Internet-Based,Culturally Sensitive,Problem-Solving Therapy for Turkish Migrants With Depression: Randomized Controlled Trial

Background

Turkish migrants living in the Netherlands have a high prevalence of depressive disorders, but experience considerable obstacles to accessing professional help. Providing easily accessible Internet treatments may help to overcome these barriers.

Objective

The aim of this study was to evaluate the effectiveness of a culturally sensitive, guided, self-help, problem-solving intervention through the Internet for reducing depressive symptoms in Turkish migrants.

Methods

A two-armed randomized controlled trial was conducted. The primary outcome measure was the severity of depressive symptoms; secondary outcome measures were somatic symptoms, anxiety, quality of life, and satisfaction with the treatment. Participants were assessed online at baseline, posttest (6 weeks after baseline), and 4 months after baseline. Posttest results were analyzed on the intention-to-treat sample. Missing values were estimated by means of multiple imputation. Differences in clinical outcome between groups were analyzed with a t test. Cohen’s d was used to determine the between-groups effect size at posttreatment and follow-up.

Results

Turkish adults (N=96) with depressive symptoms were randomized to the experimental group (n=49) or to a waitlist control group (n=47). High attrition rates were found among the 96 participants of which 42% (40/96) did not complete the posttest (6 weeks) and 62% (59/96) participants did not complete the follow-up assessment at 4 months. No significant difference between the experimental group and the control group was found for depression at posttest. Recovery occurred significantly more often in the experimental group (33%, 16/49) than in the control group (9%, 4/47) at posttest (P=.02). Because of the high attrition rate, a completers-only analysis was conducted at follow-up. The experimental group showed significant improvement in depression compared to the control group both at posttest (P=.01) and follow-up (P=.01).

Conclusions

The results of this study did not show a significant effect on the reduction of depressive symptoms. However, the effect size at posttest was high, which might be an indicator of the possible effectiveness of the intervention when assessed in a larger sample and robust trial. Future research should replicate our study with adequately powered samples.

Trial Registration

Dutch Trial Register: NTR2303. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2303 (Archived by WebCite at http://www.webcitation.org/6IOxNgoDu).     

Pet in the therapy room: An attachment perspective on Animal-Assisted Therapy

John Bowlby's (1973 Bowlby, J. 1973. Attachment and loss: Vol. 2. Separation: Anxiety and anger, New York, NY: Basic Books. [Crossref] , [Google Scholar], 1980 Bowlby, J. 1980. Attachment and loss: Vol. 3. Sadness and depression, New York, NY: Basic Books.  [Google Scholar], 1982 Bowlby, J. 1982. Attachment and loss: Vol. 1. Attachment, New York, NY: Basic Books. Original work published 1969 [Google Scholar]) attachment theory is one of the most influential theories in personality and developmental psychology and provides insights into adjustment and psychopathology across the lifespan. The theory is also helpful in defining the target of change in psychotherapy, understanding the processes by which change occurs, and conceptualizing cases and planning treatment (Daniel, 2006 Daniel, S. I.F. 2006. Adult attachment patterns and individual psychotherapy: A review. Clinical Psychology Review, 26: 968–984. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Obegi & Berant, 2008 Obegi, J. H. and Berant, E. 2008. Attachment theory and research in clinical work with adults, New York, NY: Guilford Press.  [Google Scholar]; Sable, 2004 Sable, P. 2004. Attachment, ethology, and adult psychotherapy. Attachment & Human Development, 6: 3–19. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]; Wallin, 2007 Wallin, D. J. 2007. Attachment in psychotherapy, New York, NY: Guilford Publications.  [Google Scholar]). Here, we propose a model of Animal-Assisted Therapy (AAT) based on attachment theory and on the unique characteristics of human–pet relationships. The model includes clients' unmet attachment needs, individual differences in attachment insecurity, coping, and responsiveness to therapy. It also suggests ways to foster the development of more adaptive patterns of attachment and healthier modes of relating to others.     

心理干预与艾司西酞普兰治疗轻中度抑郁发作对照研究

目的：探讨心理干预与艾司西酞普兰治疗轻中度抑郁发作的临床疗效。方法将120例轻中度抑郁发作患者随机分为两组,研究组（58例）予以心理干预,对照组（62例）口服艾司西酞普兰治疗,治疗过程中脱落病例进入脱落治疗组,予以心理干预联合艾司西酞普兰治疗,观察24周。于治疗前后采用汉密顿抑郁量表评定临床疗效。结果治疗初期研究组脱落率为36．2％,对照组为12．9％,研究组脱落率显著高于对照组（ P＜0．01）。治疗后研究组与对照组汉密顿抑郁量表评分均较治疗前显著下降（ P＜0．05或0．01）,对照组治疗2周、8周、12周末较研究组下降更显著（ P＜0．05或0．01）,治疗24周末研究组与对照组总有效率均显著高于脱落治疗组（P＜0．01）,研究组与对照组比较差异无显著性（P＞0．05）。结论心理干预治疗轻中度抑郁发作虽起效较缓慢,但远期治疗效果显著,与艾司西酞普兰疗效相当。     

躯体形式障碍的药物治疗现状

躯体形式障碍是精神科常见的一种神经症,该病具有较高的发病率和很强的专科特点。绝大多数患者到综合医院就诊,但临床识别率和有效治疗率很低,给患者造成极大的经济和心理负担。本文对不同药物治疗躯体形式障碍的疗效及常见不良反应进行了综述,旨在为临床用药提供依据。     

抑郁症的非药物治疗现状

抑郁症是一种发病率、复发率、致残率及致死率均较高的严重精神疾患。药物治疗抑郁症可以有效改善患者的临床症状,但起效滞后,且存在不良反应,从而影响了患者的治疗依从性。非药物治疗研究的不断发展为抑郁症的治疗开辟了新的有效途径。本文对抑郁症非药物治疗的研究现状进行了回顾与总结,了解非药物治疗的方法及优势,便于临床工作中尽快给予全面抗抑郁治疗,以提高临床缓解率。     

Managing Anxiety and Depression During Treatment

Here, we review the prevalence and treatment of anxiety and depression among patients with breast cancer. Cancer‐related symptoms include similarities to responses to traumatic stress. Well‐developed screening devices for identifying and tracking psychiatric comorbidity are discussed. Basic principles of psychopharmacology, and individual and group psychotherapy are presented. Finally, effects of effective treatment of anxiety and depression on quality of life and overall survival are reviewed.     

药物结合心理干预对高血压患者血压、抑郁情绪和生活满意度的影响

目的：探讨心理干预对高血压患者治疗效果的影响。方法：将不同程度抑郁状态的70例高血压患者随机分为对照组和干预组,两组均接受常规药物治疗,干预组在药物治疗的基础上进行5周综合心理干预;比较两组患者汉密尔顿抑郁量表（ HAmD ）评分和生活满意度量表（ SWLS）评分,并测定治疗前后的血压,分析心理干预对高血压患者抑郁情绪、生活满意度以及血压的影响。结果：治疗5周后,干预组HAmD评分由（24.14±8.08）分下降至（12.91±4.27）分,与对照组比较,差异有统计学意义（P<0.01）;干预组SWLS评分由（15.88±4.27）分提高到（26.15±2.95）分,与对照组比较,差异有统计学意义（ P<0.01）;治疗后干预组平均收缩压及舒张压分别下降（21.08±14.38）mmHg和（12.88±8.77）mmHg,对照组平均收缩压及舒张压分别下降（2.42±8.92）mmHg和（2.31± 8.17）mmHg,干预组下降幅度明显大于对照组（ P<0.01）。结论：药物结合心理干预治疗能有效缓解高血压患者的抑郁情绪,可有效控制血压,提高患者生活满意度。