Technology Delivered Interventions for Depression and Anxiety in Children and Adolescents: A Systematic Review and Meta-analysis

Depression and anxiety are common during adolescence. Whilst effective interventions are available treatment services are limited resulting in many adolescents being unable to access effective help. Delivering mental health interventions via technology, such as computers or the internet, offers one potential way to increase access to psychological treatment. The aim of this systematic review and meta-analysis was to update previous work and investigate the current evidence for the effect of technology delivered interventions for children and adolescents (aged up to 18 years) with depression and anxiety. A systematic search of eight electronic databases identified 34 randomized controlled trials involving 3113 children and young people aged 6–18. The trials evaluated computerized and internet cognitive behavior therapy programs (CBT: n = 17), computer-delivered attention bias modification programs (ABM: n = 8) cognitive bias modification programs (CBM: n = 3) and other interventions (n = 6). Our results demonstrated a small effect in favor of technology delivered interventions compared to a waiting list control group: g = 0.45 [95% CI 0.29, 0.60] p < 0.001. CBT interventions yielded a medium effect size (n = 17, g = 0.66 [95% CI 0.42–0.90] p < 0.001). ABM interventions yielded a small effect size (n = 8, g = 0.41 [95%CI 0.08–0.73] p < 0.01). CBM and ‘other’ interventions failed to demonstrate a significant benefit over control groups. Type of control condition, problem severity, therapeutic support, parental support, and continuation of other ongoing treatment significantly influenced effect sizes. Our findings suggest there is a benefit in using CBT based technology delivered interventions where access to traditional psychotherapies is limited or delayed.

     

Strengthening the validity of population-based suicide rate comparisons: an illustration using U.S. military and civilian data

The objectives of this study were to generate precise estimates of suicide rates in the military while controlling for factors contributing to rate variability such as demographic differences and classification bias, and to develop a simple methodology for the determination of statistically derived thresholds for detecting significant rate changes. Suicide rate estimates were calculated for the military population and each service branch over 11 years, directly standardized to the 2000 U.S. population. Military rates were highly comparable across branches and were approximately 20% lower than the civilian rate. Direct adjustment essentially controlled for the demographic confounds in this sample. Applying the Poisson-based method, we demonstrate that suicide rate fluctuations as large as 20-40% in any year may be attributed to random error.     

Drug-induced amnesia hurts recognition, but only for memories that can be unitized

Midazolam is a drug that creates temporary anterograde amnesia. In a within-subjects, double-blind experiment, participants studied a list of stimuli after receiving an injection of midazolam in one session and after receiving saline in another session. The lists consisted of three types of stimuli: words, photographs, and abstract pictures. Recognition memory was tested at the end of each session. Memory was reliably poorer in the midazolam condition than the saline condition, but this amnesic effect was significantly smaller for pictorial stimuli than for words and almost nonexistent for abstract pictures. We argue that the less familiar the stimulus, the less likely it is to be associated with an experimental context. These data bolster our claim that unitization increases the chances of episodic binding and that drug-induced amnesia prevents episodic binding regardless of unitization.     

Personal mastery predicts pain,stress, fatigue,and blood pressure in adults with rheumatoid arthritis

Among individuals with rheumatoid arthritis (RA), stress-associated disease flare can severely impact well-being. Psychological factors such as personal mastery may buffer an individual from the negative effects of those flares. We tested the hypothesis that a high sense of personal mastery would prospectively predict stress reactivity. Measures of pain, perceived stress, fatigue, and mean arterial pressure (MAP) were collected before, during, and after two interpersonal stressors conducted on 73 individuals with RA. Factor analysis of the personal mastery scale yielded two independent factors: a 5-item “fatalism” component and a 2-item “control” component. Individuals with high fatalism scores reported overall greater joint pain at baseline and those scoring high on control exhibited lower MAP, and reported less stress and fatigue at baseline. After controlling for baseline differences, those high in control exhibited greater MAP increase during stress, and less drop in pain when compared to those low in control. These results suggest that individuals high in control may be more susceptible to the effects of acute stress; however, the overall beneficial aspects of high control outweigh the acute negative effects. Personal mastery may play a role in the experience of pain, stress, and fatigue for people with RA.     

Interrelationships between Reading Disability and Attention-Deficit/Hyperactivity Disorder

Evidence from a number of investigations suggests a considerable overlap between reading disability (RD) and attention deficit-hyperactivity disorder (ADHD). We investigate the relationship between RD and ADHD in a cohort of 186 children 7.5–9.5 years of age, recruited explicitly to address classification and definitional issues in these disorders. Using multivariate methods, we examine the hypothesis that RD and ADHD represent separate diagnostic entities that frequently co-occur in the same individual. The results suggest that RD is characterized by deficits within the language system, in particular a subcomponent within that system, phonological processing; in contrast, such linguistic deficits are not characteristic of ADHD unless ADHD is associated with RD. When children with both RD and ADHD are examined, both the linguistic deficits associated with RD and the behavioral characteristics associated with ADHD are apparent, but these deficits are not synergistic. We conclude that RD and ADHD represent separate disorders that frequently co-occur.     

MAKING COMMITMENTS, CREATING LIVES

This study examined the midlife personality implications of different long-term patterns of commitment to work¹ and family in a sample of educated women. Women with different work commitment patterns differed on both observer and self-report of instrumentality, and on observer report of interpersonal orientation and valuation of social norms. Women with different family-role commitment patterns differed only on self-report of valuation of social norms. Multivariate analyses also indicated that interpersonal orientation and instrumentality may not represent bipolar ends of the same personality continuum, and that interpersonal orientation as a broad personality domain may be comprised of distinct qualities (i.e., warmth vs. dependence). Taken together, these findings imply that when variations in the nature of women's work and family commitments are taken into account, a more comprehensive understanding of the similarities and differences in their personalities can result.     

Representing Radcliffe: Perceptions and Consequences of Social Class

Using retrospective data from a sample of women who graduated from Radcliffe College in 1964, this paper examines the perceptions (what women notice) and consequences (how it makes them feel) of social class during college in these women's lives. The majority of women acknowledged that social class was salient at Radcliffe by stating so directly, by noticing members of different class groups, and/or by mentioning their own class backgrounds. In addition, women consistently perceived two markers of social class: exclusivity and the differences between public and private high school graduates. Surprisingly, there were no differences by social class background in the rates of these perceptions; social class indicators were equally apparent to women from different social class backgrounds. However, most commonly among women from working-class backgrounds, there were psychological consequences of social class that were manifested in feeling bad about themselves. In order to understand the psychology of social class most fully, it seems important to distinguish between perception and consequence in the psychological study of social class, and to pay attention to the impact not only of people's backgrounds, but of social class cues in the environments in which they operate.