A systematic review and meta-analysis of cognitive behavioural therapy for depression in adults with chronic lung conditions and a pilot randomised controlled trial of self-help cognitive behavioural therapy for depression in adults with pulmonary hypertension

Stark, Abbie 2024. A systematic review and meta-analysis of cognitive behavioural therapy for depression in adults with chronic lung conditions and a pilot randomised controlled trial of self-help cognitive behavioural therapy for depression in adults with pulmonary hypertension. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

Common chronic lung conditions include chronic obstructive pulmonary disease (COPD), cystic fibrosis and lung cancer. There are also rare types of chronic lung conditions such as pulmonary hypertension (PH). There is an overlap in the symptoms experienced by people with chronic lung conditions such as breathlessness and fatigue. Around the world, these conditions are recognised as one of the leading causes of early mortality and disability. Research demonstrates high rates of mental health difficulties including depression, in people with chronic lung conditions. Evidence suggests that people with chronic lung conditions may not receive appropriate care for depression. This is an important area of research given the high rates of mental health difficulties in this population and highlights the need for (and likely benefit of) provision of psychological support across chronic lung conditions. Cognitive behavioural therapy (CBT) is an effective treatment for depression. Research has investigated the efficacy of CBT for depression in specific chronic lung conditions, with mixed findings being reported. In the first part of the thesis, I examined the efficacy of CBT for depression in adults with chronic lung conditions when explored through evidence synthesis (meta-analysis). The primary outcome for the meta-analysis was change in depression between baseline and post-intervention scores in those allocated to a CBT intervention versus a control group. A systematic search was conducted, with studies included if they: involved adults with a primary diagnosis of a chronic lung condition, utilised a randomised controlled trial design using a CBT informed intervention, with depression severity measured using a standardised self-report scale. The results of the review showed a small reduction in symptoms of depression after treatment (measurement taken immediately after treatment) for individuals that received a CBT intervention versus those in control groups who did not receive a CBT intervention. There was a medium reduction in symptoms of depression at follow-up in the CBT intervention groups compared to the control groups. The results provide evidence for the benefit of CBT for treating depression across chronic lung conditions. These findings are relevant for healthcare professionals working in the area and are an important addition to the current evidence base. The second part of this thesis, the empirical study, focused on testing a new self-help intervention designed for depression in people with PH. PH describes a group of conditions all characterised by elevated pulmonary artery pressure. The main set of blood vessels that supply blood to the lungs become thick and rigid meaning they function less well. Common symptoms of PH include fatigue, chest pain and dizziness. A diagnosis of PH can be challenging, and can impact self-identity, relationships with family and friends, and expectations of ability. Research has demonstrated high rates of mental health difficulties including depression in people with PH. Evidence suggests people with PH do not always receive appropriate care for their psychological needs. This is an important and under researched area. Despite the clear need for psychological support for people with PH, there is limited evidence examining psychological treatments for depression in this clinical group. It is important that an intervention focuses on the unique challenges associated with PH, such as the lack of awareness or knowledge of PH given the rarity of the condition (approx. 7-8000 people in the UK) as these challenges may act as a barrier to engagement with more generic interventions for depression. This is the first study to my knowledge which tested the effectiveness of a CBT self-help intervention designed specifically for adults with PH. Participants were randomly allocated to the wait-list control group or the intervention group. Those in the intervention group received a self-help intervention which consisted of four booklets, one to be completed per week at home. The intervention was developed using the evidence base, with healthcare professionals working in the area and experts by experience. Both groups of participants were asked to complete questionnaires, for example about depression, anxiety, pain and fatigue, when signing up to the study (pre-intervention), four weeks later (post-intervention), and at one-month follow-up. The questionnaires were used to assess the impact of the intervention, by comparing scores from those in the intervention group to people in the control group. The results showed a significant reduction in depression in the intervention group compared to the control group. This suggests that the intervention was helpful in reducing depression. The benefit of this study includes a new intervention for depression in adults with PH.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	5 August 2024
Last Modified:	05 Aug 2024 15:00
URI:	https://orca.cardiff.ac.uk/id/eprint/171148

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