depression

Importance Prepregnancy care and counseling optimize maternal health before conception to improve outcomes for mothers and infants. In the US, 66.4% of reproductive-aged women have at least 1 modifiable risk factor for adverse pregnancy outcomes.

Observations For all individuals desiring pregnancy, recommended interventions include folic acid supplementation; cessation of tobacco, alcohol, cannabis, and opioids; immunizations against hepatitis B virus, varicella, and rubella; and screening for syphilis and HIV. Folic acid use before pregnancy is associated with reduced fetal neural tube defects (relative risk [RR], 0.67; 95% CI, 0.52-0.87). Maternal tobacco smoking is associated with increased risks of stillbirth (summary RR [sRR], 1.46; 95% CI, 1.38-1.54), neonatal death (sRR, 1.22; 95% CI, 1.14-1.30), and perinatal death (sRR, 1.33; 95% CI, 1.25-1.41). Screening for and treatment of syphilis and HIV prior to and during pregnancy decrease rates of fetal and neonatal infection. Prepregnancy immunizations against hepatitis B virus, varicella, and rubella decrease neonatal infection and mortality. Individuals using tobacco, alcohol, cannabis, and opioids should receive counseling and treatment prior to pregnancy (eg, buprenorphine or methadone for opioid use disorder). For individuals with chronic disease, routine health examinations and contraceptive care in the year before conception can optimize pregnancy timing and are associated with decreased risk of severe maternal morbidity. Compared with planned pregnancies, unintended pregnancies are associated with increased risk of postpartum depression (15.7% vs 9.6%; adjusted odds ratio [aOR], 1.51; 95% CI, 1.40-1.70), preterm birth (9.4% vs 7.7%; aOR, 1.21; 95% CI, 1.12-1.31), and low infant birth weight (7.3% vs 5.2%; aOR, 1.09; 95% CI, 1.02-1.21). Weight loss prior to conception is recommended for individuals with a body mass index of 25 or greater because overweight and obesity are associated with increased risk of gestational diabetes, gestational hypertension, and cesarean delivery. Among patients with pregestational diabetes (type 1 or 2), hemoglobin A1c of less than 6.5% is associated with a decreased risk of fetal anomaly compared with hemoglobin A1c of 6.5% or greater. Cardiovascular complications such as hypertension and heart failure occur in 15% of pregnancies and are more common among those with preexisting cardiovascular disease. These patients should receive counseling on maternal and neonatal risk, monitoring, and medication management by specialists in cardiology and maternal fetal medicine.

Conclusions and Relevance Prepregnancy counseling and care reduce maternal morbidity and neonatal morbidity and mortality. Primary care–based discussion of reproductive goals, immunizations, screening for infections and substance use, and risk-reducing interventions such as folate supplementation can optimize outcomes in individuals contemplating pregnancy.

Author/s:

Kylie M. Cooper, Linda M. Szymanski, Paru S. David

HEADSSS Assessment

Megan George — Wed, 04 Feb 2026 18:21:19 +0000

Date Added:

February 4, 2026

Journal/Publication:

Teach Me Paediatrics

Publication Date:

July 24, 2018

URL:

HEADSSS Assessment

Type:

Clinical Decision Aids

Format:

Web Page

Keywords

MeSH

HEADSSS is a set of questions relevant to the care of adolescents. James W. Mold, MD, MPH

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The HEADSSS assessment is an internationally recognised tool used to structure the assessment of an adolescent patient, encompassing Home, Education/Employment, Activities, Drugs, Sex and relationships, Self harm and depression, Safety and abuse. The assessment starts with simple and easy questions about life to allow a rapport to be built, before delving into more personal and embarrassing aspects.

The assessment does not necessarily have to be completed in one sitting, it may take multiple conversations to build up the trust for the young person to disclose such personal information to you. Once a HEADSSS assessment is completed, it is important to document your findings in the notes and communicate appropriate information to other members of the healthcare team. Follow through on any offers of help or support you have made.

If concerns about the young person’s safety have been raised, you must explain to them that you need to pass that information on to the relevant agency. Reassure them that the main priority is their safety and establish what they will do in the meantime to help keep themselves safe.

Author/s:

Dr Nicola Martin, Dr Louise Ingram, Adam Bonfield

Pharmacologic Treatment of Perinatal Depression

Megan George — Fri, 21 Nov 2025 19:44:10 +0000

Date Added:

November 21, 2025

Journal/Publication:

JAMA Insights

Publication Date:

November 19, 2025

URL:

Pharmacologic Treatment of Perinatal Depression

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.17250

Keywords

Pharmacology

Perinatal Depression

Major Depressive Disorder

abuse

depression

PMID (1):

41259042

A review of the treatment of patients with perinatal depression with an emphasis on pharmalogic therapy. James W. Mold, MD, MPH

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Approximately 1 in 7 individuals are affected by perinatal depression, defined as a depressive episode occurring during pregnancy or within 12 months after delivery. Although the diagnostic criteria are similar to those of major depressive disorder, perinatal depression may also include symptoms such as difficulty forming an emotional attachment with the fetus or infant, persistent doubts about parenting abilities, and intrusive thoughts of harm to self or infant.1 Mental health conditions are leading contributors to maternal mortality in the US; among reporting states, the rate of death from perinatal suicide ranges from 4.2 to 21.4 per 100 000 pregnancies.2 Untreated or undertreated perinatal depression increases other maternal risks, including limited engagement in care, impaired relationships, substance use, preeclampsia, and suicide, as well as fetal or neonatal risks, including preterm birth, low birth weight, and disrupted attachment with long-term developmental consequences.3 Individuals from marginalized communities, such as those who are non–English speaking, uninsured, or geographically isolated, experience a higher prevalence of perinatal depression and are at increased risk of underdiagnosis and undertreatment.3

Risk factors for perinatal depression include a personal or family history of depression, abuse, stressful life events, low socioeconomic status, adolescent or single parenthood, and pregnancy complications, such as preterm birth or pregnancy loss. Each factor individually confers only a small increase in risk, making accurate prediction based on clinical factors challenging.4 Therefore, to facilitate early identification and treatment, universal screening during and after pregnancy is recommended. The American College of Obstetricians and Gynecologists (ACOG) recently issued 2 Clinical Practice Guidelines on perinatal mental health, 1 on screening and diagnosis5 and 1 on treatment and management,3 highlighting opportunities for obstetricians to address existing health gaps.

Author/s:

Emily S. Miller, S. Karlene Cunningham, Lauren M. Osborne

Uniting depression care through generalism: a primary care-informed response to the Lancet–World Psychiatric Association Commission’s call for action on depression

Megan George — Thu, 06 Nov 2025 14:44:00 +0000

Date Added:

November 6, 2025

Journal/Publication:

The Lancet

Publication Date:

October 9, 2025

URL:

Uniting depression care through generalism: a primary care-informed response to the Lancet–World Psychiatric Association Commission’s call for action on depression

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.lanprc.2025.100042

Keywords

MeSH

I thoughtful, evidence-based set of recommendations for improving the care of patients with depression in primary care settings. James W. Mold, MD, MPH

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In this Viewpoint, we respond to the 2022 Lancet–World Psychiatric Association Commission’s call for united action on depression. We present primary care-focused recommendations synthesised from key outcomes of 16 observational cohorts of adults with depression in primary care, representing more than 26 000 individuals from 26 countries. Identified areas for action included prediction of the depression severity trajectory, the complexity of the depressive experience, and the need for tailored yet holistic depression-care plans. Personal resilience and reductions in social burden were identified as powerful predictors of improved depression outcomes. Aimed at policy makers in primary care, researchers, and primary care providers, our recommendations emphasise a generalist model of care that is person focused and trauma informed. We advocate for increased primary care capacity for depression risk prediction, social support integration, care navigation, and continuity of care. By bridging the gap between primary care and psychiatric knowledge, our recommendations provide actionable guidance for reducing the global burden of depression.

Author/s:

Alison Flehr, Christopher Dowrick, Catherine Kaylor-Hughes, Jane Gunn

Cognitive Behavior Therapy for Mental Disorders in Adults: A Unified Series of Meta-Analyses

Alex Haga — Mon, 19 May 2025 15:17:16 +0000

Date Added:

May 19, 2025

Journal/Publication:

JAMA Psychiatry

Publisher:

JAMA

Publication Date:

April 16, 2025

URL:

Cognitive Behavior Therapy for Mental Disorders in Adults: A Unified Series of Meta-Analyses

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamapsychiatry.2025.0482

Keywords

cognitive behavior therapy

mental disorders

counseling

PMID (1):

40238104

MeSH

Cognitive Behavioral Therapy

depression

anxiety disorders

Obsessive-Compulsive Disorder

Stress Disorders

stress disorder, post-traumatic

Cognitive behavioral therapy appears to be effective for treating a wide variety of psychiatric disorders. James W. Mold, MD, MPH

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Importance: Cognitive behavior therapy (CBT) is a first-line treatment for most mental disorders. However, no meta-analytic study has yet integrated the results of randomized clinical trials on CBT across different disorders, using uniform methodologies and providing a complete overview of the field.

Objective: To examine the effect sizes of CBT for 4 anxiety disorders, 2 eating disorders, major depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and psychotic and bipolar disorders on symptoms of the respective disorders using uniform methodologies for data extraction, risk of bias (RoB) assessment, and meta-analytic techniques.

Data sources: Major bibliographical databases (PubMed, PsycINFO, and Embase for all disorders) were searched up to January 1, 2024, for each disorder separately. Data analysis was performed from August 2024 to January 2025.

Study selection: Randomized clinical trials comparing CBT with inactive control conditions in adults with 1 of the mental disorders established through a clinical interview were included.

Data extraction and synthesis: Basic characteristics of patients, CBT, and studies were extracted. RoB was assessed with the Cochrane RoB tool 2. Meta-analyses were conducted using random-effects models.

Main outcomes and measures: The primary outcome was the standardized mean difference (Hedges g) indicating the difference between CBT and controls at posttreatment on symptoms of the respective disorders.

Results: A total of 375 trials (423 comparisons) between CBT and controls were included among 32 968 patients. The overall mean (SD) patient age was 43.4 (13.7) years, and the mean (SD) proportion of women was 0.68 (0.24). Effect sizes for CBT compared to all control conditions (g) were lower than 0.5 for bipolar and psychotic disorder; between 0.5 and 1.0 for panic, social anxiety, and generalized anxiety disorders, bulimia nervosa, binge eating disorders, depression, and OCD; and larger than 1.0 for PTSD and specific phobias (range of effect sizes: 0.31 for bipolar disorder to 1.27 for PTSD). Large effect sizes (g > 0.94) were observed in waitlist-controlled trials, a control condition mostly used in anxiety and eating disorders, PTSD, and OCD. Trials using care as usual showed more modest effect sizes (0.22-1.13). Study dropout rates within the CBT conditions ranged from 8% for specific phobia to 24% for PTSD.

Conclusions and relevance: In this unified series of meta-analyses, CBT was probably effective in the treatment of mental disorders, including major depression, anxiety disorders, PTSD, OCD, and eating disorders, and possibly effective in psychotic and bipolar disorders. However, the effect sizes depended on the type of control condition.

Author/s:

Pim Cuijpers, Mathias Harrer, Clara Miguel, Marketa Ciharova, Davide Papola, Djordje Basic, Cristina Botella

Diagnosis and management of depression in adolescents

Alex Haga — Wed, 06 Nov 2024 14:34:56 +0000

Date Added:

November 6, 2024

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

May 29, 2023

Issue:

Volume:

195

Pages:

E739-E746

URL:

Diagnosis and management of depression in adolescents

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.220966

Keywords

PMID (1):

37247881

MeSH

depression

child

A concise review of the diagnosis and treatment of adolescents who are depressed. James W. Mold, MD, MPH

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KEY POINTS
Depression is common among adolescents in Canada and has the potential to negatively affect long-term function and quality of life; despite this, in most affected adolescents depression remains undetected and untreated.

Management requires a multimodal approach, including risk assessment, psychoeducation, psychotherapeutic and pharmacologic treatment, and interventions to address contributing factors.

Support from child and adolescent psychiatrists may be required in the case of diagnostic uncertainty and complex presentations, as well as for patients who do not respond to first-line treatments.

Author/s:

Daphne J Korczak, Clara Westwell-Roper, Roberto Sassi

Nonpharmacologic Treatments for Maternal Mental Health Conditions

Alex Haga — Tue, 20 Aug 2024 19:53:30 +0000

Date Added:

August 20, 2024

Journal/Publication:

Agency for Healthcare Research and Quality

Publication Date:

July 31, 2024

URL:

Nonpharmacologic Treatments for Maternal Mental Health Conditions

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

Cognitive Behavioral Therapy

counseling

Postpartum period

An evidence-based review of non-pharmocologic treatments for maternal mental health conditions. James W. Mold, MD, MPH

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Objectives. This systematic review evaluates nonpharmacologic treatments for mental health conditions during the perinatal period (pregnancy and up to 12 months postpartum). We evaluated nonpharmacologic treatments for perinatal individuals with depressive disorders, anxiety disorders, bipolar disorder, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD).

Data sources and review methods. We searched MEDLINE®, PsycINFO®, Embase®, CINAHL®, the Cochrane Register of Clinical Trials, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from January 1, 2000, to January 17, 2024, to identify relevant randomized controlled trials (RCTs). Nonpharmacologic interventions of interest included, among others, cognitive behavioral therapy (CBT), interpersonal therapy (IPT), exercise, non-directive counseling, behavioral activation, bright light therapy, eye movement desensitization and reprocessing (EMDR), and acupuncture. Outcomes of interest were improvement in scores on psychological assessment tools, cure or resolution of symptoms, suicide-related outcomes, and adherence to treatment. PROSPERO registration number: CRD42023440650.

Results. We identified 103 RCTs. Nonpharmacologic treatments were compared to control or each other in 101 RCTs and to pharmacologic treatments in 2 RCTs. The risk of bias was moderate for the majority of included studies, mostly related to lack of blinding. For perinatal individuals with depressive disorders, CBT was more effective than treatment as usual (TAU) to reduce depressive and anxiety symptoms (both moderate strength of evidence [SoE]); IPT was more effective than TAU to treat depressive symptoms (moderate SoE) and anxiety symptoms (low SoE); and both behavioral activation (a CBT technique, with low SoE) and exercise interventions (moderate SoE) were more effective than TAU to reduce depressive symptoms. Remission rates for depressive symptoms were higher with CBT and IPT compared to TAU (both low SoE) and higher with specific acupuncture than nonspecific or sham acupuncture (low SoE). There were no differences between CBT and non-directive counseling (an active patient-led intervention), between counseling and TAU, and between bright light and placebo light therapy (all low SoE). CBT was more effective than TAU to reduce anxiety and depressive symptoms for individuals with combined depressive and anxiety disorders (low SoE). Few (or no) eligible studies evaluated individuals with anxiety disorder, PTSD, OCD, or bipolar disorders, precluding conclusions for these conditions. There was also insufficient evidence for suicide-related outcomes, potential harms of treatment, and adherence to treatment, and for comparisons of nonpharmacologic with pharmacologic treatments.

Conclusion. Several nonpharmacologic treatments are more effective than TAU for perinatal mental health conditions, with the strongest evidence for CBT and IPT to reduce depressive symptoms among perinatal individuals with depressive disorders or combined depressive and anxiety disorders. Future research is needed to evaluate the comparative effectiveness of lesser studied nonpharmacologic interventions and lesser studied perinatal mental health conditions.

Obesity in Adolescents: A Review

Alex Haga — Sat, 10 Aug 2024 18:21:58 +0000

Date Added:

August 10, 2024

Journal/Publication:

JAMA

Publication Date:

August 5, 2024

URL:

Obesity in Adolescents: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.11809

Keywords

PMID (1):

39102244

MeSH

cardiovascular diseases

diabetes mellitus

diabetes mellitus, type 2

depression

Life Style

exercise

A review of obesity management in adolescents. James W. Mold, MD, MPH

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Importance: Obesity affects approximately 21% of US adolescents and is associated with insulin resistance, hypertension, dyslipidemia, sleep disorders, depression, and musculoskeletal problems. Obesity during adolescence has also been associated with an increased risk of mortality from cardiovascular disease and type 2 diabetes in adulthood.

Observations: Obesity in adolescents aged 12 to younger than 18 years is commonly defined as a body mass index (BMI) at the 95th or greater age- and sex-adjusted percentile. Comprehensive treatment in adolescents includes lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Lifestyle modification therapy, which includes dietary, physical activity, and behavioral counseling, is first-line treatment; as monotherapy, lifestyle modification requires more than 26 contact hours over 1 year to elicit approximately 3% mean BMI reduction. Newer antiobesity medications, such as liraglutide, semaglutide, and phentermine/topiramate, in combination with lifestyle modification therapy, can reduce mean BMI by approximately 5% to 17% at 1 year of treatment. Adverse effects vary, but severe adverse events from these newer antiobesity medications are rare. Surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy) for severe adolescent obesity (BMI ≥120% of the 95th percentile) reduces mean BMI by approximately 30% at 1 year. Minor and major perioperative complications, such as reoperation and hospital readmission for dehydration, are experienced by approximately 15% and 8% of patients, respectively. Determining the long-term durability of all obesity treatments warrants future research.

Conclusions and relevance: The prevalence of adolescent obesity is approximately 21% in the US. Treatment options for adolescents with obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Intensive lifestyle modification therapy reduces BMI by approximately 3% while pharmacotherapy added to lifestyle modification therapy can attain BMI reductions ranging from 5% to 17%. Surgery is the most effective intervention for adolescents with severe obesity and has been shown to achieve BMI reduction of approximately 30%.

Author/s:

Aaron S Kelly, Sarah C Armstrong, Marc P Michalsky, Claudia K Fox

Management of Depression in Adults: A Review

Alex Haga — Sun, 16 Jun 2024 18:49:55 +0000

Date Added:

June 16, 2024

Journal/Publication:

JAMA

Publication Date:

June 10, 2024

URL:

Management of Depression in Adults: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.5756

Keywords

depression

Adults

PMID (1):

38856993

MeSH

depression

Depressive Disorder

depressive disorder, major

Bipolar Disorder

antidepressive agents

anxiety disorders

substance-related disorders

Self-Injurious Behavior

A comprehensive review of what we currently know about the treatment of depression in adults. James W. Mold, MD, MPH

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Importance: Approximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women.

Observations: Major depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression. A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]).

Conclusions and relevance: Effective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success.

Author/s:

Gregory E Simon, Nathalie Moise, David C Mohr

Exercise as a treatment for depression

Erin Blanchette — Tue, 14 May 2024 16:30:32 +0000

Date Added:

May 14, 2024

Journal/Publication:

Canadian Medical Association Journal

Publisher:

Canadian Medical Association

Publication Date:

May 5, 2024

Issue:

Volume:

196

Pages:

E596-E96

URL:

Exercise as a treatment for depression

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.231288

Keywords

PMID (1):

38719220

MeSH

depression

Depressive Disorder

Depressive Disorder / therapy

Depression / therapy

exercise

exercise therapy

Exercise Therapy / methods

Supervised exercise works as well as and more consistently (NNT=2) then antidepressants in adults with depression. James W. Mold, MD, MPH

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Exercise effectively treats depression and may decrease suicide attempts

A 2023 meta-analysis of randomized controlled trials (RCTs) found that supervised, group or non-group, moderate- or vigorous-intensity, aerobic or resistance exercises (excluding mind–body activities such as yoga) decreased depressive symptoms among participants with depression, with a number needed to treat of 2 and an effectiveness comparable to first-line treatments such as psychotherapy and medication. Another 2023 meta-analysis of RCTs found that exercise decreased suicide attempts among people with mental or physical illness.

Author/s:

Carl Zhou, Nicholas Fabiano

Improving behavioral health outcomes in primary care

Alex Haga — Mon, 13 May 2024 21:14:31 +0000

Date Added:

May 13, 2024

Journal/Publication:

Oklahoma Primary Healthcare Improvement Cooperative

Type:

Best Local Practices

Format:

Article

Keywords

MeSH

referral and consultation

An overview of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) initiative being implemented in primary care practices in Oklahoma. James W. Mold, MD, MPH

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Screening, Brief Intervention, and Referral to Treatment in Oklahoma (SBIRT-OK)
is an evidence-based, integrated approach to identify and intervene with patients whose
patterns of tobacco, alcohol, and/or drug use, or depression, put their health at risk.

Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials

Erin Blanchette — Tue, 26 Mar 2024 16:46:24 +0000

Date Added:

March 26, 2024

Journal/Publication:

Canadian Medical Association Journal

Publisher:

Canadian Medical Association

Publication Date:

March 17, 2024

Issue:

Volume:

196

Pages:

E327-E340

URL:

Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.230274

Keywords

cognitive behavioural therapy

CBT

telehealth

teletherapy

PMID (1):

38499303

MeSH

anxiety disorders

depression

alcoholism

Cognitive Behavioral Therapy

Feeding and Eating Disorders

Videoconferencing

Telecommunications

Cognitive behavioral therapy seems to be just as effective when delivered virtually. James W. Mold, MD, MPH

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Background: Cognitive behavioural therapy (CBT) has been shown to be effective for several psychiatric and somatic conditions; however, most randomized controlled trials (RCTs) have administered treatment in person and whether remote delivery is similarly effective remains uncertain. We sought to compare the effectiveness of therapist-guided remote CBT and in-person CBT.

Methods: We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to July 4, 2023, for RCTs that enrolled adults (aged ≥ 18 yr) presenting with any clinical condition and that randomized participants to either therapist-guided remote CBT (e.g., teleconference, videoconference) or in-person CBT. Paired reviewers assessed risk of bias and extracted data independently and in duplicate. We performed random-effects model meta-analyses to pool patient-important primary outcomes across eligible RCTs as standardized mean differences (SMDs). We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to assess the certainty of evidence and used the Instrument to Assess the Credibility of Effect Modification Analyses (ICEMAN) to rate the credibility of subgroup effects.

Results: We included 54 RCTs that enrolled a total of 5463 patients. Seventeen studies focused on treatment of anxiety and related disorders, 14 on depressive symptoms, 7 on insomnia, 6 on chronic pain or fatigue syndromes, 5 on body image or eating disorders, 3 on tinnitus, 1 on alcohol use disorder, and 1 on mood and anxiety disorders. Moderate-certainty evidence showed little to no difference in the effectiveness of therapist-guided remote and in-person CBT on primary outcomes (SMD -0.02, 95% confidence interval -0.12 to 0.07).

Interpretation: Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care. Systematic review registration: Open Science Framework (https://osf.io/7asrc).

Author/s:

Sara Zandieh, Seyedeh Maryam Abdollahzadeh, Behnam Sadeghirad, Li Wang, Randi E McCabe, Liam Yao, Briar E Inness, Ananya Pathak, Rachel J Couban, Holly Crandon, Kian Torabiardakani, Peter Bieling, Jason W Busse

What Is Perinatal Depression?

Erin Blanchette — Tue, 26 Mar 2024 16:36:41 +0000

Date Added:

March 26, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 14, 2024

URL:

What Is Perinatal Depression?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2024.0434

Keywords

Depressive Disorders

Psychiatry and Behavioral Health

Patient Information

Reproductive Health

Pregnancy

Postpartum Depression

Perinatal Depression

PMID (1):

38483381

MeSH

Information for patients about perinatal depression. James W. Mold, MD, MPH

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Perinatal depression can occur during pregnancy and the first 12 months after childbirth.

Perinatal depression, also called postpartum depression, affects about 1 in 7 perinatal individuals. More than 75% of these individuals receive no treatment for perinatal depression. Onset of perinatal depression may occur prepregnancy or may develop over the course of pregnancy and the postpartum period. Untreated perinatal depression is associated with an increased risk of suicide and has additional negative effects on the perinatal individual, the fetus (preterm birth, low birth weight), and the child (impaired attachment, which may affect neurodevelopment) and may negatively affect relationships with partners and other family members.

Author/s:

Rebecca Voelker

New in Spanish! Seasonal Affective Disorder Fact Sheet

Erin Blanchette — Tue, 12 Mar 2024 16:07:36 +0000

Date Added:

March 12, 2024

Journal/Publication:

National Institute of Mental Health

Publisher:

National Institute of Health

Publication Date:

February 26, 2024

URL:

New in Spanish! Seasonal Affective Disorder Fact Sheet

Type:

Patient Education Materials

Format:

Web Page

Keywords

spanish

Seasonal Affective Disorder

depression

light therapy

MeSH

Seasonal Affective Disorder

Information for patients about seasonal affective disorder. James W. Mold, MD, MPH

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This fact sheet provides information about seasonal affective disorder (SAD), a type of depression. It includes a description of SAD, signs and symptoms, how SAD is diagnosed, causes, and treatment options.

Esta hoja informativa ofrece una descripción del trastorno afectivo estacional, un tipo de depresión, e incluye información general sobre el trastorno, sus signos y síntomas, cómo se diagnostica, cuáles son las causas y las opciones de tratamiento disponibles.

What Is Bipolar Disorder?

Erin Blanchette — Thu, 07 Mar 2024 02:18:46 +0000

Date Added:

March 6, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 16, 2024

URL:

What Is Bipolar Disorder?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.24844

Keywords

PMID (1):

38363576

MeSH

Information for patients on bipolar disorder(s). James W. Mold, MD, MPH

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Bipolar disorder is characterized by mood swings ranging from depressive lows to manic highs.

Bipolar disorder affects about 8 million people in the US and an estimated 40 million individuals worldwide. Symptoms of bipolar disorder typically start between age 15 to 25 years, often with an initial episode of depression.

Author/s:

Rebecca Voelker