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 Efficacy of Cognitive Behavioural Therapy for Schizophrenia(QUEEN’S UNIVERSITY, BELFAST, 2025-01-21) Dabsh, Munirah; Ownes, MarkThis dissertation evaluates the efficacy of cognitive behavioural therapy (CBT) in treating schizophrenia, focusing on symptom reduction, social functioning improvement, and cultural adaptations. A systematic review of ten studies was conducted using rigorous inclusion criteria, resulting in a synthesis of evidence spanning diverse settings and methodologies. Findings highlighted CBT's significant impact on positive symptoms, moderate effect on negative symptoms, and the necessity for culturally sensitive approaches. However, barriers such as methodological limitations, cultural barriers, and limited therapist training were evident. Future research is essential to refine interventions and expand access to evidence-based care7 0Item Restricted Unveiling Maternal Mental Health: Exploring the Perceptions and Practices of Mental Health Care for Pregnant and Postnatal Women in Kingdom of Saudi Arabia: A Mixed Methods Study(University of East Anglia, 2024) Alshammari, Athar; Crozier, Kenda; Wadnerkar, MeghanaBackground: Mental health during pregnancy and the postpartum period is critical yet often overlooked. In Saudi Arabia, cultural and societal norms significantly influence perceptions and practices related to mental health and these are compounded in the context of maternal mental health. Objective: This thesis aimed to explore the knowledge, perceptions, and challenges faced by women and healthcare providers (HCPs) regarding mental health during pregnancy and postpartum in Hail, Saudi Arabia. Methods: An embedded mixed-method design was used. Semi-structured interviews with ten pregnant and postpartum women and ten HCPs. An online cross-sectional survey was conducted with 349 HCPs to evaluate their knowledge of depression symptoms, risk factors, and treatment options. Results: Qualitative interviews revealed four major themes: Awareness and Education on Maternal Mental Health, Stigma and Shame, Barriers to Accessibility, and Enhancing Maternal Mental Health Care. Women's misconceptions and fears of stigma led to reluctance to seek help. HCPs highlighted gaps in training and guidelines, with barriers including limited time and inadequate mental health education. Quantitative results showed insufficient knowledge among HCPs, with an average score of 8.62 out of 20 (44.86% correct). Knowledge was higher in treatment (53%) compared to assessment (45.88%) and education (35.71%) domains. Discussion: The integrated findings reveal gaps in knowledge and perceptions of maternal mental health among both women and HCP. This study offers novel insights by combining perspectives from both groups, uncovering underexplored cultural barriers and care gaps. It highlights how cultural stigma, HCP training, and systemic issues impact Saudi women’s perinatal and postnatal experiences. Conclusion: This thesis provides new insights into maternal mental health issues in Saudi Arabia, highlighting the need for targeted education, reduce stigma, and improved support systems. Future research should explore socio-cultural interventions to address these gaps and enhance care delivery21 0Item Restricted Introducing Stakeholder Perceptions of Refugee Children’s Wellbeing(University of Leicester, 2024-02-23) Alowaybil, Reem; Maltby, JohnThis thesis introduces a new approach of conceptualising refugee children’s wellbeing by incorporating insights of multiple stakeholders. This was achieved by five empirical studies using different qualitative and psychometric designs. The first study aimed to establish the challenges in addressing refugee children’s wellbeing using a sample of refugee children, parents, and professionals. Stakeholders highlighted the challenges in education wellbeing, indicating lack of understanding of refugee children’s mental health needs in the education system. The second study aimed to bridge this gap by introducing a new model of teachers’ perceptions of refugee children’s school wellbeing ‘The WELLS’, and developing a new scale. Study three aimed to test the underlying structure of the new developed scale using an independent sample of schoolteachers. Results suggested a three-dimensional model of teachers’ perception of refugee children’s school wellbeing; mental, academic, and social. The fourth study introduced a short form of the new scale, in order to provide schoolteachers with an efficient measure of refugee students’ mental health needs, and to support the multidimensional nature of the scale. To this end, two samples of schoolteachers were recruited in this study to confirm and test the replicability of the three-factor structure. Finally, a sample of schoolteachers was recruited in the fifth study to align the three dimensions against convergent and discriminant constructs. Overall, this thesis offers a comprehensive theoretical understanding of refugee children’s wellbeing as perceived by stakeholders. Furthermore, a novel measurement tool designed to assess refugee children's school wellbeing from the perspective of teachers was introduced. It contributes to improve our understanding of refugee children's mental health needs and offers a valuable resource for interventions that future research in this area can benefit from.13 0Item Restricted Psychological Impact of the COVID-19 Pandemic on Nurses Delivering Care in Hospitals(Saudi Digital Library, 2023) Alruwaili, Bashayer Muidh; Parkinson, DenisBackground: Nurses have faced significant challenges during the COVID-19 pandemic, with one major issue being the increased mental health concerns. These could impact the quality of healthcare provided by nurses, along with patient care and safety, as a result of multiple factors, including heavy workloads and long hours. Numerous other factors affecting nurses can influence these outcomes. Therefore, it is crucial to provide accessible resources to help nurses reduce their mental health problems and improve their overall psychological well-being. Such resources would be able to offer effective strategies to support nurses as they care for patients during these challenging times. Aim: To review and synthesize published research about the impact of COVID-19 on the psychological well-being of nurses and identify effective strategies that can assist nurses with mitigating mental health issues during the pandemic. Methodology: This study will provide a narrative review of the evidence. The researchers conducted an extensive review of the literature by utilizing various online biomedical databases, including PubMed, MEDLINE, CINAHL, and Scopus. Result: After limiting the search dates to December 2019 –2023, the literature search identified a total of 132 articles. The primary focus of the study is the COVID- 19 period, which led to the exclusion of studies published before December 2019 from consideration. Critical Appraisal and Skills Programme (CASP) tools were utilized to evaluate the credibility and quality of the articles, leading to the inclusion of 19 articles that were considered appropriate for this review. Conclusion: This review identified the impact of the COVID-19 pandemic on nurses' mental health, particularly due to certain factors such as increased workloads and fear of infection, which significantly affect their well-being. Ensuring nurses' mental health is vital for maintaining high-quality patient care. Offering efficient support and accessible resources can mitigate stress levels and enhance resilience. Given the long-term consequences of the pandemic on healthcare systems, continuous support and monitoring for nurses' mental well-being are essential. Strengthening nurses' capacity to provide patient care can be achieved through a culture that promotes well-being and provides sustained support.8 0Item Restricted The impact of shift work on the mental health, burnout syndrome, and job satisfaction of female nurses in a general hospital: a comparison between rotating night shifts and day shifts(Saudi Digital Library, 2023-07-29) Alqani, Shahalil; Zolfaghari, ParjamNumerous industries, including transportation, healthcare and hospitality, rely on the availability of employees who work beyond the conventional hours of 7:00 am to 6:00 pm (1). Up to 40% of healthcare workers within the European Union are subjected to shift work (2). Shift work is regarded as essential in the healthcare system to guarantee and facilitate continuity of care in hospitals and residential institutions. Shift work requires nurses to follow rotating schedules that include night shifts. These schedules are necessary to provide 24-hour care for patients and imply that nurses may have to work extended hours to ensure the continuous availability of healthcare professionals to address patients’ needs (3, 4), which can potentially contribute to the onset of burnout. Burnout is a state that arises from prolonged exposure to difficult and demanding work circumstances. It is primarily triggered by a combination of physical and psychological risks associated with one’s occupation, especially when the work environment lacks factors that promote well-being and satisfaction (4). Burnout is defined by extreme exhaustion, a sense of cynicism or detachment, and difficulties in thinking clearly and managing emotions effectively. It is a condition where individuals experience significant fatigue, develop negative attitudes or scepticism towards their work, and struggle with cognitive and emotional functioning (4). Studies have revealed that between 25% and 37% of nurses in Europe and the United States experience burnout (5, 6). Burnout and weariness have serious consequences for both the affected individuals and the organisations that employ them. Individuals who are burned out are more likely to request sick time and declare their intention to leave their jobs. These outcomes will have a substantial impact not just on the efficiency and well- being of individuals, nevertheless on the general functioning and performance of the organisations to which they are associated with (7). Patient safety is also affected by nurse burnout since burnout is linked to a higher risk of medication errors and increases the likelihood of patients encountering infections, falls and adverse events (8).17 0Item Restricted Exploration of burnout among Healthcare Professionals in Gulf regions during the COVID-19 pandemic: A systematic review.(Saudi Digital Library, 2023-09-04) Alhussaini, Abdullah; Skivington, KathrynAim: The aim of this study was to identify and understand the key factors that influence the likelihood of professional burnout in healthcare workers (HCWs) in the Gulf Cooperation Council (GCC) during and after the COVID-19 pandemic. Understanding these factors will help policy makers and institutional management develop and implement strategies that will protect and support HCWs, and thus develop a more flexible and robust healthcare system. Method: HCWs’ views on, and experiences of, burnout, during and after the COVID-19 pandemic, were examined. This was achieved through a systematic review and narrative synthesis of relevant qualitative studies published between 2020 and 2023. The studies were identified through a comprehensive search of three major databases (Ovid MEDLINE, EMBASE, CINHAL), and were evaluated using the Critical Appraisal Skills Programme (CASP). Results: The results of the study suggested that the causes of burnout (stressors) can be categorised under four main themes: (a) workload and role expansion, (b) fear of infection, (c) lack of administrative support, and (d) inadequacy of personal protective equipment. These, either collectively or individually, led to psychological and emotional effects, resulting in burnout. The study also found that these stressors did not affect all HCWs equally: their impact depended on the personal and professional profile of individual HCWs. HCWs appeared to exhibit a sense of professionalism, and an ability to adapt and grow professionally, through a range of coping mechanisms. Discussion: The results of the review are examined in the light of the research questions, and the case is made for improving pandemic preparedness through the implementation of context-specific strategies which take account of the identified stressors, and which include coping mechanisms. Conclusion: While the COVID-19 pandemic resulted in increased stress among HCWs across the GCC regions, burnout appeared to be highly influenced by individual context, such as age, experience and role. The factors identified, and their context dependency, should be considered in developing context-specific strategies to support healthcare workers' wellbeing and resilience during crisis conditions.21 0