Anxiety, Depression, Sleep Initiation and Maintenance Disorders, Social Isolation
Conditions
Keywords
Generalized anxiety disorder, Mental health, Mindfulness, Group-based therapy
Brief summary
The study evaluates the effectiveness of a group-based mindfulness program conducted in a primary care setting. This study also aims to identify any scale-up and implementation considerations for the program.
Detailed description
A primary care group-based mindfulness program was developed by community physicians and co-op and public health students in Ajax, Ontario. The program was started in January 2018 and is run through the Ajax Harwood Clinic, which is a clinic housing a Family Health Organization (FHO) comprising of 5 physicians and approximately 6,500 patients. The purposes of the program are: 1. To teach mindfulness skills for stress reduction, self-compassion, and dealing with difficult thoughts and emotions, 2. To promote an integrative concept of health, which treats the whole person 3. To promote community building and positive relationships 4. To capitalize on the power of groups to: 1. Foster peer-to-peer learning and support when it comes to coping with life challenges 2. Combat isolation 3. Increase efficiency, quality, and timeliness of care This study evaluates the 8-week rolling admission mindfulness program, by first doing a retrospective chart review to identify effect sizes and then conducting a before-after study evaluation of the effect of the mindfulness program on key mental health outcome measures.
Interventions
BEHAVIORALMindfulness Group Program
The mindfulness program has the following aims (Iacono, 2018): to teach mindfulness skills for stress reduction, self-compassion, and dealing with difficult thoughts and emotions, to promote an integrative concept of health, which treats the whole person, to promote community building and positive relationships, and to capitalize on the power of groups to: 1. Foster peer-to-peer learning and support when it comes to coping with life challenges 2. Combat isolation 3. Increase efficiency, quality, and timeliness of care
Sponsors
McMaster University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This study evaluates the effect of the intervention using a single group, before-after study model. The subjects will be evaluated at baseline and followed longitudinally, until study completion and a long-term followup.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Be enrolled in mindfulness-based program through Ajax Harwood Clinic * Age of 18 * English-speaking ability to participate in program * Able to provide informed consent
Exclusion criteria
* no formal
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Generalized Anxiety Disorder - 7 (GAD-7) | Change from baseline each week until 8 weeks and at 8 months post-baseline | The GAD-7 is a validated instrument for the diagnosis and treatment response of anxiety disorders (Spitzer et al, 2006; Hinz et al, 2017). It is comprised of 7 questions with 4 answer options, ranging from not at all to nearly every day and scored 0-3 with a total score ranging from 0-21 (Spitzer et al, 2006). Scores of 5-9, 10-14, and 15-21 represent mild, moderate and severe generalized anxiety disorder, respectively. In the primary care setting, the GAD-7 has high diagnostic validity, with a threshold of 10 exhibiting a sensitivity of 89% and specificity of 82% for generalized anxiety disorder (Spitzer et al, 2006). Other conditions related to generalized anxiety disorder including panic disorder, social anxiety disorder and post-traumatic stress disorder have also been sensitive to a GAD-7 score of 10 (Kroenke et al, 2007). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Heath Questionnaire 9 (PHQ-9) for depression | Change from baseline each week until 8 weeks and at 8 months post-baseline | The Patient Health Questionnaire-9 (PHQ-9) is made up of nine questions and is diagnostic for depression. Importantly, the PHQ-9 has also been found to be sensitive to change for monitoring of treatment outcomes (Kohrt et al, 2016; Lowe et al, 2004). The PHQ-9 asks participants, Over the last 2 weeks, how often have you been bothered by any of the following problems? All answers have four options ranging from not at all, several days, more than half the days, or nearly every day for a number of symptoms related to depression. Major depression and other depressive syndromes are diagnosed based on answers of more than half the days or nearly every day to Little interest or pleasure in doing things or Feeling down, depressed, or hopeless plus 2-5 or more of the other symptoms. |
| Insomnia Severity Index (ISI) | Change from baseline each week until 8 weeks and at 8 months post-baseline | The Insomnia Severity Index, a 7-item scale, was identified as the most fitting validated scale to identify insomnia symptoms (Bastien et al., 2001). Each of the questions is measured on a scale of 0-4 and the answers are added up to get a total score. Total score categories: 0-7 = No clinically significant insomnia 8-14 = Subthreshold insomnia 15-21 = Clinical insomnia (moderate severity) 22-28 = Clinical insomnia (severe) |
| DeJong Gierveld Loneliness Scale | Change from baseline each week until 8 weeks and at 8 months post-baseline | The DeJong Gierveld 6-item Loneliness Scale captures both emotional loneliness (missing an intimate relationship) and social loneliness (missing a wider social network) (Gierveld et al, 2006; Grygiel et al, 2016). Each subscale is made up of three questions with possible answers of yes, more or less, or no. Questions 1-3 are negatively worded and answers of yes or more or less are scored as 1, while no is scored as 0. On positively worded questions (4-6), neutral or negative answers (no or more or less) are scored as 1, while yes is scored as 0. This gives a range of 0 (not lonely)-3 (very lonely) in each subscale, or 0 (not lonely)-6 (very lonely) in the total scale. However, we have changed this scoring so that we can further discriminate between neutral and other answers. Therefore, our scoring on each question ranges from 0-2, giving a total scale of 0 (not lonely)-12 (very lonely). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Hemoglobin A1C (HgA1C) | Change from baseline at 8 weeks and at 8 months post-baseline | Assessing prevalence of diabetes via HgA1C levels from electronic medical record (EMR) for comorbidity comparison |
| Weight | Change from baseline at 8 weeks and at 8 months post-baseline | Assessing prevalence of obesity/comorbidities from weight through EMR data |
Countries
Canada
Outcome results
None listed