Abstract:Objective: Previous research on the minimal clinically important difference (MCID) for depression and anxiety is based on population averages. The present study aimed to identify the MCID across the spectrum of baseline severity.Study Design and Settings: The present analysis used secondary data from 2 randomized controlled trials for depression ( n = 1,122) to calibrate the Global Rating of Change with the PHQ-9 and GAD-7. The MCID was defined as a change in scores corresponding to a 50% probability of patien… Show more
“…Time-point was entered as a fixed effect and participant as a random effect to account for the repeated measures design. As change in depression is influenced by baseline severity (Bauer-Staeb et al, 2021), we entered baseline PHQ-9 scores as a fixed effect. To assess the reliability of these findings we repeated this analysis with another measure of depression, the BDI-II.…”
Background: It has been proposed that antidepressants operate by increasing sensitivity to positive versus negative information. Increasing positive affective learning within social contexts may play a key role in remediating negative self-schema. We investigated the association between change in biased learning of social evaluations about the self and others, and mood during early antidepressant treatment. Method: Prospective cohort assessing patients recruited from primary care sites in South West England at four timepoints over the first 8 weeks of antidepressant treatment. At each timepoint participants completed self-report measures of depression (BDI-II, PHQ-9), anxiety (GAD-7), and a computerised task measuring learning of social evaluations about the self, a friend, and a stranger. Results: We did not find evidence that learning about the self was associated with a reduction in PHQ-9 (b=0.08, 95%CI:-0.05,0.20, p=0.239) or BDI-II scores (b=0.10, 95%CI:-0.18,0.38, p=0.469). We found some weak evidence that increased positive learning about the friend was associated with a reduction in BDI-II scores (b=0.30, 95%CI:-0.02, 0.62, p=0.069). However, exploratory analyses indicated stronger evidence that increased positive learning about the self (b=0.18, 95% CI:0.07,0.28, p=0.002) and a friend (b=0.22, 95%CI:0.10,0.35, p=0.001) was associated with a reduction in anxiety.Conclusions: Change in social evaluation learning was more reliably associated with a reduction in anxiety rather than depression. Antidepressants may treat anxiety symptoms by remediating negative affective biases towards socially threatening information directed towards the self and close others. However, our findings are based on exploratory analyses within a small sample and require further replication.
“…Time-point was entered as a fixed effect and participant as a random effect to account for the repeated measures design. As change in depression is influenced by baseline severity (Bauer-Staeb et al, 2021), we entered baseline PHQ-9 scores as a fixed effect. To assess the reliability of these findings we repeated this analysis with another measure of depression, the BDI-II.…”
Background: It has been proposed that antidepressants operate by increasing sensitivity to positive versus negative information. Increasing positive affective learning within social contexts may play a key role in remediating negative self-schema. We investigated the association between change in biased learning of social evaluations about the self and others, and mood during early antidepressant treatment. Method: Prospective cohort assessing patients recruited from primary care sites in South West England at four timepoints over the first 8 weeks of antidepressant treatment. At each timepoint participants completed self-report measures of depression (BDI-II, PHQ-9), anxiety (GAD-7), and a computerised task measuring learning of social evaluations about the self, a friend, and a stranger. Results: We did not find evidence that learning about the self was associated with a reduction in PHQ-9 (b=0.08, 95%CI:-0.05,0.20, p=0.239) or BDI-II scores (b=0.10, 95%CI:-0.18,0.38, p=0.469). We found some weak evidence that increased positive learning about the friend was associated with a reduction in BDI-II scores (b=0.30, 95%CI:-0.02, 0.62, p=0.069). However, exploratory analyses indicated stronger evidence that increased positive learning about the self (b=0.18, 95% CI:0.07,0.28, p=0.002) and a friend (b=0.22, 95%CI:0.10,0.35, p=0.001) was associated with a reduction in anxiety.Conclusions: Change in social evaluation learning was more reliably associated with a reduction in anxiety rather than depression. Antidepressants may treat anxiety symptoms by remediating negative affective biases towards socially threatening information directed towards the self and close others. However, our findings are based on exploratory analyses within a small sample and require further replication.
“…While outcomes are worse in PLWD than a matched sample without dementia, the difference pre- and post-intervention in PLWD does appear to be clinically meaningful. 38 While causality cannot be established by this study design, our work does provide initial evidence that psychological therapies offered in primary care mental health services may be effective in reducing symptoms of depression and anxiety in PLWD. Moreover, it appears that around 62% of PLWD reliably improve and 40% reliably recover following IAPT therapy.…”
“…3 c, d). While the Wellness Qlinic is a relatively new initiative and our sample size is too small to draw conclusions generalizable to the population, this preliminary data suggests that integration of multiple modalities of care into the SRC model may contribute to clinically significant improvement for our patients and can be considered in planning models of mental health care delivery (Bauer-Staeb et al, 2021 ). Fig.…”
The Weill Cornell Medicine Wellness Qlinic (Wellness Qlinic) is a student-run mental health clinic serving the lesbian, gay, bisexual, transgender, and queer (LGBTQ +) community in New York City. Student-run clinics have successfully provided primary care to underserved communities experiencing barriers to accessing health care. Psychiatric evaluation and medication management have also been implemented in several student-run clinics, but providing sustainable psychotherapy services has been a challenge. In this paper, we present a student-run mental health program incorporating interdisciplinary trainees to provide robust short-term psychiatric treatment, including individual psychotherapy, medication management, and group therapy. Results of a chart-review study to evaluate patient engagement and treatment outcomes are presented. The Wellness Qlinic’s treatment model resulted in 90% patient retention and positive clinical outcomes for patients while addressing an education and training gap in LGBTQ + mental health for multidisciplinary mental health care providers.
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