Adrian Aguilera

Familism and psychological health: the intervening role of closeness and social support

Familism, a cultural value that emphasizes warm, close, supportive family relationships and that family be prioritized over self, has been associated with psychological health. The goal of this work was to fill a gap in the literature on how familism contributes to psychological health. Drawing from conceptual links between familism and close relationship processes, we hypothesized that familism contributes to better psychological health by facilitating closeness and social support. A university sample of U.S. women and men of Latino (n = 173), European (n = 257), and Asian (n = 642) cultural backgrounds completed measures of familism, closeness to family members, general perceived social support, and psychological health as indexed by perceived stress, general mental health, and depressive symptoms. Structural equation multiple-group modeling analyses found direct effects of familism on closeness to family members and perceived social support and an indirect effect of familism on better psychological health via greater closeness to family members and greater perceived social support. These effects did not differ by cultural background. Consistent with previous research, however, Latinos reported the highest levels of familism of the three cultural groups, and women reported higher familism and support as well as poorer psychological health than men. Discussion is focused on the implications of these findings for understanding the association of familism with psychological health and the relevance of the familism construct for diverse U.S. groups.

Group cognitive‐behavioral therapy for depression in Spanish: culture‐sensitive manualized treatment in practice

The authors applied cognitive-behavioral therapy (CBT) for depression using the Healthy Management of Reality treatment manual. This 16-week group treatment comprised four 4-week modules: thoughts (cognitive restructuring), activities (behavioral activation), people (interpersonal skills training), and health (addresses physical health and depression). They illustrated the use of the culture-sensitive treatment manuals by way of the member characteristics and clinical process of a Spanish-language CBT group for depression. They highlighted the challenges and satisfactions of working with a Spanish-speaking population in the public sector, and focused on how culture and socioeconomic status influence patients, and how to adapt treatment to these factors. Last, they demonstrated how technological advances integrate with culture-sensitive, evidence-based treatments to better serve this population and reduce disparities.

Daily mood ratings via text message as a proxy for clinic based depression assessment

BACKGROUND Mobile and automated technologies are increasingly becoming integrated into mental health care and assessment. The purpose of this study was to determine how automated daily mood ratings are related to the Patient Health Questionnaire-9 (PHQ-9), a standard measure in the screening and tracking of depressive symptoms. RESULTS There was a significant relationship between daily mood scores and PHQ-9 scores, and between one-week average mood scores and PHQ-9 scores, controlling for linear change in depression scores. PHQ-9 scores were not related to the average of two week mood ratings. This study also constructed models using variance, maximum, and minimum values of mood ratings in the preceding week and two-week periods as predictors of PHQ-9. None of these variables significantly predicted PHQ-9 scores when controlling for daily mood ratings and the corresponding averages for each period. LIMITATIONS This study only assessed patients who were in treatment for depression, therefore findings might not generalize to the relationship between text message mood ratings for those who are not depressed. The sample was also predominantly Spanish speaking and low-income making generalizability to other populations uncertain. CONCLUSIONS Our results show that automatic text message based mood ratings can be a clinically useful proxy for the PHQ-9. Importantly, this approach avoids the limitations of the PHQ-9 administration, which include length and a higher requirement for literacy.

Interpreting the Outcomes of Automated Internet-Based Randomized Trials: Example of an International Smoking Cessation Study

Background Smoking is one of the largest contributors to the global burden of disease. Internet interventions have been shown to reduce smoking rates successfully. However, improved methods of evaluating effectiveness need to be developed for large-scale Internet intervention trials. Objective To illustrate a method to interpret outcomes of large-scale, fully automated, worldwide Internet intervention trials. Methods A fully automated, international, Internet-based smoking cessation randomized controlled trial was conducted in Spanish and English, with 16,430 smokers from 165 countries. The randomized controlled trial replicated a published efficacy trial in which, to reduce follow-up attrition, 1000 smokers were followed up by phone if they did not provide online follow-up data. Results The 7-day self-reported abstinence rates ranged from 36.18% (2239/6189) at 1 month to 41.34% (1361/3292) at 12 months based on observed data. Given high rates of attrition in this fully automated trial, when participants unreachable at follow-up were presumed to be smoking, the abstinence rates ranged from 13.63% (2239/16.430) at 1 month to 8.28% (1361/16,430) at 12 months. We address the problem of interpreting results with high follow-up attrition rates and propose a solution based on a smaller study with intensive phone follow-up. Conclusions Internet-based smoking cessation interventions can help large numbers of smokers quit. Large-scale international outcome studies can be successfully implemented using automated Internet sites. Interpretation of the studies’ results can be aided by extrapolating from results obtained from subsamples that are followed up by phone or similar cohort maintenance methods. Trial Registration ClinicalTrials.gov NCT00721786; http://clinicaltrials.gov/ct2/show/NCT00721786 (Archived by WebCite at http://www.webcitation.org/63mhoXYPw)

From Online Randomized Controlled Trials to Participant Preference Studies: Morphing the San Francisco Stop Smoking Site into a Worldwide Smoking Cessation Resource

Background Internet interventions have the potential to address many of the health problems that produce the greatest global burden of disease. We present a study illustrating this potential. The Spanish/English San Francisco Stop Smoking Internet site, which yielded quit rates of 20% or more at 12 months in published randomized controlled trials (RCTs), was modified to make it accessible to Spanish- and English-speaking smokers 18 years of age or older anywhere in the world. Objective To illustrate that Internet interventions designed to conduct RCTs can be adapted to serve as universal health care resources. We also examine quit rates obtained in the current participant preference study (in which users could choose from all elements tested in previous RCTs) to determine whether they differ from the quit rates found in the RCTs. Methods We modified the San Francisco Stop Smoking Internet site so that, instead of being randomly assigned to a specific intervention, participants could personalize the site by choosing among nine site elements (eg, stop smoking guide, reminder emails, journal, mood management intervention, or virtual group). Participants completed a baseline assessment, and reported smoking and mood data at 1-, 3-, 6-, and 12-month follow-ups. We assessed the modified website’s reach and outcomes (quit rates), and compared the quit rates of the current participant preference study with those of the previous RCTs. Results In the first year of recruitment, 94,158 individuals from 152 countries and territories visited the site; 13,488 participants left some data; 9173 signed consent; 7763 completed the baseline survey; and 1955, 1362, 1106, and 1096 left 1-, 3-, 6-, and 12-month data, respectively. Observed quit rates were 38.1% (n = 668), 44.9% (n = 546), 43.6% (n = 431), and 45.4% (n = 449), respectively. The current participant preference study yielded higher observed quit rates (odds ratio 1.30) than the previous RCT when controlling for individuals’ demographic and smoking characteristics. Conclusions After strict RCTs are completed, Internet intervention sites can be made into worldwide health intervention resources without reducing their effectiveness. Trial Registration Clinicaltrials.gov NCT00721786; http://clinicaltrials.gov/ct2/show/NCT00721786 (Archived by WebCite at http://www.webcitation.org/66npiZF4y)

Qualitative Feedback From a Text Messaging Intervention for Depression: Benefits, Drawbacks, and Cultural Differences

Background Mobile health interventions are often standardized and assumed to work the same for all users; however, we may be missing cultural differences in the experiences of interventions that may impact how and if an intervention is effective. Objective The objective of the study was to assess qualitative feedback from participants to determine if there were differences between Spanish speakers and English speakers. Daily text messages were sent to patients as an adjunct to group Cognitive Behavioral Therapy (CBT) for depression. Methods Messages inquired about mood and about specific themes (thoughts, activities, social interactions) of a manualized group CBT intervention. There were thirty-nine patients who participated in the text messaging pilot study. The average age of the participants was 53 years (SD 10.4; range of 23-72). Results Qualitative feedback from Spanish speakers highlighted feelings of social support, whereas English speakers noted increased introspection and self-awareness of their mood state. Conclusions These cultural differences should be explored further, as they may impact the effect of supportive mobile health interventions. Trial Registration Trial Registration: Clinicaltrials.gov NCT01083628; http://clinicaltrials.gov/ct2/show/study/NCT01083628 (Archived by WebCite at http://www.webcitation.org/6StpbdHuq).

Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art

Mobile phones are becoming a communication tool commonly used by people all over the world; and they are started to be adopted in psychosocial therapies involving vulnerable people. We are herein presenting the results of an academic literature review. We identified scientific papers published between 2006 and 2015 resorting to academic databases available on the Internet, applying a systematic selection method based on quality criteria. Secondly, we analysed contents, highlighting the scarcity of research involving vulnerable people. The available literature specialized in psychosocial therapies offers investigation results which involve mobile phones and patients in general, focusing particularly on the clinical psychology field and, to a lesser extent, on the social work field. Particularly significant are the investigation works developed in the United States. In the present paper we introduce a first “state of the art”, identifying opportunities and also the limitations surrounding the use of mobile phones in psychosocial therapies targeting the vulnerable. Issues concerning privacy and data confidentiality, and the access of vulnerable people to mobile phones and how they use them, pose significant challenges; but they offer the opportunity to reach isolated or impoverished populations, or even to facilitate access to social and healthcare services. We close this paper formulating possible orientations, hypotheses and goals to design new investigation works involving vulnerable populations.

Automated Text Messaging as an Adjunct to Cognitive Behavioral Therapy for Depression: A Clinical Trial

Background Cognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy. Objectives The aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, we aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients. Methods Patients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week’s content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills. Results Intent-to-treat analyses on therapy attendance during 16 sessions of weekly therapy found that patients assigned to the text messaging adjunct stayed in therapy significantly longer (median of 13.5 weeks before dropping out) than patients assigned to the control condition (median of 3 weeks before dropping out; Wilcoxon-Mann-Whitney z=−2.21, P=.03). Patients assigned to the text messaging adjunct also generally attended more sessions (median=6 sessions) during this period than patients assigned to the control condition (median =2.5 sessions), but the effect was not significant (Wilcoxon-Mann-Whitney z=−1.65, P=.10). Both patients assigned to the text messaging adjunct (B=−.29, 95% CI −0.38 to −0.19, z=−5.80, P<.001) and patients assigned to the control conditions (B=−.20, 95% CI −0.32 to −0.07, z=−3.12, P=.002) experienced significant decreases in depressive symptom severity over the course of treatment; however, the conditions did not significantly differ in their degree of symptom reduction. Conclusions This study provides support for automated text messaging as a tool to sustain engagement in CBT for depression over time. There were no differences in depression outcomes between conditions, but this may be influenced by low follow-up rates of patients who dropped out of treatment.

Ecological momentary interventions for depression and anxiety

Ecological momentary interventions (EMIs) are becoming more popular and more powerful resources for the treatment and prevention of depression and anxiety due to advances in technological capacity and analytic sophistication. Previous work has demonstrated that EMIs can be effective at reducing symptoms of depression and anxiety as well as related outcomes of stress and at increasing positive psychological functioning. In this review, we highlight the differences between EMIs and other forms of treatment due to the nature of EMIs to be deeply integrated into the fabric of peoples day‐to‐day lives. EMIs require unique considerations in their design, deployment, and evaluation. Furthermore, given that EMIs have been advanced by changes in technologies and that the use of behavioral intervention technologies for mental health has been increasing, we discuss how technologies and analytics might usher in a new era of EMIs. Future EMIs might reduce user burden and increase intervention personalization and sophistication by leveraging digital sensors and advances in natural language processing and machine learning. Thus, although current EMIs are effective, the EMIs of the future might be more engaging, responsive, and adaptable to different people and different contexts.

How Can Geography and Mobile Phones Contribute to Psychotherapy

Interdisciplinary relationships between Geography and Psychotherapy are an opportunity for innovation. Indeed, scientific works found on bibliographic databases and concerning this theme are scarce. Geographical sub-fields, such as the Geography of Emotions or Psychoanalytical Geography have started to emerge, theorizing about and interpreting feelings, emotions, moods, sufferings, of the chronically ill or diversified social groups and sites. But a less theoretical and more practical approach, in the sense of proposing, predicting and intervening, is lacking; as well as research into the possibilities offered by communication technologies and mobile phones. In the present work, we present the results of a review of the most relevant scientific works published internationally; we reflect on the contributions of Geography and mobile phones to psychosocial therapies and define the orientation and questions that should be posed in future research, from the point of view of geography and regarding psychotherapy. We conclude that the production of georeferenced data via mobile phones concerning the daily lives of people opens great possibilities for cognitive behavioural therapy and mental health. They allow for the development of personalized mood maps that locate the places where a person experiences greater or lesser stress on a daily basis; they allow for a cartography of emotions, a cognitive cartography of the places we access physically or through the Internet, of our feelings and psychosocial experiences. They open the door to the possibility of offering personalized psychotherapy treatments focusing on the ecological-environmental analysis of the places frequented by the person on a daily basis.