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A pilot study of a clinician-guided internet-delivered cognitive behavioural therapy for anxiety and depression among Arabs in Australia, presented in both English and Arabic languages

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      Abstract

      The present pilot study examined the efficacy and acceptability of an internet-delivered Cognitive Behaviour Therapy (iCBT) intervention delivered in both English and Arabic languages to Arab Australians, aged 18 and over, with symptoms of depression and anxiety. Thirteen participants with at least mild symptoms of depression on the (Patient Health Questionnaire 9-item; PHQ-9; total scores ≥ 5) or anxiety (Generalised Anxiety Disorder 7-item; GAD-7; total scores ≥ 5) accessed the online Arabic Wellbeing Course, which consisted of five online lessons delivered over eight weeks with weekly clinician support. Measures of depression, anxiety, distress and disability were administered at pre-treatment, post-treatment and 3-month follow-up. Data were analysed using generalised estimation equation (GEE) modelling. Seventy-seven percent (10/13) of participants completed the five lessons over eight weeks, with 10/13 providing post-treatment and 3-month follow-up data. Participants improved significantly across all outcome measures, with large within-group effect sizes based on estimated marginal means (Cohen's d) at post-treatment ( d = 1.18 to 1.62) and 3-month follow-up ( d = 1.28 to 1.72). In addition, 40% and 38% of participants obtained, at least, a 50% improvement in symptoms of both anxiety and depression at 3-month follow-up respectively. Participants rated the Arabic Wellbeing Course as acceptable, and 70% of those who completed follow-up questionnaires reported accessing the course in both English and Arabic languages. Notwithstanding the limitations of an open trial design, these results are encouraging and indicate that culturally modified clinician-guided internet-delivered versions of Western psychological interventions have the potential for increasing access to treatment for Arabic-speaking Australians, and potentially other groups.

      Highlights

      • This pilot study examined the efficacy of an internet-delivered Cognitive Behaviour Therapy (iCBT) for Arab Australians.
      • iCBT was found to be effective and acceptable among Arab Australian participants.
      • Seventy percent of participants who completed follow up data reported accessing the Course in both English and Arabic languages.
      • iCBT has the potential for increasing access to treatment for Arabic-speaking Australians, and other groups.

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      Most cited references 45

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      The PHQ-9: validity of a brief depression severity measure.

      While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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        A brief measure for assessing generalized anxiety disorder: the GAD-7.

        Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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          Short screening scales to monitor population prevalences and trends in non-specific psychological distress.

          A 10-question screening scale of psychological distress and a six-question short-form scale embedded within the 10-question scale were developed for the redesigned US National Health Interview Survey (NHIS). Initial pilot questions were administered in a US national mail survey (N = 1401). A reduced set of questions was subsequently administered in a US national telephone survey (N = 1574). The 10-question and six-question scales, which we refer to as the K10 and K6, were constructed from the reduced set of questions based on Item Response Theory models. The scales were subsequently validated in a two-stage clinical reappraisal survey (N = 1000 telephone screening interviews in the first stage followed by N = 153 face-to-face clinical interviews in the second stage that oversampled first-stage respondents who screened positive for emotional problems) in a local convenience sample. The second-stage sample was administered the screening scales along with the Structured Clinical Interview for DSM-IV (SCID). The K6 was subsequently included in the 1997 (N = 36116) and 1998 (N = 32440) US National Health Interview Survey, while the K10 was included in the 1997 (N = 10641) Australian National Survey of Mental Health and Well-Being. Both the K10 and K6 have good precision in the 90th-99th percentile range of the population distribution (standard errors of standardized scores in the range 0.20-0.25) as well as consistent psychometric properties across major sociodemographic subsamples. The scales strongly discriminate between community cases and non-cases of DSM-IV/SCID disorders, with areas under the Receiver Operating Characteristic (ROC) curve of 0.87-0.88 for disorders having Global Assessment of Functioning (GAF) scores of 0-70 and 0.95-0.96 for disorders having GAF scores of 0-50. The brevity, strong psychometric properties, and ability to discriminate DSM-IV cases from non-cases make the K10 and K6 attractive for use in general-purpose health surveys. The scales are already being used in annual government health surveys in the US and Canada as well as in the WHO World Mental Health Surveys. Routine inclusion of either the K10 or K6 in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.
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            Author and article information

            Affiliations
            Department of Psychology, Macquarie University, Sydney, Australia
            Author notes
            [* ]Corresponding author at: eCentreClinic, Department of Psychology, Macquarie University, North Ryde 2109, Australia. rony.kayrouz@ 123456mq.edu.au
            Contributors
            Journal
            Internet Interv
            Internet Interv
            Internet Interventions
            Elsevier
            2214-7829
            16 June 2016
            September 2016
            16 June 2016
            : 5
            : 5-11
            6096205 S2214-7829(16)30015-X 10.1016/j.invent.2016.06.002
            © 2016 The Authors

            This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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