Olga Díaz

Recent evidence supports the efficacy of conference call cognitive–behavioral interventions in preventing depression in caregivers at post-intervention, but we do not know whether the results are sustained long term. The main objective of this study was to evaluate the long-term efficacy of a cognitive–behavioral intervention administered by telephone conference call in preventing depression in caregivers with elevated depressive symptoms, comparing all components of the intervention versus only the behavioral ones. A randomized controlled trial was conducted using a dismantling strategy. At total of 219 caregivers were randomly assigned to a cognitive–behavioral conference call intervention (CBCC; n = 69), a behavioral-activation conference call intervention (BACC; n = 70), or a usual care control group (CG, n = 80). Information was collected on depressive symptoms and depression at pre-intervention and at 1, 3, 6, 12, and 36 months post-intervention. At 36 months, there was a reduction in depressive symptoms (p < 0.001) and a lower incidence of major depressive episodes in both the CBCC and BACC groups compared to CG (8.7%, 8.6%, and 33.7%, respectively). The results show that a conference call intervention was effective in the long term to prevent depression in caregivers and that the behavioral-activation component was comparable to the complete cognitive–behavioral protocol.

Effective and accessible interventions for indicated prevention of depression are necessary and lacking, especially for informal caregivers. Although telephone-based interventions could increase the accessibility for caregivers, randomized controlled trials are scarce, with no examination of prevention to date. Moreover, the efficacy of specific therapeutic components in preventive cognitive-behavioral programs is unknown. The main objective of this study was to evaluate the efficacy of a telephone-administered psychological preventive intervention in informal caregivers with high depressive symptoms. A total of 219 caregivers were randomized to a cognitive-behavioral conference call intervention (CBCC, n = 69), a behavioral-activation conference call intervention (BACC, n = 70), or a usual care control group (CG, n = 80). Both interventions consisted of five 90-minute group sessions. At the post-intervention, incidence of depression was lower in CBCC and BACC compared to CG (1.5% and 1.4% vs. 8.8%). Relative risk was 0.17 for the CBCC and 0.16 for the BACC, and the number-needed-to-treat was 14 in both groups. Depressive symptoms were significantly lower in BACC and BACC groups compared to CG (d = 1.16 and 1.29), with no significant differences between CBCC and BACC groups. The conference call intervention was effective in preventing depression and the behavioral-activation component (BACC) was comparable to the CBCC intervention.

Although major depression is a frequent disorder in non-professional caregivers and there are effective psychological interventions to prevent it, caregivers have difficulty accessing them. Interventions for depression applied through an app could improve accessibility; yet, to date, adherence to such interventions has been low. The objectives of this study are to (1) evaluate the efficacy of a cognitive behavioral depression prevention intervention administered through a smartphone app with and without telephone conference calls, (2) analyze the mediators of the change in the incidence of depression and depressive symptoms, and (3) assess adherence and satisfaction with the interventions. A randomized controlled clinical trial will be conducted. Caregivers with elevated symptoms will be randomly assigned to a cognitive behavioral intervention administered by a smartphone app (CBIA) group, a CBIA plus telephone conference calls (TCCs) group (CBIA + TCC), or an attention control group. Each condition will consist of approximately 58 participants. Both interventions will be administered in five modules through a smartphone app and the CBIA + TCC group will receive additional TCCs in group format (four sessions of 30 min each). Trained blind assessors will conduct pre-treatment, post-treatment and follow-up assessments at 1, 3, 6, and 12 months. This study will provide evidence of the efficacy of a cognitive behavioral intervention to prevent depression in caregivers with elevated depressive symptoms administered through a smartphone app and the impact of feedback applied through conference calls to increase program adherence and efficacy. If the results were favorable, it would mean that we have developed a more effective, accessible, and clinically useful preventive depression intervention than the currently available ones for many present and future caregivers. ClinicalTrials.gov: NCT03110991 . Registered 5 April 2017.

Although the mental health problems of college students have been the subject of increasing research, there are no studies about its prevalence in Ecuadorian college students. The aim of this study was to determine the mental health problems and their associated factors in Ecuadorian freshmen university students. A sample of 1092 students (53.7% women; mean age = 18.3 years) were recruited from the Technical Particular University of Loja (Ecuador). Socio-demographic, academic, and clinical characteristics were gathered, as well as information on the participants’ mental health through a number of mental health screens. Prevalence of positive screens was 6.2% for prevalence of major depressive episodes, 0.02% for generalized anxiety disorders, 2.2% for panic disorders, 32.0% for eating disorders, 13.1% for suicidal risk. Mental health problems were significantly associated with sex, area of study, self-esteem, social support, personality and histories of mental health problems. The findings offer a starting point for identifying useful factors to target prevention and intervention strategies aimed at university students.

Objectives: The primary aim was to assess the feasibility/acceptability of a preventive cognitive-behavioral intervention implemented via conference call for caregivers. The secondary aim was to conduct a preliminary assessment of the efficacy of the behavioral activation component alone compared to the complete cognitive-behavioral intervention. Method: Sixty-one caregivers (mean age 58.4 years) were randomly assigned to a cognitive-behavioral intervention via conference call (CBC, n = 20), a behavioral activation intervention via conference call (BAC, n = 22) or a control group receiving usual care (CG, n = 19). Both interventions consisted of five 90-minute group sessions implemented weekly. Results: Only 6.6% of caregivers discontinued the study. In the CBC and BAC groups, attendance and satisfaction with the intervention were similarly high among both groups. Homework adherence was also high in both groups. At post-treatment, there was a lower incidence of depression in the CBC and BAC groups compared to the CG (0.0% for BAC and CBC vs. 10.5% for CG). The relative risk was 0.0, and number needed to treat was 10 in both groups. Depressive symptoms were significantly reduced in the CBC and BAC groups compared to the CG (d = 2.18 and d = 2.06). Conclusion: The results support the feasibility of the intervention. Moreover, the BAC intervention was non-inferior to the CBC intervention for reducing depressive symptoms.

Eficacia de las intervenciones psicológicas breves para reducir los síntomas depresivos en cuidadores: Revisión sistemática y meta-análisis [Efficacy of brief psychological interventions to reduce depressive symptoms in caregivers: Systematic Review ...]

Although depression is a common problem in caregivers and there are effective cognitive-behavioral interventions for its prevention, the ability of caregivers to attend these treatments is often limited by logistics. Furthermore, the efficacy of the components of these interventions is unknown. The objectives of this study are to (a) evaluate the efficacy of a telephone-administered cognitive-behavioral intervention to prevent depression with all its components (cognitive and behavioral) and only with behavioral activation, and to (b) analyze the mediators of the change in depressive symptoms. A randomized controlled clinical trial was designed to dismantle the components of a cognitive-behavioral intervention. Caregivers with elevated depressive symptoms will be randomly assigned to a cognitive-behavioral intervention, an intervention with only the behavioral activation component, or a usual care control group. Each condition will consist of approximately 60 participants. The two interventions will consist of five sessions lasting 90 min each, applied to groups of about 5 participants at a time via conference call. Trained interviewers, blind to the experimental conditions, will conduct the assessments at the pre-treatment, post-treatment and 1-, 3-, 6- and 12-month follow-ups. This study will provide evidence of the efficacy of a cognitive-behavioral intervention to prevent depression in caregivers with elevated depressive symptoms administered via conference call, and on the impact of the behavioral activation component on the overall efficacy of the program. If we find favorable results, it would mean that we have developed a program of prevention of depression of higher clinical utility and efficacy than those currently available, which would make it possible for a large number of caregivers to have access to such resources. ClinicalTrials.gov: NCT02292394 . Registered 6 November 2014.

Activities designed to be performed outside of the intervention are considered an essential aspect of the effectiveness of cognitive-behavioral therapy. However, these have received little attention in interventions aimed at individuals with subclinical depressive symptoms who do not yet meet diagnostic criteria for depression (indicated prevention). In this study, the completion of tasks given as homework and their relationship with post-treatment depressive symptoms was with relation to an indicated prevention of depression intervention. Eighty-nine female non-professional caregivers recruited from an official registry completed an intervention involving 11 homework tasks. Tasks performed were recorded and depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES–D). Among caregivers, 80.9% completed 9–11 tasks. The number of tasks performed was associated with post-treatment depressive symptoms, with 9 being optimal for clinically significant improvement. These findings highlight the relationship between homework and post-treatment depressive symptoms.