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Training for Awareness, Resilience and Action (TARA) for medical students: a single-arm mixed methods feasibility study to evaluate TARA as an indicated intervention to prevent mental disorders and stress-related symptoms
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.ORCID iD: 0000-0003-0496-7158
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professional Development.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
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2022 (English)In: BMC Medical Education, E-ISSN 1472-6920, Vol. 22, no 1, article id 132Article in journal (Refereed) Published
Abstract [en]

Background: Medical students have a higher risk for depression, anxiety, stress-related symptoms, burnout, and suicide, and more rarely seek professional help or treatment than the general population. Appeals are being made to address the mental health and resilience of physicians-to-be. The novel program Training for Awareness, Resilience, and Action (TARA) was originally developed to treat depressed adolescents, targeting specific neuroscientific findings in this population. TARA has shown feasibility and preliminary efficacy in clinically depressed adolescents and corresponding brain-changes in mixed community adolescent samples. The present study investigated the feasibility and acceptability of TARA as a potential indicated prevention program for symptoms of depression, anxiety, stress and burnout in Swedish medical students.

Methods: We conducted a single-arm trial with 23 self-selected students in their early semesters of medical school (mean age 25.38 years, 5 males and 18 females), with or without mental disorders. All participants received TARA. Self-reported symptoms of depression, anxiety, perceived stress and psychological inflexibility were collected before (T0) and after the intervention (T1). Qualitative data on the participants’ experiences of TARA were collected in focus-group interviews conducted halfway through the program and upon completion of the program. Individual interviews were also conducted 2 years later. Qualitative content analysis was performed.

Results: The mean attendance rate was 61.22% and the dropout rate was 17.40%. The Child Session Rating Scale administered after every session reflected an overall acceptable content, mean total score 34.99 out of 40.00. Trends towards improvement were seen across all outcome measures, including the Hospital Anxiety and Depression Scale Anxiety (t = 1.13, p = 0.29) and Depression (t = 1.71, p = 0.11) subscales, Perceived Stress Scale (t = 0.67, p = 0.51) and Avoidance and Fusion Questionnaire for youth (t = 1.64, p = 0.10). None of the participants deteriorated markedly during the intervention. Qualitative content analysis resulted in a main theme labeled: “An uncommon meeting-ground for personal empowerment”, with 4 themes; “Acknowledging unmet needs”, “Entering a free zone”, “Feeling connected to oneself and others” and “Expanding self-efficacy”.

Conclusion: TARA is feasible and acceptable in a mixed sample of Swedish medical students. The students’ reports of entering an uncommon meeting-ground for personal empowerment supports effectiveness studies of TARA in this context.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2022. Vol. 22, no 1, article id 132
Keywords [en]
Anxiety, Depression, Medical students, Mental health, Psychological stress, Qualitative research
National Category
Psychiatry Nursing
Identifiers
URN: urn:nbn:se:umu:diva-193011DOI: 10.1186/s12909-022-03122-2ISI: 000762282000001PubMedID: 35227281Scopus ID: 2-s2.0-85125536398OAI: oai:DiVA.org:umu-193011DiVA, id: diva2:1643728
Funder
Region VästerbottenRegion VästernorrlandThe Kempe FoundationsAvailable from: 2022-03-10 Created: 2022-03-10 Last updated: 2024-03-27Bibliographically approved
In thesis
1. Depression in teenagers and young adults: foundational studies of the new treatment paradigm TARA: Training for Awareness, Resilience, and Action
Open this publication in new window or tab >>Depression in teenagers and young adults: foundational studies of the new treatment paradigm TARA: Training for Awareness, Resilience, and Action
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Depression bland tonåringar och unga vuxna : grundläggande studier av det nya behandlingsparadigmet TARA: Training for Awareness, Resilience and Action
Abstract [en]

Introduction: Depression in adolescents and young adults is an increasing global health concern and available treatments are not convincingly effective. It is therefore important to develop and test novel treatments to improve treatment outcomes. This dissertation lays the foundation for the evaluation of a Swedish version of the treatment program Training for Awareness, Resilience, and Action (TARA), and tests the psychometric properties of the primary outcome measure for that evaluation.

Objectives: This dissertation aims to 1. Translate and pilot test TARA in Swedish medical students, 2. Evaluate the psychometric properties of the Swedish version of the Reynolds Adolescent Depression Scale second edition (RADS-2) in a clinical sample, 3. Perform a single arm multicenter clinical pilot study of the feasibility and safety of TARA and 4. Design a randomized controlled trial to test the clinical effectiveness of TARA.

Methods: The TARA manual was translated into Swedish and 23 self-selected medical students, with or without mental disorders, received TARA. Self-rating as well as qualitative evaluation was performed. Patients (N = 536 individuals) with a variety of psychiatric diagnoses completed RADS-2 and other questionnaires for psychometric evaluation of RADS- 2. Thirty-five adolescents and young adults with depression received TARA either face-to-face or online, with data collection before, during, and after the treatment. The study design and statistical analysis plan for the randomized controlled trial was conceived and developed.

Results: It was feasible and acceptable to give TARA to Swedish medical students and they described the program as an uncommon meeting ground for personal empowerment. Support was found for the four-factor structure of RADS-2, and the scale demonstrated good validity and acceptable to good reliability. The clinical pilot study further supported the feasibility and clinical safety of TARA, and preliminary signs of effectiveness were seen. A detailed description of the pragmatic, multicenter, randomized controlled superiority trial that will evaluate the clinical effectiveness of TARA compared to standard treatment for depression was outlined, peer reviewed, and published in a study protocol with a statistical analysis plan.

Conclusions: The present results indicate that TARA is feasible and safe in Swedish clinical and non-clinical contexts. RADS-2 is a suitable outcome measure to use in routine clinical practice as well as in the present and future trials of depression. The initiated randomized controlled trial will be an important next step logically following the studies and results presented in this dissertation.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. p. 114
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2294
Keywords
Depression, adolescents, young adults, medical students, mental health, anxiety, psychological stress, qualitative research, randomization, yoga, mindfulness, psychotherapy, antidepressant drugs, biomarkers, clinical trial, feasibility studies, online intervention, reliability, validity, confirmatory factor analysis, measurement invariance
National Category
Other Clinical Medicine
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:umu:diva-222788 (URN)978-91-8070-281-2 (ISBN)978-91-8070-282-9 (ISBN)
Public defence
2024-04-26, Umeälven, byggnad 28, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
Swedish Research CouncilRegion VästerbottenRegion VästernorrlandThe Kempe FoundationsFredrik och Ingrid Thurings StiftelseSwedish Society of Medicine
Available from: 2024-04-05 Created: 2024-03-27 Last updated: 2024-04-02Bibliographically approved

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Ekbäck, Erikvon Knorring, JohannaLöfgren Burström, AnnaDennhag, IngaMolin, JennyHenje Blom, Eva

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