’ intimacy to the care recipients, communal motivation to care, and to decrease caregiver burden.
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| 36. |
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| 37. |
- Hagström, Josefin, et al.
(author)
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Heeding the psychological concerns of young cancer survivors : A single-arm feasibility trial of CBT and a cognitive behavioral conceptualization of distress
- 2020
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In: PeerJ. - : PeerJ. - 2167-8359. ; 8
-
Journal article (peer-reviewed)abstract
- BackgroundA subgroup of adolescent and young adult (AYA) survivors of cancer during adolescence report high levels of psychological distress. To date, evidence-based psychological interventions tailored to the cancer-related concerns experienced by this population are lacking. The present study aimed to (1) examine the feasibility and preliminary efficacy of an individualized cognitive behavioral therapy (CBT) intervention for AYA survivors of cancer during adolescence; and (2) identify and conceptualize cancer-related concerns as well as maintaining factors using cognitive-behavioral theory.MethodsA single-arm trial, whereby AYA survivors of cancer during adolescence (aged 17–25 years) were provided individualized face-to-face CBT at a maximum of 15 sessions. Clinical outcomes were assessed at baseline, post-intervention, and three-month follow-up. Intervention uptake, retention, intervention delivery, and reliable change index scores were examined. An embedded qualitative study consisted of two unstructured interviews with each participant pre-intervention. Along with individual behavioral case formulations developed to guide the intervention, interview data was analyzed to identify and conceptualize cancer-related concerns and potential maintaining factors.ResultsTen out of 213 potential participants invited into the study were included, resulting in an overall participation rate of 4.7%. Nine participants completed the intervention, with respectively seven and eight participants completing the post-intervention and three month follow-up assessment. The majority of reported cancer-related concerns and maintaining factors were conceptualized into four themes: social avoidance, fear of emotions and bodily symptoms, imbalance in activity, and worry and rumination.ConclusionsGiven significant recruitment difficulties, further research is required to examine barriers to help-seeking in the AYA cancer survivor population. However, the conceptualization of cancer-related concerns and maintaining factors experienced by the population may represent an important first step in the development of psychological support tailored toward AYA cancer survivors’ unique needs.
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| 38. |
- Hagström, Josefin, et al.
(author)
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Opt-out rates and reasons for non-participation in a single-arm feasibility trial (ENGAGE) of a guided internet-administered CBT-based intervention for parents of children treated for cancer : A nested cross-sectional survey
- 2022
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:4
-
Journal article (peer-reviewed)abstract
- Objectives Difficulties with recruitment into clinical trials are common. An opt-out recruitment strategy, whereby potential participants can decline further contact about a study (opt-out), and non-responders are contacted, may facilitate participation. Primary objectives examined opt-out and consent rates, mode and time point of opt-out, and sociodemographic characteristics of those who opted out versus those who chose to participate in a single-arm feasibility trial (ENGAGE) of a guided, internet-administered, cognitive–behavioural therapy-based intervention for parents of children treated for cancer. Secondary objectives examined reasons for non-participation.Design A cross-sectional survey nested within theENGAGE feasibility trial.Setting The intervention was delivered from Uppsala University, with parents located throughout Sweden.Participants Potential participants were recruited 3 months–5 years following their child ending treatment for cancer and were identified via their personal identification number (via the Swedish Childhood Cancer Registry and Swedish Tax Agency) and invited via postal invitation packs and could opt out via post, online, telephone or email. Those who did not opt out or consent, within 4 weeks, received up to five telephone calls and/or one postal reminder.Results Of 509 invited, 164 (32.2%) opted out, 78 (47.6%) via post, 53 (32.3%) via telephone, 24 (14.6%) online, and 6 (3.7%) via email, 88 (53.7%) opted out after at least one telephone call and/or postal reminder. There was a trend for parents with lower educational levels to opt out. No need of psychological support, lack of time, and no interest in internet-administered self-help were frequently reported reasons for non-participation.Conclusions Results emphasise the importance of using different opt-out modes and suggest future research should consider how to widen study participation for parents with lower education levels. Self-identifying a need for psychological support and the acceptability of internet-administered self-help are important factors for participation and should be considered in future research to increase recruitment.
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| 39. |
- Lundgren, Johan, 1977-, et al.
(author)
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Concerns experienced by parents of children treated for cancer : A qualitative study to inform adaptations to an internet-administered, low-intensity cognitive behavioral therapy intervention
- 2023
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In: Psycho-Oncology. - : John Wiley & Sons. - 1057-9249 .- 1099-1611. ; 32:2, s. 237-246
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Journal article (peer-reviewed)abstract
- Abstract Objective Childhood cancer treatment completion is associated with mental health difficulties and negative socioeconomic consequences for parents. However, psychological support needs are often unmet. We developed an internet-administered, guided, low-intensity cognitive behavioral therapy-based self-help intervention (EJDeR) and examined feasibility and acceptability with a single-arm feasibility trial (ENGAGE). Results suggest EJDeR is acceptable, however, adherence, especially for fathers, could be improved. Following the Medical Research Council complex interventions framework, this study explores concerns experienced by parents actively seeking support related to their child's cancer who were recruited into ENGAGE to inform further adaptation of EJDeR. Method Seventy-three semi-structured interviews (26 fathers, 47 mothers) were conducted, with data analyzed using manifest content analysis. Results Analysis resulted in seven categories: (1) Feeling lost and lonely in life; (2) Low mood; (3) Parenting difficulties; (4) Productivity difficulties; (5) Relationship challenges; (6) Stress reactions; and (7) Worry. With the exception of subcategories Afraid of not being a good parent, Cancer recurrence, and Child's development and future a somewhat higher percentage of mothers than fathers mentioned all identified concerns. Conclusion Parents described experiencing a range of concerns after their child had completed cancer treatment. EJDeR will be adapted to address these concerns and include indirect intervention modules targeting concerns such as stress. Information to support parenting, relationships, finance, and employment difficulties, alongside signposting to inform help-seeking, will be included. Findings also suggest a need to improve the gender-sensitivity of EJDeR.
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| 40. |
- Mårtensson, Erika, et al.
(author)
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Psychological interventions for depression among informal caregivers of older adult populations : protocol of a systematic review and meta-analysis of randomised controlled trials.
- 2020
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:9
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Research review (peer-reviewed)abstract
- Introduction: Increased life expectancy has led to an increased demand for family members to provide informal care for their older relatives in the home. Many studies suggest informal caregivers are at greater risk of experiencing symptoms of depression. However, there is a lack of research examining the effectiveness of psychological interventions targeting these symptoms alongside clinical and methodological moderators potentially associated with intervention effectiveness. This review aims to address this gap and will inform the development of a psychological intervention targeting depression among adult-child caregivers of older parents, given many studies show that among informal caregivers of older adults, adult children experience specific difficulties and needs for psychological support. Further, the lack of studies targeting adult children specifically necessitates conducting this review targeting caregivers of older adults in general.Methods and analysis: Randomised controlled trials of psychological interventions targeting symptoms of depression among informal caregivers will be identified via a systematic search of electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica DataBase, PsycINFO, Cochrane Library and Web of Science) and supplemented by handsearching of previous systematic reviews, reference and forward citation checking, and expert contact. If possible, a meta-analysis will be conducted to examine the: (1) effectiveness of psychological interventions for depression among informal caregivers of older adults, (2) effectiveness of psychological interventions for secondary outcomes such as anxiety, stress, caregiver burden, psychological distress, quality of life, well-being and self-efficacy and (3) moderating effects of clinical and methodological factors on effectiveness.Ethics and dissemination: Ethical approval will not be necessary for this study given primary data will not be collected. Results will inform the development of a psychological intervention for adult-child caregivers of older parents and will be disseminated through publication in peer-reviewed journals and conference presentations.PROSPERO registration number: CRD42020157763.
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| 41. |
- Mårtensson, Erika, et al.
(author)
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Psychological interventions for symptoms of depression among informal caregivers of older adult populations : A systematic review and meta-analysis of randomized controlled trials
- 2023
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In: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 320, s. 474-498
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Journal article (peer-reviewed)abstract
- Background: Symptoms of depression are commonly experienced by informal caregivers of older adults, howeverthere is uncertainty concerning effectiveness of psychological interventions targeting symptoms of depression inthis population. Further, there is uncertainty concerning important clinical moderators, including interventiontype and care recipient health condition. This review examined the effectiveness of psychological interventionstargeting symptoms of depression in informal caregivers of older adults.Methods: PubMed, CINAHL, Embase, PsycINFO, Cochrane Library and Web of Science were searched. Risk of biaswas assessed using the Cochrane Risk of Bias tool version 2.Results: Fifteen studies were identified and twelve (1270 participants) provided data for the meta-analysis. Interventionsincluded cognitive behavioral therapy (4 studies), problem-solving therapy (4 studies); non-directivesupportive therapy (4 studies) and behavioral activation (3 studies). A small effect size favouring the interventionwas found for symptoms of depression (g = - 0.49, CI = - 0.79, - 0.19, I2 = 83.42 %) and interventions wereeffective in reducing incidence of major depression (OR = 0.177, CI = 0.08, 0.38), caregiver burden (g = - 0.35,CI = - 0.55, - 0.15) and psychological distress (g = - 0.49, CI = - 0.70, - 0.28). Given high heterogeneity,findings should be interpreted with caution. Overall risk of bias was high.Limitations: Studies were limited to those in English or Swedish.Conclusion: Psychological interventions may be effective in reducing symptoms of depression among informalcaregivers of older adults. However, evidence is inconclusive due to heterogeneity, high risk of bias, and indirectnessof evidence.
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| 42. |
- Nordin-Remberger, Carita, et al.
(author)
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Preferences of support and barriers and facilitators to help-seeking in pregnant women with severe fear of childbirth in Sweden : a mixed-method study
- 2024
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In: BMC Pregnancy and Childbirth. - : BioMed Central (BMC). - 1471-2393. ; 24:1
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Journal article (peer-reviewed)abstract
- BackgroundThere are few support interventions for women with fear of childbirth tailored towards type of fears and parity. To inform the future development of an acceptable and relevant intervention for women with severe fear of childbirth, primary objectives were to examine: (1) pregnant women’s experiences of and preferences for support and (2) barriers and facilitators to help-seeking. Secondary objectives were to examine if there are any differences based on pregnant women’s parity.MethodsPregnant women with a severe fear of childbirth in Sweden completed an online cross-sectional survey between February and September 2022. Severe fear of childbirth was measured using the fear of childbirth scale. Quantitative data were analysed using descriptive and inferential statistics and free answers were analysed using manifest content analysis. A contiguous approach to integration was adopted with qualitative and quantitative findings reported separately.ResultsIn total, 609 participants, 364 nulliparous and 245 parous women, had severe fear of childbirth. The main category “A twisting road to walk towards receiving support for fear of childbirth” was explored and described by the generic categories: Longing for support, Struggling to ask for support, and Facilitating aspects of seeking support. Over half (63.5%), of pregnant women without planned or ongoing treatment, wanted support for fear of childbirth. Most (60.2%) pregnant women with ongoing or completed fear of childbirth treatment regarded the treatment as less helpful or not at all helpful. If fear of childbirth treatment was not planned, 35.8% of women would have liked to have received treatment. Barriers to help seeking included stigma surrounding fear of childbirth, previous negative experiences with healthcare contacts, fear of not being believed, fear of not being listened to, and discomfort of having to face their fears. Facilitators to help seeking included receiving respectful professional support that was easily available, flexible, and close to home.ConclusionsMost pregnant women with severe fear of childbirth felt unsupported during pregnancy. Findings emphasise the need to develop individual and easily accessible psychological support for women with severe fear of childbirth, delivered by trained professionals with an empathetic and respectful attitude.
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| 43. |
- O'Mahen, Heather A., et al.
(author)
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Internet-based behavioral activation—Treatment for postnatal depression (Netmums): A randomized controlled trial
- 2013
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In: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 150:3, s. 814-822
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Journal article (peer-reviewed)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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| 44. |
- O'Mahen, H A, et al.
(author)
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Netmums : a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression.
- 2014
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In: Psychological Medicine. - 0033-2917 .- 1469-8978. ; 44:8, s. 1675-89
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Journal article (peer-reviewed)abstract
- BACKGROUND: Despite the high prevalence of postnatal depression (PND), few women seek help. Internet interventions may overcome many of the barriers to PND treatment use. We report a phase II evaluation of a 12-session, modular, guided Internet behavioural activation (BA) treatment modified to address postnatal-specific concerns [Netmums Helping With Depression (NetmumsHWD)].METHOD: To assess feasibility, we measured recruitment and attrition to the trial and examined telephone session support and treatment adherence. We investigated sociodemographic and psychological predictors of treatment adherence. Effectiveness outcomes were estimated with the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder-7, Work and Social Adjustment Scale, Postnatal Bonding Questionnaire, and Social Provisions Scale.RESULTS: A total of 249 women were recruited via a UK parenting site, Netmums.com. A total of 83 women meeting DSM-IV criteria for major depressive disorder were randomized to NetmumsHWD (n = 41) or treatment-as-usual (TAU; n = 42). Of the 83 women, 71 (86%) completed the EPDS at post-treatment, and 71% (59/83) at the 6-month follow-up. Women completed an average of eight out of 12 telephone support sessions and five out of 12 modules. Working women and those with less support completed fewer modules. There was a large effect size favouring women who received NetmumsHWD on depression, work and social impairment, and anxiety scores at post-treatment compared with women in the TAU group, and a large effect size on depression at 6 months post-treatment. There were small effect sizes for postnatal bonding and perceived social support.CONCLUSIONS: A supported, modular, Internet BA programme can be feasibly delivered to postpartum women, offering promise to improve depression, anxiety and functioning.
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| 45. |
- O'Mahen, Heather A., et al.
(author)
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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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In: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 2:1, s. 84-90
-
Journal article (peer-reviewed)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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| 46. |
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| 47. |
- Pettman, Danelle, et al.
(author)
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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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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:12
-
Journal article (peer-reviewed)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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| 48. |
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| 49. |
- Pettman, Danelle, et al.
(author)
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Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression : a systematic review and meta-analysis
- 2023
-
In: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 23:1
-
Journal article (peer-reviewed)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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| 50. |
- Pettman, Danelle, et al.
(author)
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Effectiveness of cognitive behavioural therapy-based interventions for maternal perinatal depression : A systematic review and meta-analysis
- 2022
-
In: BABCP 50th Annual Conference.
-
Conference paper (peer-reviewed)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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