PUBLICATIONS - �ǿ��

Depression

2021-12-07T17:22:19-05:00

A leading cause of disability worldwide, depression is a common mental health disorder that affects over 300 million people globally. Depression is characterized by sadness or irritability, lack of interest, and a variety of somatic and vegetative symptoms. It alters people’s moods, thoughts, and behaviors, resulting in impairment in daily functioning. Depression often co-occurs alongside other physical and mental health concerns, and depression increases the risk of several chronic and acute physical health conditions.

Evidence suggests that depression can be prevented but that most people with symptoms of depression do not receive intervention. Integrated care within primary care settings provides opportunities to identify individuals who are at risk for developing depression through screening and to increase access to appropriate evidence-based interventions.

This book chapter presents important background information on depression and reviews associated risk factors, such as parental depression, cognitive factors, gender, and sociodemographic and environmental factors. The authors discuss effective depression screening to identify those at risk, evidence to support preventive interventions, and stepped care interventions that may be used in primary care settings. Finally, they end the chapter with five specific recommendations to assist with the management of depression within primary care.

Adaptation of an Evidence-Based Online Depression Prevention Intervention for College Students: Intervention Development and Pilot Study

2021-10-01T12:08:35-04:00

College and university students across the United States are experiencing increases in depressive symptoms and risk for clinical depression. As college counseling centers strive to address the problem through wellness outreach and education, limited resources make it difficult to reach students who would most benefit. Technology-based prevention programs have the potential to increase reach and address barriers to access encountered by students in need of mental health support.

This article describes the development of the Willow intervention, an adaptation of the researchers’ technology-based CATCH-IT depression prevention intervention for use by students at a women’s liberal arts college. The article then presents data from a pilot study of Willow with 34 students. Twenty-nine participants (85%) logged onto Willow at least once, and eight (24%) completed the full intervention.

Participants positively rated the acceptability, appropriateness, and feasibility of Willow. After eight weeks of use, results suggested decreases in depressive symptoms, anxiety symptoms, and rumination. This internet-based prevention intervention was found to be acceptable, feasible to implement, and may be associated with decreased symptoms.

Depressive Symptoms Among Adolescents: Testing Vulnerability-Stress and Protective Models in the Context of COVID-19

2021-07-15T10:51:43-04:00

The main objective of this study was to investigate the impact of the COVID-19 pandemic on depressive symptoms among adolescents, and to examine the relationship between COVID-19-related distress and vulnerability/protective factors in accounting for change in depressive symptoms over time.

The COVID-19 pandemic is a significant stressor for many adolescents, yet to date, there has been limited longitudinal research examining the effect of the pandemic on depressive symptoms in adolescents. And there has been no research examining the possible moderating effects of vulnerability factors (i.e., dysfunctional attitudes, negative cognitive style) and protective factors (i.e., resilience, strong parent/child relationship) on depressive symptoms among adolescents with varying degrees of distress related to the COVID-19 pandemic.

In this study, the researchers found that adolescents—particularly females—reported an increase in symptoms of depression during the pandemic. Moreover, as predicted, in the face of high COVID-19-related distress, low resilience and negative cognitive styles were associated with higher depression scores.

These results suggest that mental health professionals and school personnel should be aware of potential increases in depression among teenagers during the pandemic. In addition, these findings suggest the importance of exploring ways to decrease vulnerability factors while strengthening protective factors in order to support adolescents who may be experiencing distress related to the pandemic and other significant negative life events.

Society of Behavioral Medicine (SBM) Position Statement: Increase Access to Mental Health Services Due to COVID-19-Related Parent and Family Stress

2021-06-14T19:44:05-04:00

In this position statement from the Society of Behavioral Medicine, the authors state that COVID-19 has caused drastic increases in family stress, contributing to harmful social and emotional ramifications. Before COVID-19, millions of Americans lacked access to mental health resources, and now in the midst of a global pandemic, resources are more limited in times of greater need.

In March 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act provided funding for mental health reforms, yet many barriers remained to receiving sufficient care.

In February 2021, the Society of Behavioral Medicine recommended federal legislators expand Community Behavioral Healthcare Centers, increase funding for Federally Qualified Healthcare Centers and School-Based Health Centers, incentivize providers to accept Medicaid, and institute more statewide licensing flexibilities to expand the reach of mental health care.

In March 2021, the American Rescue Plan was signed into law and provided an additional $4 billion in funding for community mental health services, implementing substance abuse prevention and treatment programs, increasing the behavioral health workforce, promoting behavioral telehealth within primary care, increasing school-based mental health services, implementing suicide prevention programs, and improving services for traumatized families. This significant investment in parents’ and children’s mental health is a tremendous step in the right direction and provides reassurance that relief is underway.

Ongoing surveillance of the outcomes of these new policy reforms will be important for identifying areas that may need continual support as our nation recovers from COVID-19.

Engaging stakeholders for change: A learning community methodology for implementing evidence-based, trauma-focused care on college campuses

2022-01-19T17:20:09-05:00

Implementing evidence-based treatments into practice settings requires novel and collaborative methods of adapting treatments to be responsive to the specific contextual and cultural features of various practice settings. This article describes the use of a learning community method of implementation, which brought together campus and researcher stakeholders to adapt a trauma-focused treatment to be offered in university counseling centers. This paper highlights the unique strengths and challenges of serving trauma-exposed students in university counseling centers and can be used to inform implementation in other types of settings as well.

The leaders of this project convened campus and community stakeholders, including counseling center clinicians, administrators, student life professionals, and students, to collaborate with researchers to work toward dissemination and implementation. These stakeholders participated in a learning community that reviewed, selected, and adapted a trauma-focused, evidence-based treatment and other tools for dissemination and implementation in university counseling centers and by other campus professionals.

There were a number of benefits and challenges of using the learning community as a method of dissemination and implementation. Benefits included context-specific knowledge sharing, clarification of the scope of trauma among college students, creation of helpful tools, emphasis on cultural competence, and facilitating connections between professionals. Challenges included balancing flexibility with progress toward project goals and recruitment and retention of stakeholders.

Stakeholder engagement is an integral component of dissemination and implementation efforts. The learning community method allowed for stakeholders to take an active part in adapting a trauma-focused, evidence-based treatment for university counseling centers and can be utilized in other settings to aid in adoption and utilization of evidence-based treatments.

Working with Parents with Depression in Family Intervention

2022-01-19T16:23:46-05:00

Parental depression is associated with maladaptive cognitive, academic, socio-emotional and psychological outcomes in their children. Children with a depressed parent are three to four times more likely to be diagnosed with depression than children with non-depressed parents, making parental depression a significant risk factor in the onset of childhood depression.

Preventive interventions aim to reduce the likelihood that depressive symptoms will onset by decreasing risk factors and increasing protective factors. In family-based preventive interventions for children who are at risk for depression due to parental depressive symptoms, clinicians aim to build resilience in children by addressing risk and protective factors. Such intervention programs have been shown to effectively reduce depressive symptoms in children.

This book chapter summarizes the effects of parental depression on children, risk and protective factors associated with resilience, and the family-based preventive interventions used to mitigate the effects of parental depression on children, and presents an example case study highlighting one of these preventive interventions. Finally, the chapter reviews essential clinical competencies for productive work in family-based depression preventive interventions.

The Insula in Women with Posttraumatic Stress Disorder

2022-01-19T17:11:54-05:00

The past decade has seen a significant increase in our understanding of the neurobiological mechanisms of posttraumatic stress disorder (PTSD). This chapter in The Wiley Encyclopedia of Health Psychology examines the possible role the insula—a small region of the cerebral cortex—plays in the etiology and maintenance of PTSD symptoms, particularly in women with PTSD.

Within the context of the neurocircuitry of PTSD, disruption of insula activity is thought to be associated with numerous PTSD symptoms, including deficits in autobiographical memories and interoceptive cues. Moreover, recent findings of altered functional connectivity of insular subregions in women with PTSD point to important neural pathways underlying fear extinction of traumatic memories.

These results may assist in advancing our understanding of current treatment approaches for PTSD as well as aid in the development of new targeted psychological or psychiatric interventions.

Randomized Clinical Trial of an Internet-Based Adolescent Depression Prevention Intervention in Primary Care: Internalizing Symptom Outcomes

2022-01-19T16:55:26-05:00

Approximately 20% of people will experience a depressive episode by adulthood, making adolescence an important developmental target for prevention.

CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic, and Interpersonal Training), an online depression prevention intervention, has demonstrated efficacy in preventing depressive episodes among adolescents reporting elevated symptoms. This study examines the effects of CATCH-IT compared to online health education (HE) on internalizing symptoms in adolescents at risk for depression.

Participants ages 13–18 were recruited across eight U.S. health systems and were randomly assigned to CATCH-IT or HE. Assessments were completed at baseline and after two, six, 12, 18, and 24 months. There were no significant differences between groups in change in depressive symptoms or anxiety. Improvement in depressive symptoms was statistically significant for both groups; improvement in anxiety was significant for CATCH-IT but not HE. Parental depression and positive relationships with primary care physicians moderated the anxiety findings, and adolescents’ externalizing symptoms and positive relationships with primary care physicians moderated the depression findings.

This study demonstrates the long-term positive effects of both online programs on depressive symptoms and suggests that CATCH-IT demonstrates cross-over effects for anxiety as well.

This research was funded by The National Institute of Mental Health of the National Institutes of Health, grant number R01MH090035.

Effects of an adolescent depression prevention program on maternal criticisms and positive remarks

2022-01-19T16:42:46-05:00

This study examined effects of an adolescent depression prevention program on maternal criticisms and positive remarks, whether the extent of adolescents’ depression accounted for effects, and whether effects of the program on maternal criticisms and positive remarks differed by adolescents’ gender.

The participants in the study were 298 adolescents whose mothers had histories of depression; youth were randomized to either a cognitive-behavioral prevention (CBP) program or usual care (UC). At baseline and 9-month post-intervention evaluations, the researchers measured the number of criticisms and positive remarks mothers made during an open-ended description of their child and their relationship. Adolescents’ depression from pre- through post-intervention was assessed with interviews.

Controlling for baseline criticism, at post-intervention, mothers of girls in CBP made significantly more criticisms than did mothers of girls in UC, whereas mothers of boys in CBP made fewer criticisms than did mothers of boys in UC. The extent of adolescents’ depression from pre- through post-intervention partially mediated the relation between intervention condition and mothers’ criticisms, for boys but not for girls. Second, controlling for pre-intervention positive remarks, at post-intervention, mothers of youth in CBP made significantly more positive remarks about their child than did mothers of youth in UC, regardless of gender; this relation was not mediated by adolescent depression from pre- through post-intervention. The researchers suggest possible explanations for the observed effects of CBP on mothers’ criticisms and positive remarks.

24-Month Outcomes of Primary Care Web-Based Depression Prevention Intervention in Adolescents: Randomized Clinical Trial

2022-01-19T14:11:41-05:00

Adolescent depression carries a high burden of disease worldwide, but access to care for this population is limited. Prevention is one solution to curtail the negative consequences of adolescent depression. Internet interventions to prevent adolescent depression can overcome barriers to access, but few studies examine long-term outcomes.

This study compares CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training), an internet-based intervention, to a general health education active control for depression onset at 12 and 24 months in adolescents presenting to primary care settings.

The researchers’ conclusion was that a technology-based intervention for adolescent depression prevention implemented in primary care did not have additional benefit at 12 or 24 months. Further research is necessary to determine whether internet interventions have long-term benefit.

Research reported in this article was supported by the National Institute of Mental Health of the National Institutes of Health under award number R01MH090035. The implementation process was developed with funding from the Robert Wood Johnson Foundation.

PUBLICATIONS - �ǿ�����