The association of health literacy with adherence in older 2 adults, and its role in interventions: a systematic meta-review

Background: Low health literacy is a common problem among older adults. It is often suggested to be associated with poor adherence. This suggested association implies a need for effective adherence interventions in low health literate people. However, previous reviews show mixed results on the association between low health literacy and poor adherence. A systematic meta-review of systematic reviews was conducted to study the association between health literacy and adherence in adults above the age of 50. Evidence for the effectiveness of adherence interventions among adults in this older age group with low health literacy was also explored. Methods: Eight electronic databases (MEDLINE, ERIC, EMBASE, PsycINFO, CINAHL, DARE, the Cochrane Library, and Web of Knowledge) were searched using a variety of keywords regarding health literacy and adherence. Additionally, references of identified articles were checked. Systematic reviews were included if they assessed the association between health literacy and adherence or evaluated the effectiveness of interventions to improve adherence in adults with low health literacy. The AMSTAR tool was used to assess the quality of the included reviews. The selection procedure, data-extraction, and quality assessment were performed by two independent reviewers. Seventeen reviews were selected for inclusion. Results: Reviews varied widely in quality. Both reviews of high and low quality found only weak or mixed associations between health literacy and adherence among older adults. Reviews report on seven studies that assess the effectiveness of adherence interventions among low health literate older adults. The results suggest that some adherence interventions are effective for this group. The interventions described in the reviews focused mainly on education and on lowering the health literacy demands of adherence instructions. No conclusions could be drawn about which type of intervention could be most beneficial for this population. Conclusions: Evidence on the association between health literacy and adherence in older adults is relatively weak. Adherence interventions are potentially effective for the vulnerable population of older adults with low levels of health literacy, but the evidence on this topic is limited. Further research is needed on the association between health literacy and general health behavior, and on the effectiveness of interventions

Importance of web-based intervention in minimizing depressive symptoms and associated stigma in depressed medical students

[Excerpt] There is a considerable prevalence of depression in medical students, and those who are depressed more frequently endorse feeling stigmatized than non-depressed students.1 Because concerns about confidentiality are often cited by depressed medical students as a major barrier in seeking help, there is a significant need to develop an innovative way to provide medical students with safe and confidential access to services to improve prevention, detection, and intervention in depression and its associated stigma.1 A web-based approach could be potentially useful for addressing this issue and has already been used for delivering intervention in various health conditions, with benefits such as low cost, user convenience, timely information, privacy and confidentiality, reduced levels of stigmatization, and increased user and supplier control.2 Moreover, although current evidence is limited, a recent meta-review3 points to the efficacy of web-based cognitive behavioral interventions in treating/improving depression symptoms in adults. In relation to depression stigma, there is evidence that web-based interventions (e.g., MoodGYM) can reduce personal stigmatizing attitudes toward depression. The web-based approach assumes even greater importance when we consider that stigmatization increases with either the use of prescription medication or mental health counseling, and that only a small percentage of depressed medical students seek mental health counseling services, due to lack of time, confidentiality, stigma, and fear of documentation in academic records.4 However, unintended negative effects could easily arise with web-based approaches as well (e.g. decline in seeking support from family and friends, avoidance of in-person mental health services, inadequate assessment and diagnosis). [...]- (undefined

Introducing Gamification for Advancing Current Mental Healthcare and Treatment Practices

Given the alarming rise in the mental health issues among individuals of all age groups, it somehow becomes imperative to find novel solutions to deal with the existing global mental health crisis. Since affective and cognitive processes largely define our behavioral goals and tendencies, gamification has garnered immense interest among the mental health research community as a potential methodology to help modify any maladaptive perception, cognition, and behavior. Applying gaming in a therapeutic environment, undoubtedly, comes with a diverse set of advantages, which ranges from automatic tapping into the internal psychological mechanisms to increasing motivation to change, among many others. Thus, the advances in gamification elements have provided a straight revelation about the future directions of assessment, diagnosis, and treatment of various mental health conditions. With a brief introduction to the existing application of gamification in primary healthcare sectors, the present chapter will, therefore, aim to extend the scope of gamification to improve mental health issues. An extensive review of literature in this field will further educate readers about the popular domains in mental health, which currently apply gamification app technologies. This chapter will also attempt to provide empirical instances to suggest how gamification can improve the non-compliance rate to therapies as well as motivation to induce behavioral changes. The primary focus of this chapter is to enlighten its readers on how gamification using mobile and computer apps can digitally enhance and aid the present-day mental health diagnosis and treatment practices. This advancement will hopefully allow mental health experts, therapists, and psychologists to move beyond traditional psychotherapeutic interventions and diagnostic methods to a better and futuristic approach to understanding and treating clinical disorders. Furthermore, future implications and challenges will also be discussed. © 2021, The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd

Electroencephalographic findings in patients with major depressive disorder during cognitive or emotional tasks: a systematic review

Objective: Major depressive disorder (MDD) is a prevalent psychiatric condition characterized by multiple symptoms that cause great distress. Uncovering the brain areas involved in MDD is essential for improving therapeutic strategies and predicting response to interventions. This systematic review discusses recent findings regarding cortical alterations in depressed patients during emotional or cognitive tasks, as measured by electroencephalography (EEG). Methods: A search of the MEDLINE/PubMed and Cochrane databases was carried out using the keywords EEG and depression, confined to article title. Results: The studies identified reveal the frontal cortex as an important brain structure involved in the complex neural processes associated with MDD. Findings point to disorganization of right-hemisphere activity and deficient cognitive processing in MDD. Depressed individuals tend to ruminate on negative information and respond with a pattern of relatively higher right frontal activity to emotional stimuli associated with withdrawal and isolation. Conclusion: Patients with MDD may have altered dynamic patterns of activity in several neuroanatomical structures, especially in prefrontal and limbic areas involved in affective regulation. Identification of these alterations might help predict the response of patients to different interventions more effectively and thus maximize the effects both of pharmacotherapeutic and of psychotherapeutic strategies

Technology-Delivered Mental Health Interventions for People Living with HIV/AIDS (PLWHA): a Review of Recent Advances

HIV/AIDS infection and psychiatric diagnoses are closely linked, with an estimated 50 % of HIV-infected individuals diagnosed with co-occurring mental health disorders. Mental health disorders have been shown to be associated with HIV acquisition as well as poor treatment outcomes for those infected with HIV. Therefore, behavioral interventions to improve HIV/AIDS health outcomes have included interventions addressing mental health co-morbidities, such as depression and anxiety, and the use of technology to facilitate such intervention is growing. The current review focuses on research published between January 2011 and April 2015, exploring technology-based interventions aimed to improve health outcomes among HIV/AIDS individuals with co-occurring mental health symptoms. Technologies identified in this review included telephone-delivered and computer-delivered interventions. Despite rapid advances in technology use in the medical professions, particularly in the area of psychiatric treatment, little has been translated into the area of mental health research in the context of HIV disease. This review reveals that the widespread dissemination of various technologies, especially technologies facilitating access to care among vulnerable and marginalized populations, may be a necessary way to offer evidence-based mental health interventions to HIV/AIDS populations in need

Electroencephalographic findings in patients with major depressive disorder during cognitive or emotional tasks: a systematic review

Objective: Major depressive disorder (MDD) is a prevalent psychiatric condition characterized by multiple symptoms that cause great distress. Uncovering the brain areas involved in MDD is essential for improving therapeutic strategies and predicting response to interventions. This systematic review discusses recent findings regarding cortical alterations in depressed patients during emotional or cognitive tasks, as measured by electroencephalography (EEG). Methods: A search of the MEDLINE/PubMed and Cochrane databases was carried out using the keywords EEG and depression, confined to article title. Results: The studies identified reveal the frontal cortex as an important brain structure involved in the complex neural processes associated with MDD. Findings point to disorganization of right-hemisphere activity and deficient cognitive processing in MDD. Depressed individuals tend to ruminate on negative information and respond with a pattern of relatively higher right frontal activity to emotional stimuli associated with withdrawal and isolation. Conclusion: Patients with MDD may have altered dynamic patterns of activity in several neuroanatomical structures, especially in prefrontal and limbic areas involved in affective regulation. Identification of these alterations might help predict the response of patients to different interventions more effectively and thus maximize the effects both of pharmacotherapeutic and of psychotherapeutic strategies

Computerised therapy for depression with clincian vs. assistant and brief vs. extended phone support: Protocol for a factorial RCT

<p>Abstract</p> <p>Background</p> <p>Computerised cognitive behaviour therapy (cCBT) involves standardised, automated, interactive self-help programmes delivered via a computer. Randomised controlled trials (RCTs) and observational studies have shown than cCBT reduces depressive symptoms as much as face-to-face therapy and more than waiting lists or treatment as usual. cCBT’s efficacy and acceptability may be influenced by the “human” support offered as an adjunct to it, which can vary in duration and can be offered by people with different levels of training and expertise.</p> <p>Methods/design</p> <p>This is a two-by-two factorial RCT investigating the effectiveness, cost-effectiveness and acceptability of cCBT supplemented with 12 weekly phone support sessions are either brief (5–10 min) or extended (20–30 min) and are offered by either an expert clinician or an assistant with no clinical training. Adults with non-suicidal depression in primary care can self-refer into the study by completing and posting to the research team a standardised questionnaire. Following an assessment interview, eligible referrals have access to an 8-session cCBT programme called <it>Beating the Blues</it> and are randomised to one of four types of support: brief-assistant, extended-assistant, brief-clinician or extended-clinician.</p> <p>A sample size of 35 per group (total 140) is sufficient to detect a moderate effect size with 90% power on our primary outcome measure (Work and Social Adjustment Scale); assuming a 30% attrition rate, 200 patients will be randomised. Secondary outcome measures include the Beck Depression and Anxiety Inventories and the PHQ-9 and GAD-7. Data on clinical outcomes, treatment usage and patient experiences are collected in three ways: by post via self-report questionnaires at week 0 (randomisation) and at weeks 12 and 24 post-randomisation; electronically by the cCBT system every time patients log-in; by phone during assessments, support sessions and exit interviews.</p> <p>Discussion</p> <p>The study’s factorial design increases its efficiency by allowing the concurrent investigation of two types of adjunct support for cCBT with a single sample of participants. Difficulties in recruitment, uptake and retention of participants are anticipated because of the nature of the targeted clinical problem (depression impairs motivation) and of the studied interventions (lack of face-to-face contact because referrals, assessments, interventions and data collection are completed by phone, computer or post).</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN98677176</p