The Efficacy of a Scheduled Telephone Intervention for Ameliorating Depressive Symptoms During the First Year After Traumatic Brain Injury
To determine whether an intervention designed to improve functioning after traumatic brain injury (TBI) also ameliorates depressive symptoms. Single-blinded, randomized controlled trial comparing a scheduled telephone intervention to usual care. One hundred seventy-one persons with TBI discharged from an inpatient rehabilitation unit. The treatment group received up to 7 scheduled telephone sessions over 9 months designed to elicit current concerns, provide information, and facilitate problem solving in domains relevant to TBI recovery. Brief Symptom Inventory-Depression (BSI-D) subscale, Neurobehavioral Functioning Inventory-Depression subscale, and Mental Health Index-5 from the Short-Form-36 Health Survey. Baseline BSI-D subscale and outcome data were available on 126 (74%) participants. Randomization was effective except for greater severity of depressive symptoms in the usual care (control) group at baseline. Outcome analyses were adjusted for these differences. Overall, control participants developed greater depressive symptom severity from baseline to 1 year than did the treatment group. The treated group reported significantly lower depression symptom severity on all outcome measures. For those more depressed at baseline, the treated group demonstrated greater improvement in symptoms than did the controls. Telephone-based interventions using problem-solving and behavioral activation approaches may be effective in ameliorating depressive symptoms following TBI. Proactive telephone calls, motivational interviewing, and including significant others in the intervention may have contributed to its effectiveness.
[Show abstract] [Hide abstract] ABSTRACT: Background: There are a couple of independent studies examining the effectiveness of telephone based therapy for the treatment of depression. However, up-to-date systematic reviews are lacking. Objective: To evaluate the effectiveness of telephone-based therapy in the management of patients suffering from depression compared with the usual care. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted that compared telephone-based therapy with usual care for depression. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL (up to August 28, 2012) to identify eligible studies. The primary outcome was depression level at the end of the intervention. We pooled the mean depression level data from the studies using standardized mean difference using the random-effects model. Results: A total of 11 studies met the inclusion criteria. Nine of these studies was considered for the pooled analysis. Comparison of depression levels in the immediate post-intervention period from the seven studies included in the pooled analysis was in favour of telephone-based therapy (standardized mean difference = -0.43; 95% CI: -0.74-0.12). In the remaining two studies, telephone-based therapy resulted in a statistically significant improvement in clinical outcomes and patient satisfaction. A longer duration of intervention and the presence of known medical comorbidity was positively associated with the effectiveness of telephone-based therapy. The overall effect was stable when studies with extreme characteristics were excluded. Intervention results were found to be sustained throughout the follow-up period. Conclusion: Telephone-based therapy could be more effective than face-to face therapy in reducing the symptoms of depression. However, further research is required to establish the applicability and costeffectiveness of telephone-based therapy for routine depression management in health systems0Comments 0Citations
- "Participants had different types and stages of depression. Four studies [18,565758 included participants with known medical comorbidities, such as, diabetes, breast cancer, multiple sclerosis and brain injury while the rest of the studies included participants without knowing medical comorbidities. In one study, at least one study TBT and telephone care management were administrated in patients under antidepressant treatment  . "
[Show abstract] [Hide abstract] ABSTRACT: This paper provides a selective review of cognitive and psychological flexibility in the context of treatment for psychological distress after traumatic brain injury, with a focus on acceptance-based therapies. Cognitive flexibility is a component of executive function that is referred to mostly in the context of neuropsychological research and practice. Psychological flexibility, from a clinical psychology perspective, is linked to health and well-being and is an identified treatment outcome for therapies such as acceptance and commitment therapy (ACT). There are a number of overlaps between the constructs. They both manifest in the ability to change behaviour (either a thought or an action) in response to environmental change, with similarities in neural substrate and mental processes. Impairments in both show a strong association with psychopathology. People with a traumatic brain injury (TBI) often suffer impairments in their cognitive flexibility as a result of damage to areas controlling executive processes but have a positive response to therapies that promote psychological flexibility. Overall, psychological flexibility appears a more overarching construct and cognitive flexibility may be a subcomponent of it but not necessarily a pre-requisite. Further research into therapies which claim to improve psychological flexibility, such as ACT, needs to be undertaken in TBI populations in order to clarify its utility in this group.1Comment 0Citations
- "This suggests they may be similar constructs but currently being viewed from different psychological perspectives. It is well established that people with a TBI often suffer from cognitive inflexibility as a result of damage to their executive processes but research also indicates that they respond positively to different forms of psychological therapy (Bombardier et al., 2009;Hodgson, McDonald, Tate, & Gertler, 2005;Hsieh et al., 2012;Medd & Tate, 2000;Simpson et al., 2011). If increases in psychological flexibility are central to improvements in such therapy outcomes, this suggests that cognitive flexibility, as measured by task-based neuropsychological tests, may not be a prerequisite for psychological flexibility. "
- "All but one of the studies (Powell,Heslin and Greenwood, 2002) indicates that non drug treatments are effective in the treatment of depression following brain injury. Effect size meta-analysis plot[fixed effects] -3 -2 -1 1 Tiersky, et al. 2005Pow ell, et al. 2002Ouellet, et al. 2009Ouellet, et al. 2009Medd and Tate, 2000Guetin, et al. 2009Geurtsen, et al. 2008Finset and Andersson, 2000Bradbury, et al. 2008Bradbury, et al. 2008Bombardier, et al. 2009Arundine, 2009Statistical test for heterogeneity is significant (I 2 = 47.6%, Q = 20.99, "