J. Firth, S. Teasdale, K. Allott, D. Siskind, W. Marx, J. Cotter, N. Veronese, F. Schuch, Lee Smith, M. Solmi, A. Carvalho, D. Vancampfort, M. Berk, B. Stubbs, J. Sarris
The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from “nutrient supplements”, such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements. Recently, a large number of meta‐analyses have emerged examining nutrient supplements in the treatment of mental disorders. To produce a meta‐review of this top‐tier evidence, we identified, synthesized and appraised all meta‐analyses of randomized controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders. Our systematic search identified 33 meta‐analyses of placebo‐controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention‐deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia. Folate‐based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high‐dose methylfolate in major depressive disorder. There was emergent evidence for N‐acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications. In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support. Future research should aim to determine which individuals may benefit most from evidence‐based supplements, to further elucidate the underlying mechanisms.
{"title":"The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials","authors":"J. Firth, S. Teasdale, K. Allott, D. Siskind, W. Marx, J. Cotter, N. Veronese, F. Schuch, Lee Smith, M. Solmi, A. Carvalho, D. Vancampfort, M. Berk, B. Stubbs, J. Sarris","doi":"10.1002/wps.20672","DOIUrl":"https://doi.org/10.1002/wps.20672","url":null,"abstract":"The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from “nutrient supplements”, such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements. Recently, a large number of meta‐analyses have emerged examining nutrient supplements in the treatment of mental disorders. To produce a meta‐review of this top‐tier evidence, we identified, synthesized and appraised all meta‐analyses of randomized controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders. Our systematic search identified 33 meta‐analyses of placebo‐controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention‐deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia. Folate‐based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high‐dose methylfolate in major depressive disorder. There was emergent evidence for N‐acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications. In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support. Future research should aim to determine which individuals may benefit most from evidence‐based supplements, to further elucidate the underlying mechanisms.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20672","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44113255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Forbes, Aidan G.C. Wright, K. Markon, R. Krueger
World Psychiatry 18:3 October 2019 pathic personality disorders, respectively. The obsessive-compulsive personality disorder is defined largely by maladaptive conscientiousness (e.g., perfectionism, compulsivity, workaholism, and ruminative deliberation), but most measures of FFM conscientiousness do not assess for these maladaptive variants. Measures to assess maladaptive FFM traits, though, have been developed, including the Five Factor Model Personality Disorder scales, the Personality Inventory for DSM-5, and the Personality Inventory for ICD-11. There are a number of advantages in conceptualizing the ICD and DSM personality disorders from the perspective of the FFM. Many of the ICD and DSM personality disorder syndromes have limited research interest and inadequate empirical support. The FFM brings to the personality disorders a substantial body of construct validation, including a resolution of such notable controversies as gender bias, excessive diagnostic overlap, and temporal instability. An understanding of the etiology, pathology and treatment of the personality disorders has been hindered substantially by the heterogeneity within and the overlap across the diagnostic categories. The American Psychiatric Association has been publishing treatment guidelines for every disorder within the DSM, but guidelines have been provided for only one of the ten personality disorders (i.e., borderline). The complex heterogeneity of the categorical syndromes complicates considerably the ability to develop an explicit, uniform treatment protocol. The domains of the FFM are considerably more homogeneous and distinct, lending themselves well for more distinct models of etiology, pathology and treatment. Empirically validated treatment protocols have already been developed for FFM neuroticism. A common concern regarding the FFM and any other dimensional trait model is that clinicians will be unfamiliar with this approach and will find it difficult to apply. However, the FFM organization is consistent with the manner in which persons naturally think of personality trait description. Persons who apply the FFM typically find it quite easy to use. There have in fact been a number of studies concerning the clinical utility of the FFM in comparison to the DSM syndromes. A few of these studies have favored the DSM syndromes but, when the methodological limitations of these particular studies were addressed in subsequent studies, the results consistently favored the FFM. Experienced clinicians prefer the FFM and dimensional trait models for the conceptualization of personality disorders. In sum, the FFM is the predominant model of general personality structure and offers the opportunity for a truly integrative understanding of personality structure across the fields of clinical psychiatry and basic personality science. The ICD and DSM models for the classification and diagnosis of personality disorder are shifting toward the FFM because of its empirical validatio
{"title":"The network approach to psychopathology: promise versus reality","authors":"M. Forbes, Aidan G.C. Wright, K. Markon, R. Krueger","doi":"10.1002/wps.20659","DOIUrl":"https://doi.org/10.1002/wps.20659","url":null,"abstract":"World Psychiatry 18:3 October 2019 pathic personality disorders, respectively. The obsessive-compulsive personality disorder is defined largely by maladaptive conscientiousness (e.g., perfectionism, compulsivity, workaholism, and ruminative deliberation), but most measures of FFM conscientiousness do not assess for these maladaptive variants. Measures to assess maladaptive FFM traits, though, have been developed, including the Five Factor Model Personality Disorder scales, the Personality Inventory for DSM-5, and the Personality Inventory for ICD-11. There are a number of advantages in conceptualizing the ICD and DSM personality disorders from the perspective of the FFM. Many of the ICD and DSM personality disorder syndromes have limited research interest and inadequate empirical support. The FFM brings to the personality disorders a substantial body of construct validation, including a resolution of such notable controversies as gender bias, excessive diagnostic overlap, and temporal instability. An understanding of the etiology, pathology and treatment of the personality disorders has been hindered substantially by the heterogeneity within and the overlap across the diagnostic categories. The American Psychiatric Association has been publishing treatment guidelines for every disorder within the DSM, but guidelines have been provided for only one of the ten personality disorders (i.e., borderline). The complex heterogeneity of the categorical syndromes complicates considerably the ability to develop an explicit, uniform treatment protocol. The domains of the FFM are considerably more homogeneous and distinct, lending themselves well for more distinct models of etiology, pathology and treatment. Empirically validated treatment protocols have already been developed for FFM neuroticism. A common concern regarding the FFM and any other dimensional trait model is that clinicians will be unfamiliar with this approach and will find it difficult to apply. However, the FFM organization is consistent with the manner in which persons naturally think of personality trait description. Persons who apply the FFM typically find it quite easy to use. There have in fact been a number of studies concerning the clinical utility of the FFM in comparison to the DSM syndromes. A few of these studies have favored the DSM syndromes but, when the methodological limitations of these particular studies were addressed in subsequent studies, the results consistently favored the FFM. Experienced clinicians prefer the FFM and dimensional trait models for the conceptualization of personality disorders. In sum, the FFM is the predominant model of general personality structure and offers the opportunity for a truly integrative understanding of personality structure across the fields of clinical psychiatry and basic personality science. The ICD and DSM models for the classification and diagnosis of personality disorder are shifting toward the FFM because of its empirical validatio","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20659","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42935308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tim Kendall Mental Health, National Health Service England, London, UK 1. Cuijpers P. World Psychiatry 2019;18:276-85. 2. Krueger R, Kotov R, Watson D et al. World Psychiatry 2018;17:282-93. 3. Cipriani A, Furukawa T, Salanti G et al. Lancet 2018;391:1357-66. 4. Cipriani A, Zhou X, Del Giovane C et al. Lancet 2016;388:881-90. 5. Turner E, Matthews A, Linardatos E et al. N Engl J Med 2008;358:252-60. 6. Kirsch I, Deacon B, Hueda-Medina T et al. PLoS Med 2008;5:e45.
{"title":"Targets and outcomes of psychological interventions: implications for guidelines and policy.","authors":"Mark van Ommeren","doi":"10.1002/wps.20669","DOIUrl":"https://doi.org/10.1002/wps.20669","url":null,"abstract":"Tim Kendall Mental Health, National Health Service England, London, UK 1. Cuijpers P. World Psychiatry 2019;18:276-85. 2. Krueger R, Kotov R, Watson D et al. World Psychiatry 2018;17:282-93. 3. Cipriani A, Furukawa T, Salanti G et al. Lancet 2018;391:1357-66. 4. Cipriani A, Zhou X, Del Giovane C et al. Lancet 2016;388:881-90. 5. Turner E, Matthews A, Linardatos E et al. N Engl J Med 2008;358:252-60. 6. Kirsch I, Deacon B, Hueda-Medina T et al. PLoS Med 2008;5:e45.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 3","pages":"295-296"},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20669","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychiatry, human rights and social development: progress on the WPA Action Plan 2017‐2020","authors":"H. Herrman","doi":"10.1002/wps.20686","DOIUrl":"https://doi.org/10.1002/wps.20686","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20686","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47876935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Transdiagnostic psychiatry: premature closure on a crucial pathway to clinical utility for psychiatric diagnosis","authors":"P. McGorry, B. Nelson","doi":"10.1002/wps.20679","DOIUrl":"https://doi.org/10.1002/wps.20679","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20679","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49421649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
World Psychiatry 18:3 October 2019 neurotransmitters, such as serotonin, can be attached to his tones and facilitate gene expression in neurons. In parallel, experimental approaches have become more so phisticated and informative. Several laboratory innovations are of particular interest for psychiatric epigenomics. First, single cell approaches are redefining the meaning of epigenetic sto chasticity and directly address the issues of cell type differences in the brain. Second, easily available somatic cells, such as fibro blasts, can be reprogrammed into neurons, partially addressing the need for brain tissue. Third, CRISPRCas9 technology can be used not only for editing genomes, but also epigenomes, which is of considerable interest for modeling disease components in tissue culture and animals. Fourth, progress in computational strategies has enabled the integration of epigenomic data with genomics, transcriptomics, and metabolomics. The compre hensive transomic approaches enable the identification of hub elements and cellular pathways centrally involved in disease. Given the rapid developments in molecular biology and brain imaging technologies, an ideal experiment – a prospective epi genomic study in the living brain of psychosispredisposed individuals – may not be science fiction in the near future. Despite the challenges thus far, epigenetics and epigenomics remain an important part of the psychiatric research agenda. There are still no better ways to explain the numerous dynamic features of complex diseases, which by definition do not con form with the stability of DNA sequence. Uncovering the mech anisms of discordance in monozygotic twins or the delayed age of psychosis onset would be of major importance for precision psychiatry. The success and progress of psychiatric epigenetics relies on the ever improving experimental and computational tools and, more importantly, on the diligence and creativity of scientists working on this very interesting, but also challenging, part of human biology.
{"title":"What is treatment resistance in psychiatry? A “difficult to treat” concept","authors":"K. Demyttenaere","doi":"10.1002/wps.20677","DOIUrl":"https://doi.org/10.1002/wps.20677","url":null,"abstract":"World Psychiatry 18:3 October 2019 neurotransmitters, such as serotonin, can be attached to his tones and facilitate gene expression in neurons. In parallel, experimental approaches have become more so phisticated and informative. Several laboratory innovations are of particular interest for psychiatric epigenomics. First, single cell approaches are redefining the meaning of epigenetic sto chasticity and directly address the issues of cell type differences in the brain. Second, easily available somatic cells, such as fibro blasts, can be reprogrammed into neurons, partially addressing the need for brain tissue. Third, CRISPRCas9 technology can be used not only for editing genomes, but also epigenomes, which is of considerable interest for modeling disease components in tissue culture and animals. Fourth, progress in computational strategies has enabled the integration of epigenomic data with genomics, transcriptomics, and metabolomics. The compre hensive transomic approaches enable the identification of hub elements and cellular pathways centrally involved in disease. Given the rapid developments in molecular biology and brain imaging technologies, an ideal experiment – a prospective epi genomic study in the living brain of psychosispredisposed individuals – may not be science fiction in the near future. Despite the challenges thus far, epigenetics and epigenomics remain an important part of the psychiatric research agenda. There are still no better ways to explain the numerous dynamic features of complex diseases, which by definition do not con form with the stability of DNA sequence. Uncovering the mech anisms of discordance in monozygotic twins or the delayed age of psychosis onset would be of major importance for precision psychiatry. The success and progress of psychiatric epigenetics relies on the ever improving experimental and computational tools and, more importantly, on the diligence and creativity of scientists working on this very interesting, but also challenging, part of human biology.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48677023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
World Psychiatry 18:3 October 2019 group-level rates of non-response, it is difficult to translate this information into meaningful clinical recommendations for individual patients. An important developing area of research is early detection of risk for non-response. Conventionally, nonresponse studies are conducted after the trial has closed and patients are no longer receiving treatment; i.e. treatment failure is studied retrospectively. We propose that efforts should be focused on detecting non-response or deterioration early on, after the first several sessions. Then, a stepwise treatment approach could be used in order to intervene (e.g., augment specific treatment components or shifting towards a different treatment focus). Data from RCTs are valuable as they provide opportunities to test various treatment components and outcomes over time within distinct controlled treatments. However, as funding for psychotherapy research rapidly declines in the US and around the world, researchers are faced with a significant crisis. Some are shifting towards naturalistic studies through the development of practice research networks. Such networks are based on the premise that research thrives on true continuous communication between stakeholders and collaboration between clinicians in the community and researchers in academia. Studies developed are informed and guided by clinicians’ observations and input, and findings are integrated in clinical settings. These studies also promote greater diversity and representation of individuals from minority groups, who often do not have access to academic medical centers where RCTs are conducted. We anticipate that, in the future, more of our data will emerge from such studies. Overall, future research should include combinations of rigorous method ologies and personalized approaches to psychotherapy. Studies should identify non-responders early on and develop protocols to address risk of non-response or deterioration before the trial ends. These studies should be done in collaboration between clinicians, researchers, policy makers and patients. Outcomes should include not only symptomatic changes but also a range of intermediate outcomes/mechanisms that may go beyond the researcher’s theoretical orientation. Such collaboration can expand our understanding of the complex and nuanced aspects of “therapeutic change” and move us closer towards answering the question: “what makes psychotherapy work?” .
{"title":"Putting the psychotherapy spotlight back on the self-reflecting actors who make it work.","authors":"Jim van Os, David Kamp","doi":"10.1002/wps.20667","DOIUrl":"https://doi.org/10.1002/wps.20667","url":null,"abstract":"World Psychiatry 18:3 October 2019 group-level rates of non-response, it is difficult to translate this information into meaningful clinical recommendations for individual patients. An important developing area of research is early detection of risk for non-response. Conventionally, nonresponse studies are conducted after the trial has closed and patients are no longer receiving treatment; i.e. treatment failure is studied retrospectively. We propose that efforts should be focused on detecting non-response or deterioration early on, after the first several sessions. Then, a stepwise treatment approach could be used in order to intervene (e.g., augment specific treatment components or shifting towards a different treatment focus). Data from RCTs are valuable as they provide opportunities to test various treatment components and outcomes over time within distinct controlled treatments. However, as funding for psychotherapy research rapidly declines in the US and around the world, researchers are faced with a significant crisis. Some are shifting towards naturalistic studies through the development of practice research networks. Such networks are based on the premise that research thrives on true continuous communication between stakeholders and collaboration between clinicians in the community and researchers in academia. Studies developed are informed and guided by clinicians’ observations and input, and findings are integrated in clinical settings. These studies also promote greater diversity and representation of individuals from minority groups, who often do not have access to academic medical centers where RCTs are conducted. We anticipate that, in the future, more of our data will emerge from such studies. Overall, future research should include combinations of rigorous method ologies and personalized approaches to psychotherapy. Studies should identify non-responders early on and develop protocols to address risk of non-response or deterioration before the trial ends. These studies should be done in collaboration between clinicians, researchers, policy makers and patients. Outcomes should include not only symptomatic changes but also a range of intermediate outcomes/mechanisms that may go beyond the researcher’s theoretical orientation. Such collaboration can expand our understanding of the complex and nuanced aspects of “therapeutic change” and move us closer towards answering the question: “what makes psychotherapy work?” .","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":"18 3","pages":"292-293"},"PeriodicalIF":73.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20667","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fidelity vs. flexibility in the implementation of psychotherapies: time to move on","authors":"P. Fonagy, P. Luyten","doi":"10.1002/wps.20657","DOIUrl":"https://doi.org/10.1002/wps.20657","url":null,"abstract":"","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20657","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49432587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Linardon, P. Cuijpers, P. Carlbring, Mariel Messer, M. Fuller‐Tyszkiewicz
Although impressive progress has been made toward developing empirically‐supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app‐supported smartphone interventions are touted as a possible solution, access to up‐to‐date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta‐analysis of 66 randomized controlled trials of app‐supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=–0.05, n=3), post‐traumatic stress symptoms (g=0.18, n=4), and negative affect (g=–0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)‐based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face‐to‐face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app‐supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost‐effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.
{"title":"The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials","authors":"J. Linardon, P. Cuijpers, P. Carlbring, Mariel Messer, M. Fuller‐Tyszkiewicz","doi":"10.1002/wps.20673","DOIUrl":"https://doi.org/10.1002/wps.20673","url":null,"abstract":"Although impressive progress has been made toward developing empirically‐supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app‐supported smartphone interventions are touted as a possible solution, access to up‐to‐date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta‐analysis of 66 randomized controlled trials of app‐supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=–0.05, n=3), post‐traumatic stress symptoms (g=0.18, n=4), and negative affect (g=–0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)‐based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face‐to‐face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app‐supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost‐effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20673","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47988649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Pot, D. Gallagher-Thompson, L. Xiao, B. Willemse, Iris Rosier, K. Mehta, D. Zandi, T. Dua
In 2015, it was estimated that worldwide 47 million people had dementia, increasing to 75 million in 2030 and 132 million by 2050. Nearly 9.9 million people are expected to develop dementia each year, which translates to one new case every three seconds. While dementia occurs across all levels of socioeconomic status, nearly 60% of people with dementia currently live in low‐ and middle‐income countries (LMICs) and most new cases (71%) are expected to occur in those countries. The majority of people with dementia in those countries do not have access to care and support.
{"title":"iSupport: a WHO global online intervention for informal caregivers of people with dementia","authors":"A. Pot, D. Gallagher-Thompson, L. Xiao, B. Willemse, Iris Rosier, K. Mehta, D. Zandi, T. Dua","doi":"10.1002/wps.20684","DOIUrl":"https://doi.org/10.1002/wps.20684","url":null,"abstract":"In 2015, it was estimated that worldwide 47 million people had dementia, increasing to 75 million in 2030 and 132 million by 2050. Nearly 9.9 million people are expected to develop dementia each year, which translates to one new case every three seconds. While dementia occurs across all levels of socioeconomic status, nearly 60% of people with dementia currently live in low‐ and middle‐income countries (LMICs) and most new cases (71%) are expected to occur in those countries. The majority of people with dementia in those countries do not have access to care and support.","PeriodicalId":49357,"journal":{"name":"World Psychiatry","volume":" ","pages":""},"PeriodicalIF":73.3,"publicationDate":"2019-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/wps.20684","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42440297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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