Tag: Healthcare provider

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Efficacy and Safety of a Theta Burst Stimulation Protocol of Repetitive Transcranial Magnetic Stimulation in Treatment-Resistant Depression

Conditions: Major Depressive Disorder (MDD); Depression – Major Depressive Disorder

Interventions: Drug: antidepressant therapy; Device: Active rTMS Theta Burst Stimulation; Device: Sham Stimulation

Sponsors: Jung-Sun Lee; Korea Health Industry Development Institute; Seoul National University Hospital; Nowon Eulji Medical Center, Eulji University; Seoul St. Mary’s Hospital, The Catholic University

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Development of Virtual Mental Health Stepped Care Service for a Heart Failure Remote Management Program: Qualitative Descriptive Study

Background: Depression is highly prevalent yet undertreated among people living with heart failure, indicating barriers to mental health services. Although various digital mental health interventions have been developed to detect, treat, and manage depression in this population, these interventions have seen limited integration into clinical care and a lack of implementation research. Stepped care is a service innovation that may promote the implementation of these technologies into clinical settings, but few studies have examined how these services are designed in clinical settings. Objective: This study aimed to identify strategies to address health system barriers to accessing mental health care from the perspective of people living with heart failure, clinicians, and researchers, and to incorporate these strategies into the design of a virtual mental health stepped care service within a heart failure remote management program. Methods: A qualitative description study was conducted using purposive recruitment of people living with heart failure, clinicians, and researchers from a heart failure remote patient management program. As part of a service design approach, semistructured interviews explored potential strategies to address barriers to accessing mental health services. Two researchers coded the data descriptively and constructed themes to guide the development of a virtual stepped care service. Results: A total of 22 participants were interviewed, comprising 13 people living with heart failure and 9 clinicians and researchers. Six themes were identified, comprising 4 requirements and 2 foundational principles. The requirements were to (1) adopt a collective approach to identify distress across methods, people, and time points; (2) maintain a referral-based approach; (3) rely on existing mental health human resources; and (4) offer patient choice among various mental health care options. These requirements were supported by two principles: (1) building on organizational strengths and (2) reducing treatment burden. Based on these findings, a virtual stepped care service was developed, incorporating a depression screening module, referral-based workflows, and, where clinically appropriate, patient choice in treatment selection. Conclusions: The stakeholder-informed design of this virtual stepped care service contributes to the limited literature on stepped care service design and demonstrates how such models can be tailored to their intended contexts. Although each component was designed to address health system barriers to mental health care for people living with heart failure, resource limitations may constrain the balance between feasibility and quality of care. Future research should evaluate the acceptability of this model among people living with heart failure and clinicians.
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A longitudinal analysis of the prevalence of restrictive interventions involving women with mental health conditions, learning disabilities or autism in mental health services in England

IntroductionRestrictive interventions, including physical restraint, seclusion, chemical restraint, and segregation, continue to be used within mental health services, despite sustained policy efforts to promote least-restrictive and trauma-informed care. However, little is known about national trends affecting women, for whom restrictive interventions often carry heightened risks of re-traumatisation and stigma.MethodsWe conducted a longitudinal secondary analysis of publicly available administrative data from the Mental Health Bulletin covering NHS-funded mental health services in England between 2017 and 2025. Annual counts of restrictive interventions involving women were examined relative to the number of women detained under the Mental Health Act to estimate annual rates per 1,000 detained. Regression modelling was used to assess temporal trends overall, by age group and type of restrictive intervention, and interrupted time-series analyses to examine changes following implementation of the Mental Health Units (Use of Force) Act 2018 (“Seni’s Law”). Trends were also examined alongside available national data on restrictive interventions involving men.ResultsRates of restrictive interventions involving women increased by approximately 12 percent per year over the study period, with no evidence of a reduction following the introduction of Seni’s Law. Increases were most pronounced for chemical restraint, seclusion, and segregation, while physical and mechanical restraint remained stable. Restrictive interventions declined among women under 18 but increased consistently across all adult age groups, indicating a widening age-related divergence. Although overall trends broadly mirrored those observed among men, the types of restrictive interventions used and their potential impact may differ, highlighting gendered dimensions in how restrictive practices are experienced and applied.DiscussionDespite extensive national initiatives, restrictive interventions involving women have continued to rise in England, highlighting a persistent gap between policy intent and practice. The findings suggest that legislative frameworks alone are insufficient to achieve meaningful reductions without operational changes in clinical practice, organisational culture, and monitoring systems. Internationally, the study contributes rare gender-disaggregated longitudinal evidence and highlights the need for comparable monitoring systems and coordinated research to inform rights-based, trauma-informed strategies to reduce restrictive interventions in mental health services.
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How stressful life events are associated with depression: the mediating pathway of security in a clinical adolescent sample

BackgroundStressful life events are well-established risk factors for adolescent depression; however, the psychological mechanisms underlying this association remain insufficiently understood, particularly regarding which types of stress and which dimensions of security are most closely linked to depression. This study aimed to investigate whether security and its two sub-dimensions statistically mediated the association between stressful life events and depression among clinically diagnosed adolescents, while also examining the relative strength of indirect associations across specific stress types.MethodsA cross-sectional study was conducted with 284 adolescents (70.1% female; mean age = 15.82 ± 1.86 years) diagnosed with major depressive disorder according to the DSM-5 criteria at a tertiary psychiatric hospital in Western China. Participants completed the Adolescent Self-Rating Life Events Checklist (ASLEC), Self-Rating Depression Scale (SDS), and Security Questionnaire (SQ) questionnaires. Simple mediation, parallel mediation, and dimension-specific analyses were performed using the PROCESS macro (Model 4) with 5,000 bootstrap resamples, controlling for gender and parental marital status.Resultsstressful life events were significantly positively correlated with depression (r = 0.491, p < 0.001) and negatively correlated with security (r = −0.464, p < 0.001). Simple mediation analysis revealed that security demonstrated a significant indirect association through security (indirect effect = 0.176, 95% CI [0.126, 0.232]), accounting for 53.8% of the total association. Parallel mediation analysis further indicated a dual-pathway model: both Interpersonal Security (indirect effect = 0.083, 95% CI [0.037, 0.133]) and Certainty in Control (indirect effect = 0.093, 95% CI [0.043, 0.152]) functioned as significant statistical mediators of comparable magnitude, with no significant difference between them (Contrast = −0.010, 95% CI [−0.065, 0.042]). Furthermore, dimension-specific analyses revealed that Interpersonal Stress (standardized indirect effect = 0.266) and Academic Stress (standardized indirect effect = 0.231) showed the strongest indirect associations with depression through the security pathway. Exploratory subgroup analyses revealed a gender-crossed pattern: for male adolescents (n = 85), the indirect association was significant only through Interpersonal Security (effect = 0.116, 95% CI [0.048, 0.199]); for female adolescents (n = 199), it was significant only through Certainty in Control (effect = 0.136, 95% CI [0.067, 0.212]).ConclusionSecurity functions as a significant statistical mediator in the association between stressful life events and adolescent depression. The findings are consistent with a “dual-pathway” model wherein stress is concurrently associated with lower levels of both relational security (Interpersonal Security) and personal agency (Certainty in Control). Exploratory analyses suggest that the relative importance of these two pathways may differ by gender. If confirmed by future longitudinal research, clinical interventions may benefit from an integrated approach that addresses both dimensions, with particular attention to interpersonal conflicts and academic pressure as the stressors most strongly associated with depression through security pathways.
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Unmasking deep-rooted trauma: long-term effects of childhood adversities on posttraumatic stress disorder in healthcare workers facing acute multi-trauma

PurposeIn recent years, healthcare workers (HCWs) in Lebanon have encountered compounded traumatic exposures, including the Beirut Port blast, COVID-19, and an ongoing economic crisis, often preceded by early-life adversities such as adverse childhood experiences (ACEs). Understanding how these acute stressors interact with early adversities is crucial for assessing their long-term psychological impact. Accordingly, this study examines the extent to which these combined factors predict the development of full and subthreshold posttraumatic stress disorder (PTSD) over time.MethodsA cohort study was conducted following 296 HCWs from Saint George Hospital University Medical Center, with assessments at two timepoints: 6–7 months and 2–2.5 years after the Beirut Blast. PTSD symptoms were measured using the PCL-5, applying both full-threshold criteria and six definitions of subthreshold PTSD. Bivariable and multivariable analysis were conducted.ResultsAt 6–7 months, acute stressors (financial hardship, Beirut Blast, and COVID-19) were significantly associated with PTSD across most definitions. However, by 2–2.5 years, ACEs became the strongest and most consistent predictor of both full-threshold and subthreshold PTSD, while the impact of acute stressors diminished.ConclusionThe impact of acute trauma on the risk of PTSD fades over time, while early-life adversity has an enduring impact. The findings highlight the importance of including developmental trauma histories in PTSD assessments. In concordance with stress sensitization and neurobiological models, the results indicate a marked temporal shift, where the diminishing effects of acute stressors give way to the enduring role of early life adversity in shaping PTSD symptom trajectories.