Validation of the InnoWell Platform: Protocol for a Clinical Trial

Background

New electronic health technologies are being rapidly developed to improve the delivery of mental health care for both health professionals and consumers and better support self-management of care. We developed a Web-based platform (the InnoWell Platform) that supports the prevention, early intervention, treatment, and continuous monitoring of mental health and maintenance of well-being in people aged 2 years and older. The platform is a customizable digital tool kit that operates through existing service providers who utilize the system to provide their consumers with access to evidence-based assessments and feedback, intervention options, and outcome monitoring. It does this by collecting, storing, and reporting personal and health information back to consumers and their health professionals to promote collaborative care partnerships that aim to improve the management of mental ill health and maintenance of well-being

Objective

The aim of this study was to describe the research protocol for a naturalistic prospective clinical trial wherein all consumers presenting for care to a traditional face-to-face or Web-based mental health service in which the InnoWell Platform is being offered as part of standard clinical care will be given the opportunity to use the platform.

Methods

The Web-based platform is a configurable and customizable digital tool that assists in the assessment, monitoring and management of mental ill health, and maintenance of well-being. It does this by collecting, storing, and reporting health information back to the person and his or her clinician to enable transformation to person-centered care. The clinical trial will be conducted with individuals aged 2 years and older presenting to participating services for care, including persons from the veteran community, Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, the lesbian, gay, bisexual, transgender, and intersex community, and those from broader education and workforce sectors, as well as people with disabilities, lived experience of comorbidity, complex disorders, and suicidality.

Results

Project Synergy was funded in June 2017, and data collection began in November 2018 at a youth mental health service. At the time of this publication, 5 additional services have also begun recruitment, including 4 youth mental health services and a veteran’s service. The first results are expected to be submitted in 2020 for publication.

Conclusions

This clinical trial will promote access to comprehensive, high-quality mental health care to improve outcomes for consumers and health professionals. The data collected will be used to validate a clinical staging algorithm designed to match consumers with the right level of care and reduce the rate of suicidal thoughts and/or behaviors and suicide by suggesting pathways to care that are appropriate for the identified level of need, while simultaneously enabling a timely service response.

Trial Registration

Australian New Zealand Clinical Trial Registry ACTRN12618001676202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374632 (Archived by WebCite at http://www.webcitation.org/78TOi5jwl)

International Registered Report Identifier (IRRID)

DERR1-10.2196/13955

What is the prevalence, and what are the clinical correlates, of insulin resistance in young people presenting for mental health care? A cross-sectional study

OBJECTIVES

To report the distribution and predictors of insulin resistance (IR) in young people presenting to primary care-based mental health services.

DESIGN

Cross-sectional.

SETTING

Headspace-linked clinics operated by the Brain and Mind Centre of the University of Sydney.

PARTICIPANTS

768 young people (66% female, mean age 19.7±3.5, range 12-30 years).

MAIN OUTCOME MEASURES

IR was estimated using the updated homeostatic model assessment (HOMA2-IR). Height and weight were collected from direct measurement or self-report for body mass index (BMI).

RESULTS

For BMI, 20.6% of the cohort were overweight and 10.2% were obese. However, <1% had an abnormally high fasting blood glucose (>6.9 mmol/L). By contrast, 9.9% had a HOMA2-IR score >2.0 (suggesting development of IR) and 11.7% (n=90) had a score between 1.5 and 2. Further, there was a positive correlation between BMI and HOMA2-IR (r=0.44, p<0.001). Participants in the upper third of HOMA2-IR scores are characterised by younger age, higher BMIs and depression as a primary diagnosis. HOMA2-IR was predicted by younger age (β=0.19, p<0.001) and higher BMI (β=0.49, p<0.001), together explaining 22% of the variance (F_(2,361)=52.1, p<0.001).

CONCLUSIONS

Emerging IR is evident in a significant subgroup of young people presenting to primary care-based mental health services. While the major modifiable risk factor is BMI, a large proportion of the variance is not accounted for by other demographic, clinical or treatment factors. Given the early emergence of IR, secondary prevention interventions may need to commence prior to the development of full-threshold or major mood or psychotic disorders.

Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study

Background

Globally there is increasing recognition that new strategies are required to reduce disability due to common mental health problems. As 75% of mental health and substance use disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, new and innovative technologies show promise in augmenting traditional clinic-based services.

Objective

The aim of this study was to test new and innovative technologies to assess clinical stage in early intervention youth mental health services using a prototypic online system known as the Mental Health eClinic (MHeC).

Methods

The online assessment within the MHeC was compared directly against traditional clinician assessment within 2 Sydney-based youth-specific mental health services (headspace Camperdown and headspace Campbelltown). A total of 204 young people were recruited to the study. Eligible participants completed both face-to-face and online assessments, which were randomly allocated and counterbalanced at a 1-to-3 ratio. These assessments were (1) a traditional 45- to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician and (2) an approximate 60-minute online assessment (including a self-report Web-based survey, immediate dashboard of results, and a video visit with a clinician). All assessments were completed within a 2-week timeframe from initial presentation.

Results

Of the 72 participants who completed the study, 71% (51/72) were female and the mean age was 20.4 years (aged 16 to 25 years); 68% (49/72) of participants were recruited from headspace Camperdown and the remaining 32% (23/72) from headspace Campbelltown. Interrater agreement of participants’ stage, as determined after face-to-face assessment or online assessment, demonstrated fair agreement (kappa=.39, P<.001) with concordance in 68% of cases (49/72). Among the discordant cases, those who were allocated to a higher stage by online raters were more likely to report a past history of mental health disorders (P=.001), previous suicide planning (P=.002), and current cannabis misuse (P=.03) compared to those allocated to a lower stage.

Conclusions

The MHeC presents a new and innovative method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connected with traditional clinical services and assist in providing the right care at the right time.

Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study

OBJECTIVES

Mental disorders typically emerge during adolescence and young adulthood and put young people at risk for prolonged socioeconomic difficulties. This study describes the longitudinal course of social and occupational functioning of young people attending primary care-based, early intervention services.

DESIGN

A longitudinal study of young people receiving mental healthcare.

SETTING

Data were collected between January 2005 and August 2017 from a designated primary care-based mental health service.

PARTICIPANTS

554 young people (54% women) aged 12-32 years.

MEASURES

A systematic medical file audit collected clinical and functional information at predetermined time intervals (ie, 3 months to 5+ years) using a clinical pro forma. Group-based trajectory modelling (GBTM) was used to identify distinct trajectories of social and occupational functioning over time (median number of observations per person=4; median follow-up time=23 months).

RESULTS

Between first clinical contact and time last seen, 15% of young people had reliably deteriorated, 23% improved and 62% did not demonstrate substantive change in function. Of the whole cohort, 69% had functional scores less than 70 at time last seen, indicative of ongoing and substantive impairment. GBTM identified six distinct functional trajectories whereby over 60% had moderate-to-serious functional impairment at entry and remained chronically impaired over time; 7% entered with serious impairment and deteriorated further; a quarter were mildly impaired at entry and functionally recovered and only a small minority (4%) presented with serious impairments and functionally improved over time. Not being in education, employment or training, previous hospitalisation and a younger age at baseline emerged as significant predictors of these functional trajectories.

CONCLUSION

Young people with emerging mental disorders have significant functional impairment at presentation for care, and for the majority, it persists over the course of clinical care. In addition to providing clinical care earlier in the course of illness, these data suggest that more sophisticated and more intensive individual-level and organisational strategies may be required to achieve significant and sustained functional improvements.

Using New and Emerging Technologies to Identify and Respond to Suicidality Among Help-Seeking Young People: A Cross-Sectional Study

BACKGROUND

Suicidal thoughts are common among young people presenting to face-to-face and online mental health services. The early detection and rapid response to these suicidal thoughts and other suicidal behaviors is a priority for suicide prevention and early intervention efforts internationally. Establishing how best to use new and emerging technologies to facilitate person-centered systematic assessment and early intervention for suicidality is crucial to these efforts.

OBJECTIVE

The aim of this study was to examine the use of a suicidality escalation protocol to respond to suicidality among help-seeking young people.

METHODS

A total of 232 young people in the age range of 16-25 years were recruited from either a primary mental health care service or online in the community. Each young person used the Synergy Online System and completed an initial clinical assessment online before their face-to-face or online clinical appointment. A suicidality escalation protocol was used to identify and respond to current and previous suicidal thoughts and behaviors.

RESULTS

A total of 153 young people (66%, 153/232) reported some degree of suicidality and were provided with a real-time alert online. Further levels of escalation (email or phone contact and clinical review) were initiated for the 35 young people (15%, 35/232) reporting high suicidality. Higher levels of psychological distress (P<.001) and a current alcohol or substance use problem (P=.02) predicted any level of suicidality compared with no suicidality. Furthermore, predictors of high suicidality compared with low suicidality were higher levels of psychological distress (P=.01), psychosis-like symptoms in the last 12 months (P=.01), a previous mental health problem (P=.01), and a history of suicide planning or attempts (P=.001).

CONCLUSIONS

This study demonstrates the use of new and emerging technologies to facilitate the systematic assessment and detection of help-seeking young people presenting with suicidality. This protocol empowered the young person by suggesting pathways to care that were based on their current needs. The protocol also enabled an appropriate and timely response from service providers for young people reporting high suicidality that was associated with additional comorbid issues, including psychosis-like symptoms, and a history of suicide plans and attempts.

The underlying neurobiology of key functional domains in young people with mood and anxiety disorders: a systematic review

BACKGROUND

Mood and anxiety disorders are leading causes of disability and mortality, due largely to their onset during adolescence and young adulthood and broader impact on functioning. Key factors that are associated with disability and these disorders in young people are social and economic participation (e.g. education, employment), physical health, suicide and self-harm behaviours, and alcohol and substance use. A better understanding of the objective markers (i.e. neurobiological parameters) associated with these factors is important for the development of effective early interventions that reduce the impact of disability and illness persistence.

METHODS

We systematically reviewed the literature for neurobiological parameters (i.e. neuropsychology, neuroimaging, sleep-wake and circadian biology, neurophysiology and metabolic measures) associated with functional domains in young people (12 to 30 years) with mood and/or anxiety disorders.

RESULTS

Of the one hundred and thirty-four studies selected, 7.6 % investigated social and economic participation, 2.1 % physical health, 15.3 % suicide and self-harm behaviours, 6.9 % alcohol and substance use, whereas the majority (68.1 %) focussed on clinical syndrome.

CONCLUSIONS

Despite the predominance of studies that solely examine the clinical syndrome of young people the literature also provides evidence of distinct associations among objective measures (indexing various aspects of brain circuitry) and other functional domains. We suggest that a shift in focus towards characterising the mechanisms that underlie and/or mediate multiple functional domains will optimise personalised interventions and improve illness trajectories.

Cold Face Test-Induced Increases in Heart Rate Variability Are Abolished by Engagement in a Social Cognition Task

Abstract. The vagus nerve is a major constituent in the bidirectional relationship between the heart and the prefrontal cortex. This study investigated the role of the vagus in social cognition using the cold face test (facial cooling) to stimulate the vagus nerve and increase prefrontal inhibitory control. Heart Rate Variability (HRV) was measured to index parasympathetic outflow while social cognition ability was tested using the Reading the Mind in the Eyes Test (RMET). Healthy males (n = 25) completed the RMET under two conditions: with and without facial cooling. Results indicated that although facial cooling increased HRV at rest, there was no improvement in the RMET during the facial cooling condition. Interestingly, completing the RMET with facial cooling abolished this increase in HRV, suggesting interference along the vagal reflex arc. These results are consistent with the involvement of a common cortico-subcortical circuit in autonomic and cognitive processes, important for emotion recognition.