Emergency conflict-related psychosocial interventions in Sierra Leone and Uganda: lessons from Medecins Sans Frontieres

Médecins Sans Frontières has been involved in emergency mental health or psychosocial programmes since 1990. In this article the intervention model developed for emergency settings is shared. Psychosocial programmes distinguish two elements. The 'psycho'-component facilitates the reconnection of the affected individual to his environment. The 'socio'-element aims to create an environment that facilitates the individual to re-integrate. The nature of mental health and psychosocial programmes requires a multidisciplinary approach. Emotional support can also be provided by regular medical staff and does not always require a specialist. The years ahead of us are important for the development of psychosocial interventions. Fundamental issues such as programme evaluation need systematic research.     

Interventions for alcohol-related offending by women: a systematic review

Treatment programmes specifically for women offenders are under-developed. A systematic review of studies that could inform interventions for alcohol-related offending by women is reported. Three questions were addressed: 1) What is the most up to date knowledge of ‘what works’ with females who commit alcohol-related offences? 2) What are the identifiable risk-needs factors for non-alcohol dependent women who commit offences involving alcohol misuse? 3) Are there differences between male and female alcohol-related offending? Four studies addressed the effectiveness of psychosocial interventions; three addressed identifiable risk-needs; and 19 addressed differences between male and female offenders' alcohol-related offending. Heterogeneity of these studies precluded meta-analyses, and so a narrative synthesis method was used. There is insufficient evidence to answer the question of what treatment works with women who commit alcohol-related offences. Drunk-driving is most widely studied, and women offenders appear to have more psychosocial problems than men. Alcohol increases the likelihood of violence for both men and women, and, while the mechanisms whereby alcohol increases the likelihood of violence are likely the same in men and women, the effect may be moderated by gender-associated issues. Again, women offenders appear to have more psychosocial problems than men. Implications for developing interventions are discussed.     

Psychosocial and pharmacological interventions for depressed adults in primary care: a critical review

Primary care settings are the principal context for treating clinical depression, with researchers beginning to explore the efficacy of psychosocial and pharmacological treatments for depression within this infrastructure. Feasibility and process variables also are being assessed, including issues of cost-effectiveness, viability of collaborative care models, predictors of treatment outcome, and effectiveness of treatment providers without specialized mental health training. The Agency for Health Care Policy and Research and American Psychiatric Association initially released guidelines for the treatment of depression in primary care [American Psychiatric Association, 1993. Practice Guidelines for major depressive disorder in adults. American Journal of Psychiatry, 150, 1-26., American Psychiatric Association, 2000. Practice Guideline for the treatment of patients with major depressive disorder (revision). American Journal of Psychiatry, 157, 1-45], however, a vast literature has accumulated over the past several years, calling for a systematic re-evaluation of the status of depression treatment in primary care. The present study provides a contemporary review of outcome data for psychosocial and pharmacological interventions in primary care and extends beyond AHCPR guidelines insofar as focusing on feasibility and process variables, including the training and proficiency of primary care treatment providers, cost-effectiveness of primary care interventions, and predictors of treatment response and relapse. Based on current guidelines, problem-solving therapy (PST-PC), interpersonal psychotherapy, and pharmacotherapy would be considered efficacious interventions for major depression, with cognitive-behavioral and cognitive therapy considered possibly efficacious. Psychotherapy and pharmacotherapy generally are of comparable efficacy, and both modalities are superior to usual care in treating depression. Methodological limitations and directions for future research are discussed.     

Developing Psychosocial Interventions for Depression in Dementia: Beginnings and Future Directions

Teri, McKenzie, and LaFazia's (this issue) review of outcome studies suggests that a number of psychosocial interventions have shown positive benefits relative to depression in dementia. However, considerably more research will be required to marshal convincing and practice-relevant evidence for the efficacy of particular intervention techniques in producing clinically significant amelioration of depression in older adults with dementia. This commentary discusses risk-benefit considerations surrounding the use of interventions in vulnerable older adults, as well as suggesting issues to be addressed in intervention development studies on this class of interventions.     

Psychosocial interventions in perimenopausal and postmenopausal women: A systematic review of randomised and non-randomised trials and non-controlled studies

Women's care during perimenopause and postmenopause is taking new paths to help women cope with both somatic manifestations and changes related to psychological and social factors. An updated, systematic review was conducted on non-pharmacological psychosocial interventions with regard to peri- and postmenopause. Several databases complemented with reference lists and reviews were used to perform a literature search of any relevant article. Studies were selected if they included psychoeducational programmes, health education and promotion and cognitive-behavioural techniques applied to peri- or postmenopausal women, independently of study design, main outcomes and intervention comparators. A total of 33 reports and 3 relevant reviews published between 1987 and 2013 were included. Psychosocial options are promising intervention options for self-management and self-care, as they provide multiple benefits with no side effects. Moreover, these options are recommended for women in clinical, subclinical and asymptomatic groups, as they offer women the agency and skills necessary to manage and relieve menopausal symptoms, as well as provide information and alternatives to prevent menopausal symptoms and to have a more positive experience during these life stages. These options do more than reduce distress and complaints, as they allow women in any condition to enjoy enhanced health, well-being and quality of life. Moreover, these options are accompanied by important cost reductions in pharmaceutical investment and healthcare. Nevertheless, several issues remain controversial or have scarcely been investigated, and additional high-quality research should address these issues properly in the future. Despite these limitations and the weaknesses of the review, the findings of this review are interesting and positive. Thus, we encourage women-focused institutions and policies (e.g., healthcare centres, public organisations and women's associations) to offer psychosocial interventions to peri- and postmenopausal women within a comprehensive healthcare paradigm.     

Living with mesothelioma: A systematic review of patient and caregiver psychosocial support needs

ObjectivePractice guidelines emphasize the importance of investigating psychosocial distress in mesothelioma patients and family caregivers. We aimed to synthesize research on the psychosocial support needs of mesothelioma patients and their family caregivers.MethodsWe conducted a systematic review with a narrative synthesis and quality assessment. The review process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsMEDLINE, EMBASE, Scopus, PsychArticles, and PsycINFO were searched until December 2020 and 37 studies in English met inclusion criteria. Most (n = 24) included mesothelioma patients as a very small proportion of their cancer samples. A narrative synthesis was conducted on the 13 studies including only mesothelioma patients (n = 297) and/or caregivers (n = 82). Patients and caregivers want improvements in the diagnosis delivery and access to palliative care. Patients want emotional support, patient-centered treatment, improved information about illness progression and death, and to meet others with mesothelioma. Caregivers want one-on-one practical and emotional support. Study quality varied.ConclusionsFew studies focus on the psychosocial support needs relevant to mesothelioma. Mesothelioma patients and family caregivers highlight targeted psychosocial care as an unmet need.Practice ImplicationsEfforts are required to design and test psychosocial interventions for this vulnerable and overlooked group.Protocol RegistrationPROSPERO (registration number CRD42020167852).     

Psychosocial treatments for negative symptoms in schizophrenia: Current practices and future directions

Schizophrenia can be a chronic and debilitating psychiatric disorder. Though advancements have been made in the psychosocial treatment of some symptoms of schizophrenia, people with schizophrenia often continue to experience some level of symptoms, particularly negative symptoms, throughout their lives. Because negative symptoms are associated with poor functioning and quality of life, the treatment of negative symptoms is a high priority for intervention development. However, current psychosocial treatments primarily focus on the reduction of positive symptoms with comparatively few studies investigating the efficacy of psychosocial treatments for negative symptoms. In this article, we review and evaluate the existing literature on three categories of psychosocial treatments — cognitive behavioral therapy (CBT), social skills training (SST), and combined treatment interventions — and their impact on the negative symptoms of schizophrenia. Of the interventions reviewed, CBT and SST appear to have the most empirical support, with some evidence suggesting that CBT is associated with maintenance of negative symptom improvement beyond six months after treatment. It remains unclear if a combined treatment approach provides improvements above and beyond those associated with each individual treatment modality. Although psychosocial treatments show promise for the treatment of negative symptoms, there are many unanswered questions about how best to intervene. We conclude with a general discussion of these unanswered questions, future directions and methodological considerations, and suggestions for the further development of negative symptom interventions.     

The clinical and cost-effectiveness of self-help treatments for anxiety and depressive disorders in primary care: a systematic review.

Anxiety and depression are prevalent in primary care; however, current treatments differ in their availability, cost-effectiveness, and acceptability to patients. Self-help treatments (such as manual-based bibliotherapy) may be an appropriate intervention for some patients. The aim of this research was to determine the clinical and cost-effectiveness of self-help treatments for anxiety and depression in primary care by conducting a systematic review of randomised and non-randomised trials of self-help interventions for patients with anxiety and depression in primary care, from electronic database searches, correspondence with authors, and limited handsearching. Eight studies were identified, examining written interventions based mostly on behavioural principles. Although the majority of trials reported some significant advantages in outcome associated with self-help treatments, the number of included studies was limited and a number of methodological limitations were identified. There were no data concerning long-term clinical benefits or cost-effectiveness. In conclusion, self-help treatments may have the potential to improve the overall cost-effectiveness of mental health service provision. However, the available evidence is limited in quantity and quality and more rigorous trials are required to provide more reliable estimates of the clinical and cost-effectiveness of these treatments.     

Evidence of cost-effective treatments for depression: a systematic review

BACKGROUND: High levels of public spending, rising costs of treatments and scarcity of mental health resources have intensified the need for information on the cost-effectiveness of interventions for depression. There have been few reviews that consider the cost-effectiveness of all treatments for depression together. METHODS: Systematic review of published economic evaluations of interventions for depression to identify where evidence of cost-effectiveness exists and where ambiguity remains. RESULTS: Fifty-eight papers met the criteria and were included in the review. The quality of the evaluations varied greatly. Evidence establishing the cost-effectiveness of interventions for depression is accumulating; selective serotonin reuptake inhibitors (SSRI) and the newer antidepressants venlafaxine, mirtazepine and nefazodone appear cost-effective compared with older drugs. Despite the availability of high quality economic evaluations of psychological therapies compared to usual care, there is limited evidence of their cost-effectiveness particularly when compared directly to pharmacotherapies. Changes to health systems have been found to be cost-effective in some patient groups, but there is no evidence that screening in primary care populations is a cost-effective strategy. LIMITATIONS: Vastly different interventions, outcome measures and cost perspectives meant a meta-analysis of costs and effects was not considered possible. CONCLUSIONS: On the basis of available evidence, it is not possible to identify the most cost-effective strategy for alleviating the symptoms of depression, although the SSRIs and newer antidepressants consistently appear more cost-effective than tricyclic antidepressants in many patient groups. Better quality economic evidence is needed.     

Developing interventions for chronically ill patients: is coping a helpful concept?

In this review, the role of coping in the development of psychosocial interventions for chronically ill patients is discussed. After summarizing the theoretical issues involved in the translation of the coping concept into an intervention, a review is undertaken of 35 studies concerned with the impact of interventions aimed at improving coping on patients' quality of life. These studies concern seven different chronic disease types (AIDS, asthma, cancer, cardiovascular diseases, chronic pain, diabetes, and rheumatoid arthritis) and show explicit consideration of attempts to manage illness in terms of coping to be rare. Many studies nevertheless address the equivalent of coping, namely behaviors and/or cognitions intended to deal with an illness situation appraised as stressful. The results of these studies are encouraging, although largely limited to the improvement of one or two particular coping strategies and problem-focused strategies in particular. It is argued that in order to expand on these initially positive findings, greater and more explicit consideration should be given to the potential of the coping concept for intervention with the chronically ill. The appraisal of stressful situations, the use of coping resources, and the strategic application of particular coping strategies should, for example, be given more careful consideration.     

Who benefits from psychosocial interventions in oncology? A systematic review of psychological moderators of treatment outcome

Medical and demographic characteristics and psychological morbidity of individuals with cancer prior to a psychosocial intervention can influence the efficacy of interventions. However, little is known about the moderating role of patients’ psychosocial characteristics on intervention effects. This review sought to identify and synthesize the impacts of psychosocial moderators of the effect of psychosocial interventions on the psychological well-being of cancer patients. A systematic review of the published literature was conducted. Databases searched included PsycINFO, PubMed, MEDLINE, Scopus, CINAHL, Web of Science, and Psychology and Behavioural Sciences Collection. Randomized controlled studies examining a moderator effect of patients’ psychosocial characteristics other than baseline depression and anxiety levels were included. Of 199 potential papers, a total of 20 studies, involving 3,340 heterogeneous cancer patients are included. Of the 17 potential psychosocial moderators examined in this review, 14 significantly moderated the effects of interventions. Moderators were categorized into personality traits, mental and physical quality of life, social environment, and self-efficacy. Patients with poorer quality of life, interpersonal relationships and sense of control benefitted more from interventions than those who already had adequate resources. Patients with low levels of optimism and neuroticism, high levels of emotional expressiveness, interpersonal sensitivity, and dispositional hypnotizability also showed greater benefits from various interventions. This review adds to the growing literature aimed at personalizing psychosocial cancer treatment by identifying who benefits from which psychosocial interventions.     

The contribution of teleconsultation and videoconferencing to diabetes care: a systematic literature review

Background

A systematic literature review was carried out to study the benefits of teleconsultation and videoconferencing on the multifaceted process of diabetes care. Previous reviews focused primarily on usability of technology and considered mainly one-sided interventions.

Objective

The objective was to determine the benefits and deficiencies of teleconsultation and videoconferencing regarding clinical, behavioral, and care coordination outcomes of diabetes care.

Methods

Electronic databases (Medline, PiCarta, PsycINFO, ScienceDirect, Telemedicine Information Exchange, ISI Web of Science, Google Scholar) were searched for relevant publications. The contribution to diabetes care was examined for clinical outcomes (eg, HbA_1c, blood pressure, quality of life), behavioral outcomes (patient-caregiver interaction, self-care), and care coordination outcomes (usability of technology, cost-effectiveness, transparency of guidelines, equity of care access). Randomized controlled trials (RCTs) with HbA_1c as an outcome were pooled using standard meta-analytical methods.

Results

Of 852 publications identified, 39 met the inclusion criteria for electronic communication between (groups of) caregivers and patients with type 1, type 2, or gestational diabetes. Studies that evaluated teleconsultation or videoconferencing not particularly aimed at diabetes were excluded, as were those that described interventions aimed solely at clinical improvements (eg, HbA_1c). There were 22 interventions related to teleconsultation, 13 to videoconferencing, and 4 to combined teleconsultation and videoconferencing. The heterogeneous nature of the identified videoconferencing studies did not permit a formal meta-analysis. Pooled results from the six RCTs of the identified teleconsultation studies did not show a significant reduction in HbA_1c (0.03%, 95% CI = - 0.31% to 0.24%) compared to usual care. There was no significant statistical heterogeneity among the pooled RCTs (χ ² ₇= 7.99, P = .33). It can be concluded that in the period under review (1994-2006) 39 studies had a scope broader than clinical outcomes and involved interventions allowing patient-caregiver interaction. Most of the reported improvements concerned satisfaction with technology (26/39 studies), improved metabolic control (21/39), and cost reductions (16/39). Improvements in quality of life (6/39 studies), transparency (5/39), and better access to care (4/39) were hardly observed. Teleconsultation programs involving daily monitoring of clinical data, education, and personal feedback proved to be most successful in realizing behavioral change and reducing costs. The benefits of videoconferencing were mainly related to its effects on socioeconomic factors such as education and cost reduction, but also on monitoring disease. Additionally, videoconferencing seemed to maintain quality of care while producing cost savings.

Conclusions

The selected studies suggest that both teleconsultation and videoconferencing are practical, cost-effective, and reliable ways of delivering a worthwhile health care service to diabetics. However, the diversity in study design and reported findings makes a strong conclusion premature. To further the contribution of technology to diabetes care, interactive systems should be developed that integrate monitoring and personalized feedback functions.     

Interventional programmes to improve cognition during healthy and pathological ageing: Cortical modulations and evidence for brain plasticity

A growing body of evidence suggests that healthy elderly individuals and patients with Alzheimer’s disease retain an important potential for neuroplasticity. This review summarizes studies investigating the modulation of neural activity and structural brain integrity in response to interventions involving cognitive training, physical exercise and non-invasive brain stimulation in healthy elderly and cognitively impaired subjects (including patients with mild cognitive impairment (MCI) and Alzheimer’s disease). Moreover, given the clinical relevance of neuroplasticity, we discuss how evidence for neuroplasticity can be inferred from the functional and structural brain changes observed after implementing these interventions. We emphasize that multimodal programmes, which combine several types of interventions, improve cognitive function to a greater extent than programmes that use a single interventional approach. We suggest specific methods for weighting the relative importance of cognitive training, physical exercise and non-invasive brain stimulation according to the functional and structural state of the brain of the targeted subject to maximize the cognitive improvements induced by multimodal programmes.     

Psychosocial factors influencing the eating behaviours of older adults: A systematic review

Our understanding of how eating behaviours change in later life have been dominated by the studies of physiological and biological influences on malnutrition. Insights from these studies were consequently used to develop interventions, which are predominantly aimed at rectifying nutritional deficiencies, as opposed to interventions that may enable older adults to eat well and enjoy their food-related life well into older age. The objective of the present review is to summarise the existing knowledge base on psychosocial influences on eating behaviours in later life. Following comprehensive searches, review, and appraisal, 53 articles were included (22 qualitative and 31 quantitative) to provide a greater understanding of the mechanisms underpinning the psychosocial factors influencing eating behaviours. Our analysis identified eight underpinning psychosocial factors that influences eating behaviours in later life; (1) health awareness & attitudes, (2) food decision making, (3) perceived dietary control, (4) mental health & mood, (5) food emotions & enjoyment, (6) eating arrangements, (7) social facilitation, and (8) social support. The importance and lasting influence of early food experiences were also identified as contributing to eating behaviours in later life. The review concludes with the call for further investigation into specific psychosocial factors that influence eating behaviour, calls for improvements in methodologies, and a summary of psychosocial barriers and enablers to eating well in later life.     

A systematic scoping review of psychosocial and psychological factors associated with patient activation

ObjectivePatient activation has been identified as an important predictor of how patients manage their own health, but little is known about its determinants. In this scoping review, we aim to address this research gap by (1) identifying literature on psychosocial/psychological factors associated with patient activation, and (2) extracting and synthesizing major results reported on that relationship.MethodsUsing a systematic search of four electronic databases (Web of Science, PubMed, PsychInfo, CINAHL), our search algorithm combined related terms for “psychosocial factors” or “psychological factors” and “patient activation”.ResultsOf the 1128 records identified, we included 13 studies in this scoping review. In these, we identified 21 psychosocial/psychological factors that were significantly associated with patient activation. The four most frequently investigated factors were depression, self-efficacy, hope, and health status. Overall, the methodological quality of studies was low. The majority were cross sectional in design, and only one assessed causality.ConclusionsOur results suggest that psychosocial/psychological factors explain variations in patient activation. However, further research is needed to identify causal relationships between psychosocial/psychological factors and patient activation.Practice ImplicationsThe insights from our review could be used for designing and evaluating interventions to improve patient activation.     

Triple diagnosis: dual diagnosis and HIV disease, part 2

This review highlights the psychiatric, psychosocial, and substance use treatment issues relevant to the care of patients with triple diagnosis. A discussion of the various psychosocial and psychopharmacologic strategies stresses the importance of integrating medical, psychiatric, and substance use interventions. Components of integrated treatment include a collaborative relationship with various medical services involved in the patient's care, psychotherapeutic interventions tailored to the patient's readiness for change and incorporating motivational strategies, special attention to psychosocial needs, strong emphasis on psychoeducation, and psychopharmacologic management. More research is warranted to evaluate the safety and efficacy of psychopharmacologic and psychotherapeutic modalities in patients with triple diagnosis.     

Intervention costs and cost-effectiveness for a multiple-risk-factor diabetes self-management trial for Latinas: economic analysis of ¡Viva Bien!

Information on cost-effectiveness of multiple-risk-factor lifestyle interventions for Latinas with diabetes is lacking. The aim of this paper is to evaluate costs and cost-effectiveness for ?Viva Bien!, a randomized trial targeting Latinas with type 2 diabetes. We estimated 6-month costs; calculated incremental costs per behavioral, biologic, and quality-of-life change; and performed sensitivity analyses from health plan and participant perspectives. Recruitment, intervention, and participant costs were estimated at $45,896, $432,433, and $179,697, respectively. This translates to $4,634 in intervention costs per ?Viva Bien! participant; $7,723 in both per unit reduction in hemoglobin A1c and per unit reduction in body mass index. Although costs may be higher than interventions that address one risk factor, potential risks for longer-term health-care costs are high for this at-risk group. Given the benefits of ?Viva Bien!, cost reductions are recommended to enhance its efficiency, adoption, and long-term maintenance without diluting its effectiveness.