Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.
The COVID-19 pandemic and its preventive measures had adverse consequences for mental health. However, knowledge of mental health trajectories across the pandemic is limited. This study investigated the mental health levels and changes among university students during the pandemic and lockdown in Germany, as well as their associated factors. We surveyed students' mental health (N = 363, 68% female) with the patient health questionnaire (PHQ-8) and the generalized anxiety disorder scale (GAD-7) during the first easing phase (July 2020; time 1) and the second lockdown (November 2020; time 2). Cut-off scores from the GAD-7 and PHQ-8 were used to determine clinically relevant symptoms and to define trajectory groups. Sociodemographic and pandemic-related data were assessed (e.g., coping with academic life, social contacts) as well as loneliness, stress, repetitive negative thinking, quality of life, and perceived social support. Paired t-test, multiple regression, and repeated-measures ANOVA were applied. Means and prevalence rates for symptoms of depression (38.8%) and anxiety (25.6%) did not differ between time 1 and time 2, and most students were asymptomatic on the PHQ-8 (44.4%) and the GAD-7 (56.3%) across the pandemic. Feelings of loneliness significantly increased from time 1 to time 2, d = −0.30, [−0.47, −0.13], with higher symptom levels in symptomatic groups at time 2 and greater increases in the asymptomatic groups. Levels of stress, repetitive negative thinking, quality of life, and social support did not differ during the pandemic. At time 1, loneliness and repetitive negative thinking were associated with anxiety and depressive symptoms. Anxiety and depressive symptoms were prevalent among students, and increased levels of loneliness during the pandemic were associated with elevated symptoms and differing trajectories. Further research using representative and larger samples should determine the long-term impact of the pandemic on mental health and loneliness to identify vulnerable students and offer adequate support.
Acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) is observed in 5 to 10% of patients treated with high-dose chemotherapies followed by autologous stem cell and bone marrow transplantation. Both diseases are frequently associated with monosomy 7 (-7), trisomy 8 (+8), loss of the long arm of chromosome 5 (-5q), and deletions including the TP53-gene region according to del(17)(p13). In this study, we examined whether these chromosomal aberrations are already detectable in blood stem cells from patients who have all been treated with standard chemotherapies prior to peripheral blood stem cell transplantation (PBSCT). Therefore, we screened peripheral blood derived stem cells obtained at the time of stem cell harvest for the presence of -7, +8, -5q, and del(17)(p13) by fluorescence in situ hybridization (FISH). Our series included 40 patients: 4 patients with Hodgkin's disease, 6 patients with non-Hodgkin-lymphoma (NHL), 1 patient with ALL, 4 patients with plasmocytoma, and 25 patients with solid tumors. Peripheral blood mononuclear cells (PBMC) from eight healthy blood donors served as controls. Assuming a hybridization efficiency of >98%, the cut-off level of non diploid cells was determined for each DNA-probe. None of the stem cell preparations exhibited chromosomal damage. Our findings indicate that chromosomal damage is a rare event in stem cell autografts.
Transdiagnostic cognitive-behavioral psychotherapy (TD-CBT) may facilitate treatment of emotional disorders. We investigate short- and long-term efficacy of TD-CBT for emotional disorders in individual, group, and Internet-based settings in randomized controlled trials (PROSPERO CRD42019141512). Two independent reviewers screened results from PubMed, MEDLINE, PsycINFO, Google Scholar, medRxiv, and OSF Preprints published between January 2000 and January 2023, selected studies for inclusion, extracted data and evaluated risk of bias (Cochrane risk-of-bias tool 2.0). Absolute efficacy from pre- to post-treatment and relative efficacy between TD-CBT and control treatments were investigated with random-effects models. Of 56 identified studies, 53 (6610 participants) were included in the meta-analysis. TD-CBT had large effects on depression (d = 1.15, 95%CI = 1.03 - 1.28) and anxiety (d = 1.08, 95%CI = 0.95 - 1.21), from pre- to post treatment. Across treatment formats, TD-CBT was superior to waitlist (depression: g = 1.31, 95%CI = 0.88 - 1.74; anxiety: g = 1.22, 95%CI = 0.82 - 1.63) and treatment-as-usual (depression: g = 0.87, 95%CI = 0.63 - 1.11; anxiety: g = 0.94, 95%CI = 0.57 - 1.30). TD-CBT showed comparable effects to disorder-specific treatments, with indications of TD-CBT’s superiority (depression: g = 0.16, 95%CI = 0.01 - 0.32; anxiety: g = 0.15, 95%CI = 0.04 - 0.26). Large effects were reported for Internet-based TD-CBT for up to 2 years. Studies were heterogeneous in design and methodological quality. This review and meta-analysis strengthens the evidence for TD-CBT as an efficacious treatment for emotional disorders in different settings.
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