Naturalistic use of a digital mental health intervention for depression and anxiety: A randomized clinical trial.

Background: Digital mental health interventions (DMHI) may offer scalable treatment for common mental health conditions. However, many commercially available apps have not been subjected to rigorous evaluation of effectiveness, particularly among users experiencing clinically significant symptomatology. We examined depression and anxiety symptom outcomes associated with a top-rated, commercially available self-guided DMHI based on cognitive behavioral therapy ("Sanvello") relative to waitlist control.

Comparing cognitive behavioral therapy and social prescribing in patients with loneliness on long-term opioid therapy to reduce opioid misuse: protocol for a randomized controlled trial.

Background: Patients with chronic pain on opioids frequently experience loneliness, which is associated with poorer health outcomes and higher risk for opioid misuse and opioid use disorder. Given that almost half of opioids are prescribed in primary care, a critical need exists for the development and testing of interventions to reduce loneliness in primary care patients at risk for opioid misuse. Cognitive behavioral therapy and social prescribing have been shown to be efficacious in reducing loneliness and improving outcomes in other populations but have not been tested in patients at risk for substance use disorder.

Associations of Resilience, Perceived Control of Health, and Depression with Geriatric Outcomes after Surgery.

Objective: To identify if depression, resilience, and perceived control of health are related to 2.5-year mortality and instrumental activities of daily living (IADL) decline among older adults after surgery.

Summary Background Data: The relationships of psychosocial factors with postoperative mortality and IADL decline among older adults are understudied.

Behavioral Health Workforce Development in Washington State: Addition of a Behavioral Health Support Specialist.

The mental and behavioral health workforce shortage has hindered access to care in the United States, resulting in long waitlists for persons who need behavioral health care. Global models for task sharing, combined with U.S.

"There's So Much That They're Enduring": Experiences of Older Adults Undergoing Major Elective Surgery.

Objective: This qualitative study aimed to explore the psychosocial experience of older adults undergoing major elective surgery from the perspective of both the patient and family caregiver.

Summary Background Data: Older adults face unique psychological and social vulnerabilities that can increase susceptibility to poor health outcomes. How these vulnerabilities influence surgical treatment and recovery is understudied in the geriatric surgical population.

Use and Engagement With Low-Intensity Cognitive Behavioral Therapy Techniques Used Within an App to Support Worry Management: Content Analysis of Log Data.

Background: Low-intensity cognitive behavioral therapy (LICBT) has been implemented by the Improving Access to Psychological Therapies services across England to manage excessive worry associated with generalized anxiety disorder and support emotional well-being. However, barriers to access limit scalability. A solution has been to incorporate LICBT techniques derived from an evidence-based protocol within the Iona Mind Well-being app for Worry management (IMWW) with support provided through an algorithmically driven conversational agent.

Course of Subtypes of Late-Life Depression Identified by Bipartite Network Analysis During Psychosocial Interventions.

Importance: Approximately half of older adults with depression remain symptomatic at treatment end. Identifying discrete clinical profiles associated with treatment outcomes may guide development of personalized psychosocial interventions.

Objective: To identify clinical subtypes of late-life depression and examine their depression trajectory during psychosocial interventions in older adults with depression.

"We are the sun for our community:" Partnering with community health workers/promotores to adapt, deliver and evaluate a home-based collaborative care model to improve equity in access to quality depression care for older U.S. Latino adults who are underserved.

Background: While depression is a leading cause of poor health, less than half of older adults receive adequate care. Inequities in both access and outcomes are even more pronounced for socially disadvantaged older adults. The collaborative care model (CCM) has potential to reduce this burden through community-based organizations (CBOs) who serve these populations.

Treatment Decision-Making Preferences of Older Depressed Minority Primary Care Patients.

Little research examined the decision-making preferences of older, racially and ethnically diverse minority patients with untreated depression. The study's aims were to identify decision-making preferences and the characteristics associated with a more active preference in the decision-making process for general medical and depression treatment decisions. We assessed the preferred involvement in making general medical and depression treatment decisions of 201 older primary care patients with untreated depression.

Task Sharing to Expand Access to Care: Development of a Behavioral Health Support Specialist.

Task sharing improves access to mental health care in many countries, but little formative research has examined uptake in the United States. This Open Forum proposes the development of nonspecialist professional roles to deliver low-intensity behavioral interventions for common mental health conditions in U.S.

Message-based psychotherapy for older adults: A cohort comparison study.

Objective: Digital Mental Health Interventions (DMHI) can diminish inequities in mental health care provision. As DMHIs increase in popularity, however, older adults may be unintentionally excluded due to barriers such as lack of awareness, internet access, digital tools, technological socialization and education, physiological accessibility, and communication technology infrastructure. The aim of this study was to examine longitudinal treatment engagement patterns and 15-week clinical outcomes of depressed and anxious older adults compared to a matched cohort of younger adults seeking treatment from a large asynchronous telemedicine provider.

Protocol for a collaborative randomised effectiveness trial of lay-delivered versus clinician-delivered behavioural activation in senior centres.

Introduction: Depression is common among community-dwelling older adults who make use of senior centre services yet remains undertreated due to a lack of acceptable and available treatments. Emerging evidence suggests that lay health providers can offer psychosocial interventions for mental health disorders experienced by older adults. We developed a streamlined Behavioural Activation intervention (called 'Do More, Feel Better'; DMFB) to be delivered by older adult volunteers and propose to compare its effectiveness to that of clinician-delivered behavioural activation (BA).

A low-intensity behavioral intervention for depression in older adults delivered by lay coaches: proof-of-concept trial.

Objectives: A broader workforce is necessary to expand U.S. geriatric mental health services.

"Do More, Feel Better": Pilot RCT of Lay-Delivered Behavioral Activation for Depressed Senior Center Clients.

This pilot randomized control trial (RCT) tested "Do More, Feel Better" (DMFB), a lay-delivered Behavioral Activation intervention for depressed senior center clients. The study examined: (1) the feasibility of training older lay volunteers to fidelity; and (2) the acceptability, safety, and impact of the intervention. Twenty-one lay volunteers at four senior centers were trained in DMFB.

Development and Implementation of an Integrated Care Fellowship.

Background: Integrated care is a common approach to leverage scarce psychiatric resources to deliver mental health care in primary care settings.

Objective: Describe a formal clinical fellowship devoted to professional development for the integrated care psychiatrist role.

Methods: The development of a formal year-long clinical fellowship in integrated care is described.

Modernizing Training in Psychotherapy Competencies With Adaptive Learning Systems: Proof of Concept.

Purpose: This proof-of-concept study assessed the feasibility, acceptability, and effectiveness of an intelligent tutoring system (ITS) as a classroom adjunct to improve training bachelor of social work (BSW) students in client engagement strategies.

Methods: We codeveloped the ITS with 11 undergraduate students and pilot tested it with six BSW students enrolled in a class on telephone-based cognitive behavioral therapy (tCBT). Student competencies in tCBT were assessed by expert review of role-plays.

Preventing depression in older people with multimorbidity: 24-month follow-up of a trial of internet-delivered cognitive behaviour therapy.

Background: older people coping with the impacts of living with multimorbidity are at increased risk of developing a depressive disorder.

Objective: this article reports the 24-month results of a randomised controlled trial of an internet-delivered cognitive behaviour therapy, which aimed to test whether depressive disorders could be prevented in this population.

Participants: community-based participants aged 65 years and over, who had two or more chronic physical health conditions and were assessed as having no current depressive disorder.

Understanding Psychological Distress and Protective Factors Amongst Older Adults During the COVID-19 Pandemic.

Objectives: This study examined the emotional distress and loneliness during COVID-19 and the roles of resiliency and activities.

Design: A cross-sectional national survey.

Setting: Amazon Mechanical Turk (mTurk) and Prolific Research Platforms.

Provider Perspectives on Implementing Shared Decision Making for PTSD Treatment in VA Primary Care.

Shared decision making is an important implementation "pull" strategy for increasing uptake of evidence-based mental health practices. In this qualitative study, we explored provider perspectives on implementing shared decision making at the point of mental health treatment initiation using a publicly available, patient-facing decision support tool for post-traumatic stress disorder (PTSD). We conducted semi-structured interviews with 22 mental health providers (psychiatrists, nurses, psychologists, and social workers) working in one of five VA primary care clinics.