Suchergebnisse

INTRODUCTION: The COVID-19 pandemic has driven unprecedented social and economic reform in efforts to curb the impact of disease. Governments worldwide have legislated non-essential service shutdowns and adapted essential service provision in order to minimise face-to-face contact. We anticipate major consequences resulting from such policies, with marginalised populations expected to bear the greatest burden of such measures, especially those with substance use disorders (SUDs). METHODS AND ANALYSIS: We aim to conduct (1) a scoping review to summarise the available evidence evaluating the impact of the COVID-19 pandemic on patients with SUDs, and (2) an evidence map to visually plot and categorise the current available evidence evaluating the impact of COVID-19 on patients with SUDs to identify gaps in addressing high-risk populations. ETHICS AND DISSEMINATION: Ethics approval is not required for this scoping review as we plan to review publicly available data. This is part of a multistep project, whereby we intend to use the findings generated from this review in combination with data from an ongoing prospective cohort study our team is leading, encompassing over 2000 patients with SUDs receiving medication-assisted therapy in Ontario prior to and during the COVID-19 pandemic.

Abstract. Background: For decades we have understood the risk factors for suicide in the general population but have fallen short in understanding what distinguishes the risk for suicide among patients with serious psychiatric conditions. Aims: This prompted us to investigate risk factors for suicidal behavior among psychiatric inpatients. Method: We reviewed all psychiatric hospital admissions (2008–2011) to a centralized psychiatric hospital in Ontario, Canada. Using multivariable logistic regression we evaluated the association between potential risk factors and lifetime history of suicidal behavior, and constructed a model and clinical risk score to predict a history of this behavior. Results: The final risk prediction model for suicidal behavior among psychiatric patients (n = 2,597) included age (in three categories: 60–69 [OR = 0.74, 95% CI = 0.73–0.76], 70–79 [OR = 0.45, 95% CI = 0.44–0.46], 80+ [OR = 0.31, 95% CI = 0.30–.31]), substance use disorder (OR = 1.30, 95% CI = 1.27–1.32), mood disorder (OR = 1.49, 95% CI = 1.47–1.52), personality disorder (OR = 2.30, 95% CI = 2.25–2.36), psychiatric disorders due to general medical condition (OR = 0.52, 95% CI = 0.50–0.55), and schizophrenia (OR = 0.42, 95% CI = 0.41–0.43). The risk score constructed from the risk prediction model ranges from −9 (lowest risk, 0% predicted probability of suicidal behavior) to +5 (highest risk, 97% predicted probability). Conclusion: Risk estimation may help guide intensive screening and treatment efforts of psychiatric patients with high risk of suicidal behavior.

Purpose: Major depressive disorder is the leading cause of disability worldwide. This study is part of a mixed methods pilot trial, exploring the effectiveness, acceptability, and feasibility of providing behavioral activation (BA) treatment in a group format. Methods: Using an applied, descriptive approach, qualitative data were collected from individual interviews (18) and focus groups (5) at multiple data points throughout the trial and feedback given to group facilitators, who adapted the program accordingly. Results: Group BA is an effective and acceptable treatment format when a client-centered, flexible approach is utilized. This contrasted with findings from the comparison intervention, a peer support group, from which participants reported no benefit. Conclusions: Group BA is beneficial in a fiscally responsible evidenced-based health-care culture. Comparator groups need to be carefully selected. Engaging patient and clinician perspectives when designing and implementing new clinical interventions is vital in informing future research and social work practice.

Purpose: This systematic survey evaluates the completeness of reporting in pilot and feasibility randomized controlled trials investigating behavioral interventions based on the Consolidated Standards of Reporting Trials (CONSORT) extension for pilot trials. Methods: The authors searched Medline/Pubmed and randomly selected 100 articles from 2012 through 2016 to determine the proportion of reported CONSORT extension items. They examined study factors related to reporting, including year and country of publication, psychotherapy intervention, multiple centers, industry funding, and journal endorsement of CONSORT. Results: The authors found that the mean reporting score on the CONSORT extension was 51.6% ( SD = 15.1). Studies of psychotherapy interventions had significantly higher reporting scores than other interventions (incidence rate ratio = 1.10, 95% confidence interval: 1.01–1.20). Conclusions: Our findings indicate that current reporting quality is suboptimal. Many included trials failed to provide rationale for piloting, assess feasibility objectives, or indicate clear progression to a future large trial. Reporting quality should be reevaluated following uptake of the 2016 CONSORT extension for pilot trials.

Behavioral and social sciences randomized controlled trials (BSSTs) have a significant role in life sciences. Choosing an appropriate control or comparator group for BSSTs is critical, to provide true intervention effects. The objective of this study was to determine the types of control groups used in BSSTs, and the rationale provided to justify these choices. We conducted a systematic survey of BSST protocols published between January 2012 and October 2016 in the Cochrane Library and Medline databases. We randomly selected 200 protocols. The study selection and data extraction were performed independently in duplicate. The most frequent control groups were active concurrent (97/200, 48.5%), and no treatment concurrent controls (88/200, 44.0%). The majority of studies (71.5%) did not provide justification for comparators choice. We concluded that BSSTs trials compare interventions to active and no treatment controls however the majority of trials lacked rationale for the selection of the study comparator.