Midterm 2 Flashcards
In Ritvo’s/CAMH study, inclusions involved:
Age range:
BDI-II score:
Language fluency in:
Confirmation of psychiatric disorder of MDD done through process of:
18-30 years (youth)
BDI-II of at least mild severity (equal or above 14); no upper limit
English
Mini interview
Trial exclusion criteria for online mental health study by Ritvo involved:
Individuals currently receiving: _________
Meeting ______ criteria for _________ in the past ___ months
Clinically significant _______ defined as imminent intent, or attempted suicide in the last ______ months
Comorbid diagnosis: 5 items
Weekly structured psychotherapy
DSM-V criteria for severe alcohol/substance use disorder in the past 3 months
Clinically significant suicide ideation, attempted in last 6 months
BPD, schizophrenia, bipolar disorder, OCD
An issue with the BDI-II is that it’s ______-ogenic
Depressogenic
What are some aspects of BDI-II’s curriculum?
Sadness, pessimism, past failure, loss of pleasure, guilty feelings, punishment feelings, negativity & self negativity, agitation, de-vitalization, changes in sleep/diet, tiredness
What are the similarities and difference in treatment between control and experimental group in Ritvo’s study on online mental health?
Patients in both groups received standard psychiatric care available at CAMH.
Experimental subjects additionally received the online CBT-MM intervention.
What is the difference between intention-to-treat and per-protocol analyses?
In ITT, all subjects are assessed (including drop-outs) whereas with PP only subjects who receive adequate proportions of intervention are assessed (i.e., takes into account only those who make it through the whole study)
What was the effect size in the within group findings (Cohen’s d) from Ritvo’s study on depression/online mental health?
d = 1.90, i.e., very large
What was the scale for anxiety used in Ritvo’s study on online mental health?
What was the effect size in the within group findings for anxiety from Ritvo’s study on online mental health?
Beck Anxiety Inventory
ES: Cohen’s d = 1.55; very large
Which other 2 scales were used in Ritvo’s online mental health study (other than ones mentioned first for depression and anxiety), and what were each of their effect sizes?
Hamilton Depression Rating Scale; d = 1.60
Quick Inventory of Depressive Symptomatology; d = 1.38
What percent symptom reductions were found in Ritvo/CAMH (2019)’s study?
53.4%
What differentiated CAMH online mental health study from Thase et al., 2018?
Dealt with a medicated population (per standard care CAMH) and 54.5% of patients were put on E-CBT for 24 sessions, whereas the other study had 7 sessions of E-CBT for 43% of the patients
What was unique about Ritvo/CAMH’s trial?
Diagnosed MDD, combined standard psychiatry with e-CBT, no reduction/withdrawal from drugs, significant remission %, all patients diagnosed by CAMH psychiatrists with confirmation from mini interview, blinded HDRS assessments, and no limit on depression severity
Ritvo/CAMH study:
N = _____ subjects in severe depression at baseline
N = _____ subjects in remission at follow up
% reduction was ____%, but overall mean reduction of ____% at follow up
N = 10; N = 5, 66%, 37.2%
Ritvo/CAMH study:
N = ___ subjects in moderate depression at baseline
N = ___ subjects in remission at follow up
Mean reduction of ___%, but overall mean reduction of ___%
N = 6, N =5, 72%, 61%
Ritvo/CAMH study:
N = __ subjects in mild depression at baseline
N = __ subjects in remission at follow up
Mean reduction of ____%, overall reduction of ___%
N = 3, N = 2, 66.6%, 47.3%
Ritvo/CAMH study:
N = ___ non responders defined by:
1)
2)
Reasons:
N = 6, defined by:
1) not remitted
2) <40% symptom reduction
Reasons: unmotivated, non-adherent, and social withdrawal
Wait list control subjects in Ritvo/CAMH study:
N = ____
N = ____ with completed measures
N = ____ dropped out after baseline (before 3 months)
N = ____ dropped out (after 3 months)
___% retention, ____% dropout
23 consented
9 with completed measures
9 dropped out after baseline
5 dropped out
39% retention, 61% dropout
What was the retention rate for intervention group in Ritvo/CAMH study?
91%, N = 20 with completed measures
True/false; in Ritvo/CAMH study, it’s likely that the control group had a high dropout rate because the subjects had an early response to effective treatment
False; 5 completed 3 month measures, and 2 were in remission but 3 were not in remission
What % of intervention group completers in Ritvo/CAMH study at 6 months?
60% (12/20 participants)
What are the mean BDI-II scores in Ritvo/CAMH study at baseline and follow up in intervention and control groups?
intervention :
29.2 BDI baseline
13.6 BDI follow up
53% mean reduction
control:
26.8 BDI baseline
19.7 BDI follow up
26% mean reduction
Aside from BDI-II, BAI, QIDS & HDRS, what 2 other scales were used in CAMH/Ritvo study?
Which study found a non-significant p-value?
BPI = Brief Pain Inventory
FFMQ: 5-Facet Mindfulness Questionnaire
HDRS had a non-significant p-value of 0.09
What was used in the online intervention against each of the BDI items in CAMH study?
web browser, video, and text content
What consisted of the 5-way multi-modal approach in CAMH/Ritvo study?
CBT workbooks
Steps exercise - fitbit monitoring
Mindfulness - relaxation practices (videos)
Text messages
Therapeutic alliance (sincere effort to help those who are down, i.e., generosity)
How many steps were found to help with depression in CAMH/Ritvo study?
> 5000 steps/day
Data indicates that service-provision is reduced for ______ and those who are _____ from the _______ core
ethnically diverse; distant from the downtown core
What is the ‘triple win’? (Ritvo & diabetes)
Improved health and prevention of chronic disease and prevention of worsening disease
Reduced cost
Improved economy
What is a digital divide?
Access to computer, smartphone, and internet technology is centered on urban geography and higher SES vs. rural areas and lower
Digital access is divided by ethnicity, language, and race
At range of CDA score of >8.5, what health afflictions become more likely?
Eye, kidney diseases and nerve damage
What is the link between stress and increasing CDA scores?
As you’re more stressed, you’re more indiscriminate about food and exercise, increasing CDA score and accentuating disease as a result
What are the benefits of exercise in relation to coronary heart disease and Type II diabetes?
20-30% reduction of CHD in men, 10-20% reduction in women
Decreases HbA1c in individuals with Type IID
Decreases/delays incidence of Type IID
What percentage of Canadians meet recommended physical activity guidelines?
18%
What are the similarities and differences between study designs for full intervention vs. enhanced usual care groups in Ritvo’s diabetes study?
Similarities: both have web/text support and exercise program
Differences: Full intervention group has unlimited access and number of contacts to health coaches, and access to smartphone and HealthCoach software
Whereas enhanced usual care group has access to health coach on site and just 1 phone contact/week, and no access to smartphone or HealthCoach software
What were the results in HbA1c levels between the groups in Ritvo diabetes study?
Both groups had reduced HbA1c but online intervention group’s impacts happened more within 3 months, whereas control group took 6 months for a significant effect; very important implications for health costs and triple win
What was the primary outcome collected at 0, 3, 6 months in Ritvo’s diabetes study?
Glycosylated hemoglobin (HbA1C)
What were the secondary outcomes collected at baseline and 6 months in Ritvo’s diabetes study?
Cholesterol, BMI, waist circumference;
Profile of Mood States, Center for Epidemiologic Studies-Depression Scales, Satisfaction with Life Scale, Positive and Negative Affect Scale, Hospital Anxiety and Depression Scale
What were the Black Creek Pilot outcomes for the 12 participants with baseline HbA1c > or = 7.0%?
Baseline = 8.26%
Follow up = 7.83%
True/false; Black Creek outcomes for the 8 participants with baseline HbA1C < 7.0% had no significant change from baseline to follow up
True; baseline = 6.43% & follow up = 6.41%, indicating they might be less motivated
What are the advantages of using the Type II diabetes patients targeted in Black Creek Community Health Centre for the study?
Multi-ethnic, modest-SES patients, many of which were introduced to smartphone connectivity for the first time
Participation was also supported by multi-modal, face-to-face programming (e.g., exercise room, exercise training videos, volunteer trainers)
What happened to a model participant’s Diamicron prescription when their HbA1c when from 8.5 to 7.0%
What does Diamicron do?
Physion decreased daily dose of Diamicron from 60mg to 30mg in response to lower glucose levels
Diamicron lowers blood glucose by increasing the amount of insulin produced by the pancreas
What is the difference between a pragmatic and explanatory trial?
Pragmatic = purposely inclusive, belief that treatment is beneficial to everyone
Explanatory = purposely limited, to find who responds to treatment
In Quinn’s Diabetes study, what was the study design? What were the requirements for eligible physicians?
Cluster-randomized RCT conducted in primary care practices in 4 distinct sectors of Maryland
Eligible practices were groups of 3 or more physicians without academic affiliation who provided diabetes care to more than 10% of their patients and were identified from a generic list of primary care practices in study sectors
What were the inclusions for Black Creek study?
Type II diabetes dx with hemoglobin A1c > or = 7.3
Pragmatic trial, therefore no exclusions for SES or psychiatric status
Age < 70 y/o
All subjects recruited from Black Creek Community Health Centre and North York Family Health Team
What was the mean total contact between subjects and health coaches in Black Creek study (via secure messaging, phone, and/or in-person meetings)?
38 min/week
What were the mental health effects found in Black Creek study?
General mental health effect but significant with negative affect scale/DS: anxiety subscale
What are the 5 ways in which technology impacts us?
-values
-tactile to visual balance
-internal vs. external processing (introversion – extraversion)
-tribalization vs. peaceful divergence (democracy)
-sensation seeking vs. conscientiousness
Competitions between technologies lead to _____ & ______
Conflicts and warfare
What are the 4 aspects of the sensation seeking scale?
-Disinhibition
-Boredom Susceptibility
-Thrill & danger seeking
-Experience seeking
What are the 4 tendencies of conscientiousness?
Industrious, norm adhering, planful, thoughtful inhibiting of impulses (neuro inhibition = fine-tuning)
What are the Big Five personality traits most consistently associated with positive health and longevity?
Openness, conscientiousness, extraversion, agreeableness, low neuroticism
What does walking (steps taken) or sedentariness predict?
Behavioural activation in relation to stress;
If a person is resilient under stress, walking persists; if a person gets depressed, walking ceases, or reduces
What is #1 in hierarchy of evidence?
Systematic reviews & meta-analyses
What were the results of the wearable technology study?
Statistically significant increases in PA steps/day found for intervention conditions; concluded that wearable devices positively impact physical health in clinical populations with cardiometabolic diseases
What was the inclusion criteria in the wearable tech study?
English language, peer-reviewed RCTs assessing effectiveness of wearable device intervention on PA levels in adults, with subjects who were clinically diagnosed by a health-care professional or who met self-reported criteria for cardiometabolic chronic disease (CVD, diabetes, obesity, etc.)
Not limited by gender, ethnicity, country, length or type of chronic condition; nor level or type of healthcare service delivery
Interventions in wearable tech study used a non-invasive ______ that monitored _________
______ that administered _____ were excluded given the difficulties of comparisons with noninvasive devices
health-sensing wearable devices (e.g., Fitbit) that monitored PA behaviour change outcome (e.g., steps/day) for the entire intervention
Invasive devices that administered medications (e.g., artificial pancreas) were excluded
Which bias domain is sourced from random sequence generation & allocation concealment?
Selection bias