HIV and depression--a systematic review of interventions

HIV-positive individuals are more likely to be diagnosed with major depressive disorder than HIV-negative individuals. Depression can precede diagnosis and be associated with risk factors for infection. The experience of illness can also exacerbate depressive episodes and depression can be a side effect to treatment. A systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review aims to provide a comprehensive understanding of evaluated interventions related to HIV and depression and provide some insight on questions of prevalence and measurement. Standard systematic research methods were used to gather quality published papers on HIV and depression. From the search, 1015 articles were generated and hand searched resulting in 90 studies meeting adequacy inclusion criteria for analysis. Of these, 67 (74.4%) were implemented in North America (the US and Canada) and 14 (15.5%) in Europe, with little representation from Africa, Asia and South America. Sixty-five (65.5%) studies recruited only men or mostly men, of which 31 (35%) recruited gay or bisexual men. Prevalence rates of depression ranged from 0 to 80%; measures were diverse and rarely adopted the same cut-off points. Twenty-one standardized instruments were used to measure depression. Ninety-nine interventions were investigated. The interventions were diverse and could broadly be categorized into psychological, psychotropic, psychosocial, physical, HIV-specific health psychology interventions and HIV treatment-related interventions. Psychological interventions were particularly effective and in particular interventions that incorporated a cognitive-behavioural component. Psychotropic and HIV-specific health psychology interventions were generally effective. Evidence is not clear-cut regarding the effectiveness of physical therapies and psychosocial interventions were generally ineffective. Interventions that investigated the effects of treatments for HIV and HIV-associated conditions on depression generally found that these treatments did not increase but often decreased depression. Interventions are both effective and available, although further research into enhancing efficacy would be valuable. Depression needs to be routinely logged in those with HIV infection during the course of their disease. Specific data on women, young people, heterosexual men, drug users and those indiverse geographic areas are needed. Measurement of depression needs to be harmonized and management into care protocols incorporated.     

A systematic review and narrative synthesis of occupational therapy-led interventions for individuals with anxiety and stress-related disorders

Anxiety and stress-related disorders are highly prevalent and impede participation in life activities. Occupational therapists work extensively with people diagnosed with these disorders but the effectiveness of their interventions is unclear. A systematic search strategy identified 19 papers describing 13 studies. Studies varied in methodology, intervention type, and theory base. The results show the potential for lifestyle approaches, occupational science-based programs, and skill-building to improve mental health. The variety of interventions and methodologies of many studies means that the effectiveness of occupational therapy interventions for this population is not yet determined. High-quality research is required to replicate interventions with emerging potential for effectiveness.     

Psychological interventions for carers of people with dementia: A systematic review of quantitative and qualitative evidence

Rationale: Carers of people with dementia experience significant levels of stress in their everyday role. The National Dementia Strategy in England identifies the key role that carers play in supporting people with dementia living at home, often to the detriment of their social, emotional and physical health. Aims: To add to the substantive knowledge‐base by combining search criteria used by Pinquart and Sörensen (2006) and Gallagher‐Thompson and Coon (2007) to update the literature on psychological interventions for carers of people with dementia published between 2005 and 2011. Method: Following the study inclusion criteria, comprehensive searches were conducted using the electronic databases Medline, PsycINFO, ERIC, and PubMed. Twenty studies were identified, graded and synthesised into the reported systematic review with both quantitative and qualitative studies included to maximise practice application. Results: Consistent with previous findings, three categories of psychological intervention were identified: (i) psychoeducational‐skill building (n=8); (ii) psychotherapy‐counselling (n=1); (iii) multicomponent (n=6). Our review also identified a fourth intervention category, (iv) technology‐based (n=5). The majority of studies in the updated review examine the constructs of depression, burden, social support and well‐being. The development of focused interventions for carers, whether individually tailored interventions or group interventions around a common issue, was significant for developing practice. Future studies across all categories should continue to embed supervision arrangements within their psychological intervention protocols.     

A systematic review of psychoneuroimmunology-based interventions

Psychoneuroimmunology-based interventions are used to attenuated disease progression and/or side effects of pharmacological treatment. This systematic review evaluates the different therapeutic and/or clinical psychoneuroimmunology-based interventions associated to both psychological, neuroendocrine and immunological variables. The review was conducted for all English, Portuguese and Spanish language articles published between 2005 and 2015. Independent investigators analyzed 42 studies concerning human psychoneuroimmunology-based interventions. Decreased levels of cortisol, epinephrine and norepinephrine (stress-related hormones) were associated to interventions like yoga, meditation, tai chi, acupuncture, mindfulness, religious/spiritual practices, cognitive behavior therapy, coping and physical exercises. Moreover, those interventions were also associated to reductions in inflammatory processes and levels of pro-inflammatory cytokines in cancer, HIV, depression, anxiety, wound healing, sleep disorder, cardiovascular diseases and fibromyalgia. Despite the associations between PNI variables and clinical/therapeutic interventions, only one study evidenced significant effects on a disease progression.     

A systematic review of interventions for adults who stutter

PurposeTo examine the effectiveness of (i) face to face interventions (ii) models of service delivery and (iii) psychological treatments combined with speech-focused interventions for adults who stutter.MethodsFive electronic databases and three clinical trial registries were searched. Systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with adults who stutter were included. Pharmaceutical interventions were excluded. Primary outcomes included a measure of stuttering severity. Risk of bias assessment was conducted on included studies and overall quality of the evidence was graded.ResultsFive RCTS, four registered trials and three systematic reviews met inclusion criteria. Intervention approaches included speech restructuring programs (e.g. Camperdown Program) and transcranial direct current stimulation (tDCS). One study investigated cognitive behaviour therapy (CBT) alongside speech restructuring. Overall, studies were classified low risk of bias and good quality. Speech restructuring was included in all but one study (tDCS study) and had the most evidence i.e. supported by the greatest number of RCTs. On average, stuttering frequency was reduced by 50–57 % using speech restructuring approaches. No study reduced stuttering to the same level as community controls who don’t stutter. The study on tDCS reduced stuttering frequency by 22–27 %. Speech restructuring delivered via telehealth was non-inferior to face-to-face intervention. One study reported CBT was an effective adjunct to speech restructuring interventions.ConclusionSpeech restructuring interventions were found to reduce stuttering in adults, however degree and maintenance of fluency varied. The body of evidence surrounding tDCS and psychological interventions is limited. Replication studies should be considered.     

Effects of behaviour change interventions on physical activity in people with spinal cord injury: A systematic review and meta-analysis

ObjectivesThis review investigated the effectiveness of behaviour-change interventions to improve physical activity (PA) participation in individuals with a spinal cord injury. Additionally, the review sought to analyse the change in PA behaviour that might be expected by utilising behaviour change in PA interventions and what specific intervention characteristics, application of behaviour change theories, and behaviour change techniques are most efficacious.MethodsThe protocol was prospectively registered on PROSPERO: CRD42021252744, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed in this review. Eight databases were comprehensively searched using a well-defined strategy developed in collaboration with an academic liaison librarian. Randomised, non-randomised controlled, and non-controlled studies were included in this review; however, controlled and non-controlled studies were analysed separately. Studies were included if participants were older than 16 years and had an SCI of any cause, level or severity, regardless of the time since injury. The behaviour change technique taxonomy version 1 was used to code the intervention characteristics for behaviour modification. The combined effects across studies were pooled in a meta-analysis, and the risk of bias was assessed using the Cochrane Risk of Bias 2 tool.ResultsThe search retrieved 10,155 titles and abstracts. After duplicate removal and screening against the eligibility criteria, 23 studies were included. The overall effect estimate of the change in PA participation in the controlled trials post-intervention was medium (d = 0.50, 95% CI = 0.31–0.70) in favour of behaviour-targeted interventions. The mean difference in PA volume between pre- and post-intervention was an increase of 22 minutes per week (95% CI = 5.96–38.90). Interventions that provided practical support (d = 0.81, 95% CI = 0.46–1.16), which were individualised (d = 0.62, 95% CI = 0.34–0.90) and that utilised monitoring (d = 0.59, 95% CI = 0.34–0.83) had a greater effect on change to PA than those that were group-based and did not utilise those specific techniques.ConclusionsInterventions that target behaviour change to increase PA in people with SCI appear effective. Utilising behaviour change frameworks and specific behaviour change techniques augments PA uptake and levels, and interventions aimed at improving PA in people with SCI should incorporate a behaviour modification component. More research is needed on the isolated effect of intervention structure parameters and specific behaviour change techniques.     

A systematic review of interventions to promote growth following adversity

BackgroundAthletes experience adversity across many aspects of their lives. Challenging the dominant idea that adversity is just a negative experience, a significant body of research in sport has demonstrated that these adverse events can also act as catalysts for positive change (Howells, Sarkar, & Fletcher, 2017). Yet, a limited number of researchers have focused on how to promote growth following adversity in sport. To support this line of inquiry our aim in this study was to facilitate knowledge transfer from other psychology disciplines by systematically reviewing intervention studies that aim to foster growth following adversity.MethodsWe conducted the systematic review using PRISMA guidelines. Following inclusion and exclusion criteria, we appraised the studies using the Mixed Methods Appraisal Tool (Pluye & Hong, 2014).ResultsThirty-six studies were included in the review. We synthesized the studies in relation to participant characteristics (i.e., sample size, age, gender, ethnicity, adversity), study characteristics (i.e., design, content, duration, delivery, outcome measures), intervention outcomes (i.e., statistical significance, effect size, qualitative indicators of growth), antecedents (viz. mediators, moderators), and quality appraisal.ConclusionIn the discussion we critically consider the lessons sport and exercise psychology researchers can learn from published intervention studies from other fields of research (e.g., the use of meaningful metrics, that there are different trajectories of growth, growth is a multidimensional phenomenon). Future researchers should seek to build on findings to advance knowledge and understanding in the most significant and meaningful ways.     

Physical activity interventions in the school setting: A systematic review

Objectives

To review the effectiveness of school-based interventions with a physical activity component by measuring changes in psychological determinants, physical activity, and health outcomes.

Design

Systematic Review.

Method

We conducted a literature search of school-based controlled studies that involved a physical activity intervention targeting school students. Study design, methodological quality, and effectiveness of interventions on three target levels, ‘health and fitness’ (BMI and motor performance), ‘physical activity’, and ‘psychological determinants’ (knowledge of physical activity effects, self-concept, and attitudes towards physical activity), were analysed. Furthermore, we examined the influence of specific factors (e.g., age and gender) and mediator effects.

Results

The literature search identified 129 studies. The majority of the studies examining motor performance, physical activity, and knowledge of physical activity achieved significant results (69.7%, 56.8% and 87.5%, respectively). Significant effects on self-concept and attitudes were also found but to a smaller extent (in 30% and 43.8% of the studies, respectively). Only a few studies examining BMI (2.7%), physical activity (6.8%), and attitudes towards physical activity (12.5%) revealed negative effects, with better results observed for the control group. Intervention effects were influenced by the students’ age, intervention type, and frequency of the interventions. Self-efficacy was found to mediate the relationship between the program and the students’ physical activity.

Conclusions

Numerous school-based physical activity interventions achieved positive effects on three target levels. Further research is needed to clarify the mediator effects of psychological variables on physical activity and health and to increase our knowledge about the mechanisms that underlie behavioural change.     

Gait variability in people with neurological disorders: A systematic review and meta-analysis

There has been growing evidence showing gait variability provides unique information about gait characteristics in neurological disorders. This study systemically reviewed and quantitatively synthesized (via meta-analysis) existing evidence on gait variability in various neurological diseases, including Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), cerebellar ataxia (CA), Huntington’s disease (HD), multiple sclerosis (MS), and Parkinson’s disease (PD). Keyword search were conducted in PubMed, Web of science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Meta-analysis was performed to estimate the pooled effect size for gait variability for each neurological group. Meta-regression was performed to compare gait variability across multiple groups with neurological diseases. Gait variability of 777 patients with AD, ALS, CA, HD, MS, or PD participating in 25 studies was included in meta-analysis. All pathological groups had increased amount of gait variability and loss of fractal structure of gait dynamics compared to healthy controls, and gait variability differentiated distinctive neurological conditions. The HD groups had the highest alterations in gait variability among all pathological groups, whereas the PD, AD and MS groups had the lowest. Interventions that aim to improve gait function in patients with neurological disorders should consider the heterogeneous relationship between gait variability and neurological conditions.     

Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review

Interest into the rehabilitative utility of Buddhist-derived interventions (BDIs) for incarcerated populations has been growing. The present paper systematically reviews the evidence for BDIs in correctional settings. Five databases were systematically searched. Controlled intervention studies of BDIs that utilized incarcerated samples were included. Jadad scoring was used to evaluate methodological quality. PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines were followed. The initial search yielded 85 papers, but only eight studies met the inclusion criteria. The eight eligible studies comprised two mindfulness studies, four vipassana meditation studies, and two studies utilizing other BDIs. Intervention participants demonstrated significant improvements across five key criminogenic variables: (i) negative affect, (ii) substance use (and related attitudes), (iii) anger and hostility, (iv) relaxation capacity, and (v) self-esteem and optimism. There were a number of major quality issues. It is concluded that BDIs may be feasible and effective rehabilitative interventions for incarcerated populations. However, if the potential suitability and efficacy of BDIs for prisoner populations is to be evaluated in earnest, it is essential that methodological rigor is substantially improved. Studies that can overcome the ethical issues relating to randomization in correctional settings and employ robust randomized controlled trial designs are favored.     

Predictors of anxiety and depression among newly diagnosed people living with HIV: A longitudinal study

This longitudinal study examined whether past resilience and internalized stigma predicted anxiety and depression among newly diagnosed Spanish-speaking people living with HIV (PLWH). We also analyzed whether coping strategies mediated this relationship. Data were collected at two time points from 119 PLWH. Approximately a third of participants had scores indicative of anxiety symptoms, the same result was found for depressive symptoms. Structural equations modeling revealed that 61% of the variance of anxiety and 48% of the variance of depression 8 months after diagnosis was explained by the proposed model, which yielded a good fit to data. Anxiety and depressive symptoms were significantly and negatively predicted by positive thinking, thinking avoidance, and past resilience, and positively predicted by self-blame. Additionally, anxiety was positively predicted by internalized stigma. Past resilience negatively predicted internalized stigma, self-blame, and thinking avoidance and it positively predicted positive thinking. Internalized stigma positively predicted self-blame. Moreover, internalized stigma had a significant indirect effect on anxiety symptoms through self-blame, and past resilience had significant indirect effects on anxiety symptoms and depressive symptoms through internalized stigma and coping. The results point to the need for clinicians and policy makers to conduct systematic assessments and implement interventions to reduce internalized stigma and train people living with HIV to identify and use certain coping behaviors.     

Family-based physical activity interventions and family functioning: A systematic review

Family physical activity (PA) can confer multiple health benefits, yet whether PA interventions affect general family functioning has not been appraised. The purpose of this review was to evaluate studies that have examined the effect of family PA interventions, where child PA was the focus of the intervention, on constructs of family functioning. Literature searches were concluded on January 11, 2022 using seven common databases. Eligible studies were in English, utilized a family PA intervention, and assessed a measure of family functioning as a study outcome. The initial search yielded 8413 hits, which was reduced to 20 independent PA interventions of mixed quality after screening for eligibility criteria. There was mixed evidence for whether family PA interventions affected overall family functioning; however, analyses of subdomains indicated that family cohesion is improved by PA interventions when children are in the early school years (aged 5–12). High-quality studies also showed an impact of family PA interventions on family organization. Targeted interventions at specific family subsystems (e.g., father–son, mother–daughter), characteristics (low-income, clinical populations, girls), and broad multibehavioral interventions may have the most reliable effects. Overall, the findings show that family PA interventions can promote family cohesion and organization, particularly among families with children in the early school years. Higher quality research, employing randomized trial designs and targeting specific intervention and sample characteristics (e.g., different clinical conditions, specific parent–child dyads), is recommended in order to better ascertain the effectiveness of these approaches.     

Effects of psychological interventions for patients with osteoarthritis: a systematic review and meta-analysis

The aim of this study was to determine the effects of psychological interventions (e.g. cognitive restructuring, relaxation) on physiological and psychological health in osteoarthritis patients. A systematic literature search was done using PubMed, Embase, PsycINFO, Web of Science, China National Knowledge Infrastructure, and Wanfang Database through November 2016. Studies were included if they used a randomized controlled trial designed to explore the effects of psychological interventions in osteoarthritis patients. Two independent authors assessed the methodological quality of the trials using criteria outlined by Jadad et al. Meta-analysis was done with the Revman5.0. Twelve randomized controlled trials, including 1307 osteoarthritis patients, met the study inclusion criteria. Meta-analysis showed that psychological interventions could reduce the levels of pain [standard mean difference (SMD) ?0.28, 95% CI ?0.48, ?0.08, P-value 0.005)] and fatigue (SMD ?0.18, 95% CI ?0.34, ?0.01, P-value 0.04). In addition, psychological interventions significantly improved osteoarthritis patients’ self-efficacy (SMD 0.58, 95% CI 0.40, 0.75, P-value 0.00) and pain coping (MD 1.64, 95% CI 0.03, 3.25, P-value 0.05). Although the effects on physical function, anxiety, depression, psychological disability were in the expected direction, they were not statistically significant. In conclusion, the role of psychological interventions in the management of osteoarthritis remains equivocal. Some encouraging results were seen with regard to pain, pain coping, self-efficacy, and fatigue. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.     

The effects of mindfulness interventions on prenatal well-being: A systematic review

Objective: Low well-being during pregnancy can have significant adverse outcomes for mother and child. The effects of mindfulness interventions on prenatal maternal well-being are increasingly examined but outcomes have yet to be systematically evaluated. The aims of the current paper are to systematically evaluate intervention effects and current research approaches with pregnant groups.

Design: A systematic review of eight studies examining mindfulness intervention effects on prenatal well-being.

Results: Findings indicate potential benefits of mindfulness interventions for reducing levels of depression, anxiety and negative affect during pregnancy. There is also evidence for improved self-compassion and perceived childbirth self-efficacy. Further, these effects may be more pronounced for vulnerable groups, such as women currently experiencing low prenatal well-being. Less consistent findings were observed for stress, and positive affect. Variations in research design, gestational characteristics, timing of assessments and outcome measurement may explain some inconsistencies in the extant literature.

Conclusion: Mindfulness interventions present a potentially useful means to improve prenatal well-being but improved methodological quality is essential to rigorously examine intervention effects.     

A meta-analytic study of self-help interventions for anxiety problems

The present study examined the effectiveness of self-help (SH) interventions for individuals with anxiety problems. Thirty-three studies, targeting a variety of anxiety disorders and problems, met criteria for inclusion with 1,582 clinical and subclinical participants. Self-help formats included books, audio/videotapes, and computer/Internet-based programs. The average effect sizes (Cohen's ds) comparing SH interventions to control groups for target symptoms were .62 at posttreatment and .51 at follow-up. When compared to therapist-directed interventions (TDIs), the average effect sizes (Cohen's ds) for target problems were -.42 at posttreatment and -.36 at follow-up. Format of SH materials, type of target disorder, presence of minimal therapist contact, and other study parameters were examined for their effect on treatment outcome. The results were discussed from the perspective of a stepped-care approach for anxiety problems.     

A systematic review and meta‐analysis of tertiary interventions in clinical burnout

Clinical burnout is one of the leading causes of work absenteeism in high‐ and middle‐income countries. There is hence a great need for the identification of effective intervention strategies to increase return‐to‐work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non‐randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random‐effects meta‐analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of tertiary interventions compared with treatment as usual or wait‐list controls on time until RTW was found, HR = 4.5, 95% confidence interval (CI) = 2.15–9.45; however, considerable heterogeneity was detected. The effect of tertiary interventions on full RTW was not significant, OR = 1.33, 95% CI = 0.59–2.98. No significant effects on psychological symptoms of exhaustion, depression or anxiety were observed. In conclusion, tertiary interventions for individuals with clinically significant burnout may be effective in facilitating RTW. Successful interventions incorporated advice from labor experts and enabled patients to initiate a workplace dialogue with their employers.     

The efficacy of cognitive-behavioral interventions for reducing anxiety sensitivity: a meta-analytic review

The present study meta-analytically reviewed the efficacy of cognitive-behavioral therapy (CBT) vs. control conditions in the reduction of anxiety sensitivity. A computerized search was conducted to indentify CBT outcome studies that included the Anxiety Sensitivity Index as a dependent variable. Of the 989 studies that were identified, 24 randomized-controlled trials with a total of 1851 participants met inclusion criteria and were included in the analysis. Data were extracted separately for treatment-seeking (16 studies) and at-risk (eight studies) samples. Results indicated large effect sizes for treatment-seeking samples, Hedges' g=1.40, SE=0.21, 95% CI: 1.00-1.81, p<0.001, and moderate to large effect sizes for at risk samples Hedges' g=0.74, SE=0.18, 95% CI: 0.39-1.08, p<0.001. Additionally, both the amount of therapist contact and control modality (waitlist vs. psychological control) moderated the effect sizes for treatment-seeking samples. Our review indicates that CBT is efficacious in reducing anxiety sensitivity. However, more research is needed to determine the mechanisms by which CBT exert its effects on anxiety sensitivity.     

Memory impairment among people who are homeless: A systematic review

Cognitive impairment may interfere with an individual's ability to function independently in the community and may increase the risk of becoming and remaining homeless. The purpose of this study was to systematically review the literature on memory deficits among people who are homeless in order to gain a better understanding of its nature, causes and prevalence. Studies that measured memory functioning as an outcome among a sample of homeless persons were included. Data on sampling, outcome measures, facet of memory explored and prevalence of memory impairment were extracted from all selected research studies. Included studies were evaluated using a critical appraisal process targetted for reviewing prevalance studies. Eleven studies were included in the review. Verbal memory was the most commonly studied facet of memory. Potential contributing factors to memory deficits among persons who are homeless were explored in seven studies. Memory deficits were common among the samples of homeless persons studied. However, there was a great deal of variation in the methodology and quality of the included studies. Conceptualisations of “homelessness” also differed across studies. There is a need for more controlled research using validated neuropsychological tools to evaluate memory impairment among people who are homeless.     

Sleep interventions for performance,mood and sleep outcomes in athletes: A systematic review and meta-analysis

Sleep is fundamental to sports performance and other health outcomes such as mental wellbeing. This systematic review explored the effects of sleep interventions implemented among athletes on performance, sleep, and mood outcomes. Five databases were searched, returning 5996 records for screening. Of these, 27 articles met the inclusion criteria (16 controlled deigns, 11 uncontrolled; athletes n = 617; male n = 432, female n = 93, non-binary/other n = 0 or not reported n = 92). Narrative synthesis of all studies based on intervention type suggested that sleep hygiene, assisted sleep, and sleep extension interventions may be associated with improved sleep, performance, and mood outcomes. Twelve controlled trials were eligible for quantitative meta-analysis, investigating the effect of sleep interventions on athlete sleep, performance, and negative affect, compared to controls post-intervention. Utilizing random-effects meta-analyses, sleep interventions improved subjective sleep quality (g = 0.62, 95% CI [0.21, 1.02]), reduced sleepiness (g = 0.81, 95% CI [0.32, 1.30]) and decreased negative affect (g = 0.63, 95% CI [0.27, 0.98]), but did not appear to influence subjective sleep duration. No effects were identified for objective sleep measures (e.g., actigraphy), or aerobic/anaerobic performance indices. While sleep interventions may offer some benefit to athletes, caution is warranted given limitations of the extant research relating to small, non-representative studies with methodological concerns.