The Role of Therapy Dogs in Reducing Depression, Anxiety, and Loneliness Among Hospitalized Children

Overview

The purpose of this research study is to test whether an animal-assisted intervention (AAI) is better than conversation with another person or treatment as usual for improving mood, anxiety, loneliness, quality of life, and indicators of health care services such as number of hospitalizations, length of hospital stay, and cost of services for children and adolescents.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Basic Science
    • Masking: None (Open Label)
  • Study Primary Completion Date: February 2024

Detailed Description

Rationale: Loneliness is linked to a number of health threats, is considered to be as harmful as smoking 15 cigarettes a day, and is potentially more dangerous than obesity.1 Loneliness was considered to be at epidemic proportions2 prior to the COVID-19 pandemic. The resulting need for social distancing has exacerbated loneliness and other mental health concerns. Loneliness is associated with significant morbidity and mortality risks among people with Mental Illness (MI). As many as 70% of community-dwelling adults with MI endorse experiencing loneliness,3which increases exponentially with the number of co-morbid psychiatric diagnoses.4 A growing body of evidence indicates that companion animals offer a number of health and wellbeing benefits.5,6 Interacting with a trained therapy animal as part of an animal-assisted interaction (AAI) may provide social support for patients with mental illness, thus reducing the risk of loneliness. The use of AAIs for hospitalized patients with MI as a strategy for reducing loneliness has been understudied. Scientists and practitioners need clear answers to some key questions before specific recommendations can be made. Hypothesis/Objectives: 1. Evaluate the feasibility of a therapy dog visitation intervention (AAI) over four consecutive days on an inpatient psychiatry unit, compared to a conversational control intervention (CC), and a treatment as usual control condition (TU) in psychiatric inpatients; 2. Assess the efficacy of an AAI over four consecutive days, compared to CC, and a treatment as usual control condition (TU) in psychiatric inpatients; 3. Obtain information required to estimate sample size for a large randomized controlled trial (RCT) of a therapy dog visitation program in the population of psychiatric inpatients, combined with already funded pilot data from a sample of older adults to calculate power, determine sample size, and pursue federal funding for a large scale, multi-site, clinical trial. Study Design and Methods: The proposed study employs a three-group RCT design to examine study implementation feasibility and effects of AAI compared to CC and TU conditions. We will randomize 60 psychiatry inpatients to one of three conditions (AAI, CC, or TU) for a four-day treatment period. Preliminary Data: Demonstrated reductions in anxiety7 and fear8 in hospitalized psychiatric patients following brief AAI provide a foundation for this work. Expected Results: We anticipate that patients will demonstrate greater improvements in the primary outcome of loneliness, and in the secondary mental health and well-being outcomes of anxiety, depression, HRQOL and mood in the therapy dog visitation program compared to the CC and TU conditions from phase 1-4 and from pre to post intervention during phase 2. We anticipate that at least 50% of patients approached will consent to participation in the study. We anticipate greater than 75% adherence (session completion) and less than 25% attrition (failure to attend sessions) in the AAI and CC groups. We anticipate similar rates of completion in phase 3 and phase 4 assessments in the three groups, with greater failure longer after study completion. We anticipate that a high proportion (at least 75%) of patients will report satisfaction with the AAI (phase 3) and that the proportion will be higher than for the CC. We will explore differences in willingness to consent, instrument completion (rates of missing data), and adherence and attrition across conditions. Potential Impact on Human-Animal Bond Research: This proposal uniquely addresses loneliness, a critical mechanism that contributes to mortality and potential morbidity among people with serious mental illness. Completing the proposed research will allow us to collect necessary pilot data to support a larger, funded, fully powered RCT to test the effectiveness of therapy dog visitation as an adjunctive treatment for people with serious mental disorders . If findings support the superior efficacy of therapy dog visitation compared to other conditions, this information can be used not only to support its use as an inpatient intervention, but to provide a foundation for studying its utility in community-based mental health contexts, such as assertive community treatment, wellness action and recovery programs, and in supportive housing. References 1. Holt-Lunstad J, Smith, T.B., Layton, J.B. . Social relationships and mortality risk: a meta-analytic review. PLoS med. 2010;27(7:e1000316). 2. Administration HRaS. The Loneliness Epidemic. https://www.hrsa.gov/enews/past-issues/2019/january-17/loneliness-epidemic. Published 2019. Accessed January 23, 2021. 3. Dell NA, Pelham M, Murphy AM. Loneliness and depressive symptoms in middle aged and older adults experiencing serious mental illness. Psychiatric Rehabilitation Journal. 2019;42(2):113-120. 4. Meltzer H, Bebbington P, Dennis MS, Jenkins R, McManus S, Brugha TS. Feelings of loneliness among adults with mental disorder. Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services. 2013;48(1):5-13. 5. Wells DL. The state of research on human-animal relations: implications for human health. Anthrozoös. 2019;32(2):169-181. 6. Krause-Parello CA, Gulick, E.E., Basin, B. Loneliness, depression, and physical activity in older adults: The therapeutic role of human-animal interactions. Anthrozoös. 2019;32(2):239-254. 7. Barker SB, & Dawson, K. S. The effects of animal-assisted therapy on anxiety ratings of hospitalized psychiatric patients. Psychiatric Services. 1998;49(6):797-801. 8. Barker SB, Pandurangi, A. K., & Best, A. M. . Effects of animal-assisted therapy on patients' anxiety, fear, and depression before ECT. . Journal of ECT. 2003;19(1):38-44.

Interventions

  • Behavioral: Animal-assisted interaction
    • Visits will occur on 3 consecutive days during your participant’s inpatient hospital stay. A dog-handler team or a handler alone will visit participants with a dog for approximately 20 minutes at a convenient time for the participant. During this visit, the participant will be able to pet the dog if they wish. The handler will talk with the participants about the dog, the weather, sports, or other light topics. Participants can also suggest light topics to talk about as well.
  • Behavioral: Conversational interaction
    • Visits will occur on 3 consecutive days during your participant’s inpatient hospital stay. A dog-handler team or a handler alone will visit participants without a dog for approximately 20 minutes at a convenient time for the participant. During this visit, the handler will talk with the participants about the weather, sports, or other light topics. Participants can also suggest light topics to talk about as well.

Arms, Groups and Cohorts

  • Experimental: Animal-assisted interaction
    • A dog-handler team will visit participants in their hospital room
  • Experimental: Conversational interaction
    • Conversational interaction with the participants and the dog-handler
  • No Intervention: Treatment as usual
    • Participants will received the regular services currently being received in the hospital

Clinical Trial Outcome Measures

Primary Measures

  • Change in Depression
    • Time Frame: Baseline to end of treatment (about 5 days), 1 month after treatment
    • Depressive symptomology will be measured with the 13-item Mood and Feelings Questionnaire (MFQ) which are rated on a 3 point scale. Higher scores indicate greater depression.
  • Change in Anxiety
    • Time Frame: Baseline to end of treatment (about 5 days), 1 month after treatment
    • Anxiety will be measured using the 6-item state scale of the State-Trait Anxiety Inventory for Children (STAI-C) which are rated on a 3 point scale. Higher scores indicate more anxiety.
  • Change in Mood
    • Time Frame: Baseline to end of treatment (about 5 days), 1 month after treatment
    • Mood will be measured using the Smiley Face Assessment Scale in which participants select which face fits their current mood. The scale depicts five emoticons from very sad to very happy.
  • Change in Loneliness
    • Time Frame: Baseline to end of treatment (about 5 days), 1 month after treatment
    • Child loneliness will be assessed using the 11-item version of the De Jong Gierveld Loneliness Scale for children which are answered on a 5 point scale. Higher scores indicate greater loneliness.

Participating in This Clinical Trial

Inclusion Criteria

Inclusion criteria for children:

  • Projected to be admitted to the hospital for the upcoming five days – between 8-17 years of age – speak English – be able to provide assent (understand what the study is about and what activities are involved) Inclusion criteria for parents: – Age 18+ – English-speaking – Access to working phone, email, or address so that follow-up measures can be completed/sent. Exclusion Criteria:

Exclusion criteria for children:

  • Fear of or allergy to dogs – documented contact precautions – cognitive impairment that prevents consent/assent or completion of measures – inability to participate in the study in the clinical judgment of their healthcare provider. Exclusion criteria for parents: – Inability to understand documents written in English – Fear of or allergy to dogs

Gender Eligibility: All

Minimum Age: 8 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Virginia Commonwealth University
  • Collaborator
    • Purina Mills, Inc
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Nancy R Gee, PhD, Principal Investigator, Virginia Commonwealth University
  • Overall Contact(s)
    • Nancy R Gee, PhD, 804-827-7297, Nancy.Gee@vcuhealth.org

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