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Preventing depression in older adults living in low-income and middle-income countries is important because of scarce resources and high morbidity. In a randomized clinical trial, Dias and colleagues randomized 181 older adults with subsyndromal depressive symptoms in primary care clinics in India to a lay counselor intervention or usual care and found significantly fewer incident depressive episodes in the intervention arm over 12 months. In an Editorial, Thirthalli and colleagues discuss the study’s implications.
Digital cognitive behavior therapy is a scalable and effective therapy for insomnia. In a large randomized clinical trial, Espie and colleagues studied 1711 participants who received the intervention or sleep hygiene education as control; digital cognitive behavioral therapy was associated with a large and significant improvement in insomnia that mediated small improvements in health and psychological well-being and a large improvement in sleep-related quality of life. These results indicate that digital cognitive behavioral therapy improves multiple aspects of health in people with insomnia.
Continuing Medical Education
In men with depressive symptoms, adjunct testosterone treatment is a controversial option. Walther and colleagues conducted a meta-analysis of 27 randomized clinical trials comprising 1890 hypogonadal or eugonadal men and found that testosterone treatment is associated with a significant reduction in depressive symptoms and good acceptability compared with placebo. Thus, testosterone treatment appears to be efficacious in reducing depressive symptoms in men. In an Editorial, Bhasin and Seidman sound a cautionary note on use of testosterone in men with depression in clinical practice.
Author Audio Interview
As many as 1 in 5 children will experience an anxiety disorder, and psychological treatments are among the most effective ways to intervene. Zhou and colleagues used a network meta-analysis to examine the relative efficacy of different psychological interventions and found that group cognitive behavioral therapy (CBT) was the only intervention that was significantly more effective than a neutral control condition and most other psychotherapies. Therefore, group CBT should be considered the preferred treatment for children with anxiety disorders.
Associations between childhood trauma and psychotic experiences are reported, but the role of age of exposure or trauma type is unknown. Using data from a population-based birth cohort, Croft and colleagues studied 4433 individuals and found exposure to any trauma type up to age 17 years was significantly associated with psychosis at age 18 years; 45% of psychotic experiences were attributable to trauma, and exposure to multiple trauma types and during multiple age periods raised risk. The association between trauma in childhood and psychosis in early adulthood appears to be nonselective.
Highlights. JAMA Psychiatry. 2019;76(1):1. doi:10.1001/jamapsychiatry.2018.2960
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