SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted Does Integrating Cognitive Behavioural Therapy into Cardiac Rehabilitation Improve Depression and Quality of Life in Adults with Cardiovascular Disease? A Systematic Review.(Cardiff University, 2025) Alqahtani, Ola; Gale, NicholaDoes Integrating Cognitive Behavioural Therapy into Cardiac Rehabilitation Improve Depression and Quality of Life in Adults with Cardiovascular Disease? A Systematic Review. Background & Rationale Cardiovascular disease (CVD) is the world’s leading cause of death and disability, placing significant clinical and economic burdens on healthcare systems. While cardiac rehabilitation (CR) encompassing exercise, education, and routine psychosocial support has been shown to improve clinical outcomes, up to thirty percent of cardiac patients experience clinically meaningful depressive symptoms which reduce CR adherence and long-term success. Cognitive behavioural therapy (CBT) offers a structured approach to modifying maladaptive thoughts and behaviours, potentially addressing psychological barriers more effectively than generic psychosocial support. However, many reviews have evaluated heterogeneous ‘psychological interventions’ rather than isolating CBT’s specific impact. This systematic review set out to determine whether CBT, when integrated into CR, alleviates depression and enhances health-related quality of life (HRQoL) more effectively than CR alone. Methods A systematic literature search was conducted across five major databases (Medline, EMBASE, CINAHL, Cochrane CENTRAL, and PsycINFO) from inception to the most recent feasible date, adhering to PRISMA guidelines for study selection and reporting. Six randomised controlled trials, totalling 708 participants, satisfied the inclusion criteria by focusing on adults (≥18 years) undergoing CR for various cardiac conditions (such as myocardial infarction, heart failure, or post-cardiac surgery). Studies which integrated structured CBT sessions into standard CR were compared to CR alone or other forms of standard care. The primary outcome was the reduction in depressive symptoms, measured by validated scales (e.g., the Hamilton Rating Scale for Depression or the Hospital Anxiety and Depression Scale (HADS)). Secondary outcomes involved changes in HRQoL, assessed by either generic or cardiac-specific instruments (such as the Minnesota Living with Heart Failure Questionnaire). Quality appraisal followed the Joanna Briggs Institute guidelines and due to heterogeneity in intervention formats, population characteristics, and outcome measures, a narrative synthesis approach was applied rather than a meta-analysis. Key Findings and Discussion Although the six trials varied in terms of sample size, intervention intensity, and follow-up duration, they shared an overarching conclusion that integrating CBT within CR can lead to notable reductions in depressive symptoms and meaningful improvements in HRQoL. The degree of benefit was generally greater in patients presenting with moderate-to-severe baseline depression. Face-to-face CBT delivery typically achieved better adherence (often exceeding 75%) and larger effect sizes, whereas fully digital CBT programmes suffered from low engagement (approximately 15% module completion). These findings suggest that the personal interaction and therapeutic alliance inherent in face-to-face sessions remain critical for maximising CBT’s clinical impact in cardiac populations, particularly those facing multiple stressors related to their disease. CBT combined with exercise, in several trials, appeared to deliver synergistic benefits for depression and HRQoL, possibly through complementary behavioural (cognitive restructuring and skill-building) and physiological (improved cardiovascular function) mechanisms. The interplay between exercise encouragement and cognitive-behavioural strategies against fear-avoidance thinking also emerged as an important determinant of enhanced functional capacity and sustained improvements in mood. Limitations Several limitations may constrain the generalisability of these results. First, the overall sample predominantly comprised of male participants (approximately two-thirds were male), leaving questions regarding whether women, who often exhibit different depressive symptom profiles and a greater prevalence of depression post-myocardial infarction, would experience similar outcomes. Second, varied measures of depression and HRQoL, along with wide differences in the intervention ‘dose’ (ranging from five-session brief interventions to twelve-week combined programmes), precluded direct quantitative comparisons across studies. Some trials were also underpowered and only a few extended follow-up beyond six to twelve months. Digital CBT approaches did not yield strong results in this review but that may reflect poor adherence rather than intrinsic ineffectiveness, highlighting a need for more engaging and personalised technological platforms. Finally, these RCTs spanned multiple healthcare settings in Europe and the United States where infrastructural and cultural factors might influence both the feasibility of CBT delivery and participant engagement. Conclusions and Recommendations This review provides evidence that structured CBT, when delivered in tandem with cardiac rehabilitation, can significantly alleviate depressive symptoms and promote better quality of life. The most robust outcomes were observed in trials that targeted moderate-to-severe depression, employed face-to-face group or individual CBT sessions, and ensured consistent patient follow-up. These findings strengthen the case for systematically screening CR entrants for depressive symptoms and offering a dedicated CBT component to those above a certain severity threshold. Practical feasibility can be enhanced by training nurses, physiotherapists, or other allied professionals in CBT skills, as illustrated in studies where task shifting maintained strong outcomes. Policy-making bodies, such as national cardiac societies and health agencies, may wish to recommend CBT as a priority psychological intervention in CR programmes, particularly for patients with moderate or severe depression. Future research should further refine the optimal ‘dose’ of CBT, compare blended or stepped-care digital and in-person models, and evaluate the cost-effectiveness to guide broader adoption. By focusing on cognitive restructuring and behaviour change within the supportive framework of CR, healthcare systems can potentially improve both the mental health and functional recovery of individuals with CVD.7 0Item Restricted THE IMPACT OF RELIGIOUS INVOLVEMENT ON DEPRESSIVE SYMPTOMS AMONG YOUNG ADULTS(Imperial College London, 2024-06-07) Raboui, Haneen; Preux, LaureThe relationship between religious involvement and mental health has been a significant area of study, particularly in understanding its impact on depressive symptoms among young adults. This research examines the role of religious importance and prayer frequency in influencing depression levels, using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). The findings indicate that individuals who place greater importance on religion report lower levels of depression, whereas frequent prayer is positively associated with depressive symptoms, suggesting it may serve as a coping mechanism rather than a protective factor. Additionally, health status, educational attainment, household income, and parental education levels emerged as significant predictors of depression, highlighting the multifaceted nature of mental health determinants. Gender differences were also observed, with females reporting higher levels of depression and greater religious engagement than males. Despite limitations such as low explained variance and potential self-report biases, this study underscores the complex interactions between religious involvement and mental health, suggesting that both religious and secular interventions should be considered in addressing depression among young adults.9 0Item Restricted PERSONALITY TRAITS AS RISK FACTORS FOR RECURRENT DEPRESSION AND OTHER DEPRESSION OUTCOMES(University of Birmingham, 2024) Altaweel, Nada; Marwaha, StevenBackground: Major depressive disorder (MDD) is a common, debilitating, highly recurrent disorder representing a significant health concern and a leading cause of disability and mortality worldwide. Despite effective treatments, many depressed patients relapse, with around 50% to 80% likely to experience further episodes after achieving recovery. Personality has been proposed as an essential risk factor for recurrent depression. However, researchers have addressed limited personality traits and focused on personality disorders, leaving the role of many other personality traits in recurrent depression unclear. This thesis aimed to identify what personality traits contribute to the risk of recurrent depression in addition to other MDD outcomes (onset, persistence, recovery). Methods: Chapter two comprises a systematic review of personality traits as risk factors for relapse/recurrence in MDD. Chapter three includes a secondary data analysis that used prospective data from the Adults Psychiatric Morbidity Survey (APMS, 2000) to evaluate the association between borderline, obsessive-compulsive, and dependent personality traits and the change of depression status at 18 months (onset, persistence, and recovery). Chapter four presents a case-control study that examines the association between emotional dysregulation, affective lability, impulsivity, and recurrent depression. Results: The systematic review revealed that individuals with high neuroticism, borderline, obsessive-compulsive and dependent personality traits or disorders are more prone to the risk of recurrence compared to those without these traits. Additionally, the secondary data analysis study showed that borderline personality was the most robust factor; increased dependent personality traits were significantly associated with persistent MDD, and elevated traits of obsessive-compulsive personality were found to be related to the onset of MDD. The case-control study showed that emotional dysregulation and childhood maltreatment could work as risk factors for recurrent depression. Conclusion: These findings have important theoretical and practical implications, including efforts to develop targeted intervention plans tailored to patients’ characteristics. This thesis concludes by contextualising the findings within the existing literature, addressing their limitations, and proposing future directions. Overall, this thesis presents valuable insight into the role of personality traits in the risk of recurrent depression, highlighting their role in other important MDD outcomes and emphasising the need for further investigations in this area.26 0Item Restricted Prevalence of Depression among University Students in Saudi Arabia An Adopted Systematic Review(University of Manchester, 2024-03-27) Alzahrani, Raghad; Shields, GemmaThe prevalence of depression is one of the critical mental disorders that affect a large population. The symptoms of the disorders include sad mood, anhedonia, low self-esteem insomnia, general fatigue, lack of appetite, and decreased concentration. The global prevalence rate is estimated at 4.4% across the populations, and a 49% prevalence of depression and anxiety symptoms among university students in Saudi Arabia. Studies on the prevalence of depression have confirmed that various factors such as sociocultural, biological, and psychological are the main contributors to depression and affect people of all ages. Depression disorders affect the level of quality of life for individuals, which leads to changes in physical activities, emotional functions, and behavioral changes. This study focuses on the prevalence of depression among university students in Saudi Arabia. This group of the population encounters a critical transition from one level of education to another, which requires them to be self-reliant and responsible individuals for them to survive, and from a transition from adolescence to adulthood, which turns out to be stressful at times. The stress mostly emanates from trying to blend into a new lifestyle, maintaining the pressure to excel academically, being away from home, and uncertainty about the future. The prevalence of depressive disorders is the most typical disease affecting many different factors of humanity. University students in Saudi Arabia may be at increased risk of depression owing to the pressure and stress they encounter. Therefore, the purpose of this study is to focus on the level of prevalence of depression among undergraduate university students in Saudi Arabia. A total of 460 journal sources were screened, which resulted in 3 appropriate journal sources for the final inclusion in the study on the prevalence of depression. A systematic review was used to evaluate several kinds of literature on the prevalence of depression among undergraduate university students.42 0Item Restricted “What is the impact of gardening on the psychological health of adults? A scoping review.”(Exeter University, 2024-03-06) Alomiri, Abeer; Garsid, RuthRecently, there have been concerns that the prevalence of mental disorders has increased significantly, threatening the mental health of a large segment of the population. Therefore, there has been a call to improve the psychological health of the general population using non-pharmacological interventions (e.g., gardening and green spaces). Although several scoping reviews have examined the psychological outcomes of green spaces, there is a lack of scoping reviews that examine the psychological outcomes of gardening. Scoping reviews in this research area can be valuable because they identify potential methodological limitations, informing future research. Further, they can explore the scope of evidence, which can identify unanswered research questions. Therefore, this scoping review aimed to explore the scope of evidence as well as identify the methodological limitations in this research area in order to inform future research. The scoping review was guided by a framework developed by Arksey and O'Malley (2005). Different databases were used to access relevant studies, including Scopus, Medline, and the Web of Science Core Collection (WSCC). The search yielded 26 studies. Gardening can lead to a wide range of psychological outcomes, including a reduced risk of depression, with a higher effectiveness of community gardening in decreasing depression compared to individual/home gardening, a decrease in anxiety, mental resilience and relief from stress, escape, enjoyment, and relaxation, better cognitive performance, a sense of community and social relationships, and a greater sense of meaning of life, although there is a greater effect size in individualistic than collectivist cultures and an overly simplistic approach to the association between gardening and psychological outcomes. Further, there were several methodological limitations, such as limited use of objective measures (e.g., salivary cortisol levels, fMRI), a lack of use of the Core Outcome Sets (COS), a lack of studies with long-term follow-up, a lack of studies that examined the difference between doing the gardening activity and the mere presence of being at the gardening site, and a lack of studies from different countries (Africa, Asia, and South America). Limited studies examined the impact of mediators and moderators. Further, known facts were usually not taken into account. Researchers are advised to address these methodological gaps, as this will improve the quality of evidence in this emerging research area. Moreover, policymakers are advised to provide the required financial support to urban planners to increase the presence of gardens, as they can encourage local people to engage in gardening activities. Further, initiatives that introduce community gardening in public gardens can be adopted by local governments worldwide. Keywords: gardening, green spaces, psychological health, depression, anxiety, stress14 0Item Restricted Gender-based depression factors of older adults in England during the COVID-19 pandemic(University of Sheffield, 2023-08-29) Alkunaydiri, Shaden; Path, PeterAbstract Background The proportion of older adults in the United Kingdom is increasing. In addition, 487,100 older adults experience a major depressive disorder and 191,740 experience chronic depressive disorder. Depression was one of the significant mental health issues that attracted increasing attention soon after the spread of the Covid-19 pandemic. Several studies conducted among older adults investigated the change in depressive symptoms and have yielded inconsistent findings. However, studies on gender-based depression factors for older adults in the UK during the pandemic are limited. This study aims to examine differences in depression depending on gender and other participant characteristics and identify factors related to depression by gender among older adults in the UK. Methods This study conducted a cross-sectional analysis using data from the English Longitudinal Study of Ageing (ELSA) Covid-19 sub-study (wave 1). Depressive symptoms were assessed by the 8-item Center for Epidemiological Studies Depression (CES-D) scale. Differences in depression during the pandemic periods and factors related to depression by gender were assessed by chi-square tests and binary logistic regression using the Statistical Package for the Social Sciences software (SPSS). Results Seven thousand and forty participants were included; 56.5% of the sample were women, 43.5% were men, and the most frequently occurring age group was people aged 60–69. The depression scores among women were significantly higher than those of men. Gender was statistically associated with depression. Self-reported health, quality of sleep and social isolation were the most significant predictors of depression for both older men and women. However, current employment status due to COVID-19 and low educational level were specifically related to depression in older women. For older men, alcohol drinking and lower communication with family were significant factors of depression. Conclusions Our results suggest women experienced higher scores of depressions than men in response to the pandemic. However, the differences in factors related to depression among men and women were almost similar. These findings underscore the necessity to assess and intervene with the factors affecting depression to preserve the psychological well-being of older adults. Nevertheless, future policies should also 1 consider developing ways that support the influence groups to limit the adverse impact on mental health and maintain optimal mental health status during the pandemic crisis.32 0Item Restricted Workplace Factors Associated with Psychological Effects in Paramedics, A systematic Review and Meta- Analysis(Saudi Digital Library, 2023-10-13) Zahran, Rahaf; Brad, MetcalfThis systematic review and meta-analysis study aims to assess the correlation between workplace factors and psychological effects on paramedics. A search of four databases found 1794 papers, from which 31 were deemed eligible from the years 2000 to 2023. Their methodological quality was assessed using the Critical Appraisal Skill Program (CASP, 2018) tool and the Strengthening the Reporting of Observational Studies in Epidemiology (STOBE) guidelines to help in assessing cross-sectional studies. The results give the overall effect size with an OR=1.65 and a P<0.001, indicating statistical significance for the first forest plot. Similarly, forest plot 2 demonstrates an overall effect size with a correlation r= 0.29 and a P<0.001, also indicating statistical significance. In summary, this review found a small and positive correlation in reported odds ratio studies. For Pearson correlation r reported studies, a moderate and positive correlation were found linking psychological effect to workplace factors in paramedics. The limitation of this study included research published in English and variation in reporting results in the studies. The findings will inform future research and help policymakers, healthcare organizations, and practitioners in developing strategies to support paramedics' mental health and enhance quality of care.23 0