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Duke S, Macdonald J, Kennedy AJ. Steering Straight: Adapting suicide risk safety planning as a prevention-focused self-management resource for the Australian farming community. Aust J Rural Health 2023. [PMID: 36762906 DOI: 10.1111/ajr.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/15/2023] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE This paper draws on the principles of suicide risk safety planning to co-design a farming community resource for preventing and managing risks to mental health. SETTING This project was undertaken in the Great South Coast Region of Victoria, Australia. PARTICIPANTS A working group (n = 6-8) from the Victorian farming community contributed to the iterative co-design and co-production of Steering Straight: My plan to keep on track. Twenty-four members of the farming community pilot tested Steering Straight. DESIGN Co-design to develop, pilot and refine the resource with working group and target farming community. RESULTS Steering Straight was viewed positively by the farming community as a tool that prompts prioritising well-being; encourages reflection, planning and concrete steps towards taking action; helps set and meet personal goals; is simple and practical; and identifies pathways to support. Most participants (94%) completed Steering Straight on their own, taking approximately 15-30 min to create their personalised plan. Questions most likely to be filled in related to recognising personal signs of deteriorating well-being and listing and planning enjoyable activities. A majority of participants (67%) kept a hard copy of their Steering Straight plan on hand to refer back to, while 78% expressed a preference for a digital version. CONCLUSION The co-design and co-production process resulted in a tailored prevention-focused resource that was accepted and valued by the farming community.
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Affiliation(s)
- Sonya Duke
- Western District Health Service, Hamilton, Victoria, Australia
| | - Joanna Macdonald
- National Centre for Farmer Health, School of Medicine, Deakin University, Hamilton, Victoria, Australia
| | - Alison J Kennedy
- National Centre for Farmer Health, School of Medicine, Deakin University, Hamilton, Victoria, Australia
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Lean M, Fornells-Ambrojo M, Milton A, Lloyd-Evans B, Harrison-Stewart B, Yesufu-Udechuku A, Kendall T, Johnson S. Self-management interventions for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry 2019; 214:260-268. [PMID: 30898177 PMCID: PMC6499726 DOI: 10.1192/bjp.2019.54] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Self-management is intended to empower individuals in their recovery by providing the skills and confidence they need to take active steps in recognising and managing their own health problems. Evidence supports such interventions in a range of long-term physical health conditions, but a recent systematic synthesis is not available for people with severe mental health problems.AimsTo evaluate the effectiveness of self-management interventions for adults with severe mental illness (SMI). METHOD A systematic review of randomised controlled trials was conducted. A meta-analysis of symptomatic, relapse, recovery, functioning and quality of life outcomes was conducted, using RevMan. RESULTS A total of 37 trials were included with 5790 participants. From the meta-analysis, self-management interventions conferred benefits in terms of reducing symptoms and length of admission, and improving functioning and quality of life both at the end of treatment and at follow-up. Overall the effect size was small to medium. The evidence for self-management interventions on readmissions was mixed. However, self-management did have a significant effect compared with control on subjective measures of recovery such as hope and empowerment at follow-up, and self-rated recovery and self-efficacy at both time points. CONCLUSION There is evidence that the provision of self-management interventions alongside standard care improves outcomes for people with SMI. Self-management interventions should form part of the standard package of care provided to people with SMI and should be prioritised in guidelines: research on best methods of implementing such interventions in routine practice is needed.Declaration of interestsNone.
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Affiliation(s)
- Melanie Lean
- Trainee Clinical Psychologist, Division of Psychology and Language Sciences, University College London, UK,Correspondence: Dr Melanie Lean, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
| | - Miriam Fornells-Ambrojo
- Lecturer in Clinical Psychology, Division of Psychology and Language Sciences, University College London, UK
| | - Alyssa Milton
- Postdoctoral Research Fellow, Brain and Mind Centre, University of Sydney, Australia
| | - Brynmor Lloyd-Evans
- Senior Lecturer in Mental Health and Social Care, Division of Psychiatry, University College London, UK
| | - Bronwyn Harrison-Stewart
- Research Assistant, Centre for Outcomes Research and Effectiveness, University College London, UK
| | - Amina Yesufu-Udechuku
- Research Associate, Centre for Outcomes Research and Effectiveness, University College London, UK
| | - Tim Kendall
- National Clinical Director, Mental Health NHS England, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, University College London, UK
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Fletcher K, Foley F, Murray G. Web-Based Self-Management Programs for Bipolar Disorder: Insights From the Online, Recovery-Oriented Bipolar Individualised Tool Project. J Med Internet Res 2018; 20:e11160. [PMID: 30355553 PMCID: PMC6231852 DOI: 10.2196/11160] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/25/2018] [Accepted: 08/17/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a complex, relapsing mood disorder characterized by considerable morbidity and mortality. Web-based self-management interventions provide marked opportunities for several chronic mental health conditions. However, Web-based self-management programs targeting BD are underrepresented compared with programs targeting other psychiatric conditions. OBJECTIVE This paper aims at facilitating future research in the area of self-management of BD and draws insights from the development of one such intervention-the Online, Recovery-Oriented Bipolar Individualised Tool (ORBIT)-that is aimed at improving the quality of life of people with BD. METHODS We have discussed the opportunities and challenges in developing an engaging, evidence-based, safe intervention within the context of the following three nested domains: (1) intervention development; (2) scientific testing of the intervention; and (3) ethical framework including risk management. RESULTS We gained the following insights across the three abovementioned overlapping domains: Web-based interventions can be optimized through (1) codesign with consumers with lived experience to ensure relevance and appropriateness to the target audience; (2) novel content development processes that iteratively combine evidence-based information with lived experience perspectives, capitalizing on multimedia (eg, videos) that the digital health space provides; and (3) incorporating Web-based communities to connect end users and promote constructive engagement by access to a Web-based coach. CONCLUSIONS Self-management is effective in BD, even for those on the more severe end of the spectrum. While there are challenges to be aware of, guided self-management programs, such as those offered by the ORBIT project, which are specifically developed for Web-based delivery provide highly accessible, engaging, and potentially provocative treatments for chronically ill populations who may otherwise have never engaged with treatment. Key questions about engagement, effectiveness, and cost-effectiveness will be answered by the ORBIT project over the next 18 months.
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Affiliation(s)
- Kathryn Fletcher
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Fiona Foley
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
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Beck AK, Baker A, Jones S, Lobban F, Kay-Lambkin F, Attia J, Banfield M. Exploring the feasibility and acceptability of a recovery-focused group therapy intervention for adults with bipolar disorder: trial protocol. BMJ Open 2018; 8:e019203. [PMID: 29391366 PMCID: PMC5829875 DOI: 10.1136/bmjopen-2017-019203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/08/2017] [Accepted: 11/07/2017] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Improving accessible, acceptable recovery-oriented service provision for people with bipolar disorder (BD) is an important priority. Mindfulness and acceptance-based cognitive and behavioural therapies (or 'third -wave' CBT) may prove fruitful due to the considerable overlap between these approaches and key features of personal recovery. Groups also confer therapeutic benefits consistent with personal recovery and may improve recovery-oriented service provision by adding another modality for accessing support. The primary objective of this trial is to explore the feasibility and acceptability of a new recovery-focused group therapy (RfGT) intervention for adults with BD. This is the first published feasibility assessment of a time-limited RfGTrecovery-focused group therapy intervention for BD. METHODS/ ANALYSIS This protocol describes an open feasibility study, utilising a pre-treatment design versus post- treatment design and nested qualitative evaluation. Participants will be recruited from the Central Coast region of New South Wales, Australia, from primary care providers, specialist mental health services, non-government organisations and via self-referral. The primary outcomes are feasibility and acceptability as indexed by recruitment, retention, intervention adherence, adverse events (if any) and detailed consumer feedback. Clinical outcomes and process measures will be assessed to inform future research. Primary outcome data will utiliseuse descriptive statistics (eg, summarizingsummarising recruitment, demographics, attendance, attrition and intervention adherence). Secondary outcomes will be assessed using repeated-measures analysis of covariance across all time points (including change, effect size and variability). ETHICS AND DISSEMINATION Ethical approval has been granted by the Northern Sydney Local Health District HREChuman research ethics committee (HREC) (HREC/16/HAWKE/69) and The University of Newcastle HREC (H-2016-0107). The Ffindings will be used to improve the intervention per user needs and preferences, and inform what amendments and/or information are required before a follow-on trial would be possible. This study contributes to a growing body of innovative, recovery-oriented innovations of psychological treatments for adults with BD. TRIAL REGISTRATION NUMBER ACTRN12616000887471; Pre-results.
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Affiliation(s)
- Alison K Beck
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, Sydney, Australia
| | - Amanda Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, Sydney, Australia
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- NHMRC Centre for Research Excellence in Mental Health and Substance Use, Sydney, Australia
| | - John Attia
- Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, University of Newcastle, Newcastle, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, Australian National University, Canberra, Australia
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Rajagopalan A, Shah P, Zhang MW, Ho RC. Digital Platforms in the Assessment and Monitoring of Patients with Bipolar Disorder. Brain Sci 2017; 7:E150. [PMID: 29137156 PMCID: PMC5704157 DOI: 10.3390/brainsci7110150] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/24/2017] [Accepted: 11/06/2017] [Indexed: 01/12/2023] Open
Abstract
This paper aims to review the application of digital platforms in the assessment and monitoring of patients with Bipolar Disorder (BPD). We will detail the current clinical criteria for the diagnosis of BPD and the tools available for patient assessment in the clinic setting. We will go on to highlight the difficulties in the assessment and monitoring of BPD patients in the clinical context. Finally, we will elaborate upon the impact that diital platforms have made, and have the potential to make, on healthcare, mental health, and specifically the management of BPD, before going on to evaluate the benefits and drawbacks of the use of such technology.
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Affiliation(s)
- Arvind Rajagopalan
- Imperial College School of Medicine, South Kensington Campus, London SW7 2AZ, UK.
| | - Pooja Shah
- Imperial College School of Medicine, South Kensington Campus, London SW7 2AZ, UK.
| | - Melvyn W Zhang
- Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore 119228, Singapore, Singapore.
| | - Roger C Ho
- Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore 119228, Singapore, Singapore.
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore.
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Lobban F, Robinson H, Appelbe D, Barraclough J, Bedson E, Collinge L, Dodd S, Flowers S, Honary M, Johnson S, Mateus C, Mezes B, Minns V, Murray E, Walker A, Williamson P, Wintermeyer C, Jones S. Protocol for an online randomised controlled trial to evaluate the clinical and cost-effectiveness of a peer-supported self-management intervention for relatives of people with psychosis or bipolar disorder: Relatives Education And Coping Toolkit (REACT). BMJ Open 2017; 7:e016965. [PMID: 28720617 PMCID: PMC5541455 DOI: 10.1136/bmjopen-2017-016965] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Despite clinical guidelines recommendations, many relatives of people with psychosis or bipolar disorder do not currently receive the support they need. Online information and support may offer a solution. METHODS AND ANALYSIS This single-blind, parallel, online randomised controlled trial will determine clinical and cost-effectiveness of the Relatives Education And Coping Toolkit (REACT) (including an online resource directory (RD)), compared with RD only, for relatives of people with psychosis or bipolar disorder. Both groups continue to receive treatment as usual. Independent, web-based variable, block, individual randomisation will be used across 666 relatives. Primary outcome is distress at 24 weeks (measured by General Health Questionnaire; GHQ-28) compared between groups using analysis of covariance, adjusting for baseline score. Secondary clinical outcomes are carer well-being and support. Cost-effectiveness analysis will determine cost of a significant unit change (three-point reduction) in the GHQ-28. Costs include offering and supporting the intervention in the REACT arm, relevant healthcare care costs including health professional contacts, medications prescribed and time off (or ability to) work for the relative. Cost utility analysis will be calculated as the marginal cost of changes in quality-adjusted life years, based on EuroQol. We will explore relatives' beliefs, perceived coping and amount of REACT toolkit use as possible outcome mediators. We have embedded two methodological substudies in the protocol to determine the relative effectiveness of a low-value (£10) versus higher value (£20) incentive, and an unconditional versus conditional incentive, on improving follow-up rates. ETHICS AND DISSEMINATION The trial has ethical approval from Lancaster National Research Ethics Service (NRES)Committee (15/NW/0732) and is overseen by an independent Data Monitoring and Ethics Committee and Trial Steering Committee. Protocol version 1.5 was approved on 9 January 2017. All updates to protocols are uploaded to the National Institute for Health Research (NIHR) Journals Library. A full statistical analysis plan is available at https://figshare.com/account/home#/projects/19975. Publications will be in peer-reviewed journals (open access wherever possible). Requests for access to the data at the end of the study will be reviewed and granted where appropriate by the Trial Management Group. TRIAL REGISTRATION NUMBER ISRCTN72019945, pre-results.
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Affiliation(s)
- Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Heather Robinson
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Duncan Appelbe
- Medical Research Council North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Johanna Barraclough
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Emma Bedson
- Medical Research Council North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Lizzie Collinge
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Susanna Dodd
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Sue Flowers
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Mahsa Honary
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Ceu Mateus
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Barbara Mezes
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Valerie Minns
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Andrew Walker
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Paula Williamson
- Medical Research Council North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Catherine Wintermeyer
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK
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González-Ortega I, Ugarte A, Ruiz de Azúa S, Núñez N, Zubia M, Ponce S, Casla P, Llano JX, Faria Á, González-Pinto A. Online psycho-education to the treatment of bipolar disorder: protocol of a randomized controlled trial. BMC Psychiatry 2016; 16:452. [PMID: 28007034 PMCID: PMC5178094 DOI: 10.1186/s12888-016-1159-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/07/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Bipolar disorder patients frequently present recurrent episodes and often experience subsyndromal symptoms, cognitive impairment and difficulties in functioning, with a low quality of life, illness relapses and recurrent hospitalization. Early diagnosis and appropriate intervention may play a role in preventing neuroprogression in this disorder. New technologies represent an opportunity to develop standardized psychological treatments using internet-based tools that overcome some of the limitations of face-to-face treatments, in that they are readily accessible and the timing of therapy can be tailored to user needs and availability. However, although many psychological programs are offered through the web and mobile devices for bipolar disorder, there is a lack of high quality evidence concerning their efficacy and effectiveness due to the great variability in measures and methodology used. METHODS This clinical trial is a simple-blind randomized trial within a European project to compare an internet-based intervention with treatment as usual. Bipolar disorder patients are to be included and randomly assigned to one of two groups: 1) the experimental group (tele-care support) and 2) the control group. Participants in both groups will be evaluated at baseline (pre-treatment) and post-treatment. DISCUSSION This study describes the design of a clinical trial based on psychoeducation intervention that may have a significant impact on both prognosis and treatment in bipolar disorder. Specifically, bringing different services together (service aggregation), it is hoped that the approach proposed will significantly increase the impact of information and communication technologies on access and adherence to treatment, quality of the service, patient safety, patient and professional satisfaction, and quality of life of patients. TRIAL REGISTRATION NCT02924415 . Retrospectively registered 27 September 2016.
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Affiliation(s)
- Itxaso González-Ortega
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004, Vitoria, Spain.
| | - Amaia Ugarte
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004 Vitoria, Spain
| | - Sonia Ruiz de Azúa
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004 Vitoria, Spain
| | - Nuria Núñez
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004 Vitoria, Spain
| | - Marta Zubia
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004 Vitoria, Spain
| | - Sara Ponce
- Centro de Investigación en Cronicidad-Kronikgune, Barakaldo, Spain
| | | | | | - Ángel Faria
- Subdirección de Informática, Sistemas de Información-Osakidetza, Vitoria, Spain
| | - Ana González-Pinto
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004 Vitoria, Spain
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Schuurmans J, van der Linden JL, van Ballegooijen W, Ruwaard J, Stek ML, Smit JH, Riper H. Tablet-based support for older adults with severe mood disorders treated in an ambulatory geriatric psychiatry setting: Protocol of a feasibility study of the eCare@Home platform. Internet Interv 2016; 6:22-28. [PMID: 30135811 PMCID: PMC6096249 DOI: 10.1016/j.invent.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Although older adults are just as likely to benefit from e-mental health as their younger counterparts, there are virtually no applications specifically designed to accommodate the needs of older adults with recurrent depression or bipolar disorder. Recurrent mood disorders constitute a large and rising proportion of the global disease in older populations, indicating a need for more e-mental health applications targeting this group. This paper describes the theoretical background and methodology of a study examining the feasibility of a tablet-based self-management platform for older adults with recurrent mood disorders. The eCare@Home platform was designed to 1) improve patients' awareness and knowledge of recurrent mood disorders and their treatment, 2) promote self-management through the use of a simple daily monitoring tool, and 3) facilitate online contact with their clinician through videoconferencing. METHODS The design involves a single-group four-month pilot study, with measurements at baseline (T0), and at weeks 8 and 16 (T1 and T2). The target group consists of older outpatients (aged 60 or above) who are undergoing treatment for recurrent depressive or bipolar disorder (N = 50), and their clinicians (N = 10). Primary feasibility endpoints will be system acceptability, system usability, and client satisfaction with the platform. In addition, qualitative data from semi-structured interviews in N = 10 patients and N = 5 clinicians will be gathered to provide more insight into user experiences and evaluations of the platform's added value. DISCUSSION To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a tablet-based e-mental health platform for older adults with severe mood disorders. If tablet-based support for this group is shown to be feasible, the intention is to proceed with the design of a large-scale process and outcome evaluation. The strengths and limitations of the methodology used are addressed in this article.Trial Registration: registration is pending.
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Affiliation(s)
- Josien Schuurmans
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
| | - Juliette L. van der Linden
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - Wouter van Ballegooijen
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences/Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Faculty of Behavioural and Movement Sciences/Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Max L. Stek
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - Jan H. Smit
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Research & Innovation, GGZ inGeest, Amsterdam, P.O. Box 7057, Amsterdam MB 1007, The Netherlands
- Department of Psychiatry and EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van der Boechorststraat 7, BT 1081 Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences/Department of Clinical, Neuro- and Developmental Psychology, Clinical Psychology section, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
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Hidalgo-Mazzei D, Mateu A, Reinares M, Murru A, Del Mar Bonnín C, Varo C, Valentí M, Undurraga J, Strejilevich S, Sánchez-Moreno J, Vieta E, Colom F. Psychoeducation in bipolar disorder with a SIMPLe smartphone application: Feasibility, acceptability and satisfaction. J Affect Disord 2016; 200:58-66. [PMID: 27128358 DOI: 10.1016/j.jad.2016.04.042] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/11/2016] [Accepted: 04/16/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND During the last fifteen years, the possibility of delivering psychoeducation programs through Internet-based platforms have been explored. Studies evaluating those programs have shown good to acceptable retention rates. In this context, we developed a smartphone application (SIMPLe) collecting information about mood symptoms and offering personalized psychoeducation messages. The main aims of this study were to evaluate the feasibility, acceptability and satisfaction of the smartphone application. METHODS The study was conducted from March to August 2015. Participation in the study was proposed to a consecutive sample of adult patients attending an outpatient mental health clinic. Sociodemographic data, clinical and functional assessments alongside smartphone ownership and uses were collected at baseline and at 3 months' follow-up. A 5 item Likert-scale satisfaction questionnaire was also employed. RESULTS 51 participants were initially enrolled in the study, 36 (74%) remained actively using the application after 3 months. The whole sample interacted with the application a mean of 77 days (SD=26.2). During these days they completed 88% of the daily tests. Over 86% of the participants agreed that the experience using the application was satisfactory. LIMITATIONS The diversity of smartphones operating systems led to a moderate, although representative, sample number. Additionally, the subjective data reporting, narrow time frame of use and stability of the patients could have affected the results. CONCLUSIONS The results confirm that this particular intervention is feasible and represent a satisfactory and acceptable instrument for the self-management of bipolar disorder as an add-on to the usual treatment but future clinical trials must still probe its efficacy.
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Affiliation(s)
- Diego Hidalgo-Mazzei
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Ainoa Mateu
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - María Reinares
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Andrea Murru
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Caterina Del Mar Bonnín
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Cristina Varo
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Marc Valentí
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Juan Undurraga
- Department of Psychiatry, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile; Early Intervention Program, Instituto Psiquiátrico "Dr Horwitz Barak", Santiago, Chile
| | - Sergio Strejilevich
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina
| | - José Sánchez-Moreno
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar disorder program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Francesc Colom
- Mental Health Group, IMIM-Hospital del Mar, Barcelona, Catalonia, Spain
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Faurholt-Jepsen M, Munkholm K, Frost M, Bardram JE, Kessing LV. Electronic self-monitoring of mood using IT platforms in adult patients with bipolar disorder: A systematic review of the validity and evidence. BMC Psychiatry 2016; 16:7. [PMID: 26769120 PMCID: PMC4714425 DOI: 10.1186/s12888-016-0713-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/08/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Various paper-based mood charting instruments are used in the monitoring of symptoms in bipolar disorder. During recent years an increasing number of electronic self-monitoring tools have been developed. The objectives of this systematic review were 1) to evaluate the validity of electronic self-monitoring tools as a method of evaluating mood compared to clinical rating scales for depression and mania and 2) to investigate the effect of electronic self-monitoring tools on clinically relevant outcomes in bipolar disorder. METHODS A systematic review of the scientific literature, reported according to the Preferred Reporting items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted. MEDLINE, Embase, PsycINFO and The Cochrane Library were searched and supplemented by hand search of reference lists. Databases were searched for 1) studies on electronic self-monitoring tools in patients with bipolar disorder reporting on validity of electronically self-reported mood ratings compared to clinical rating scales for depression and mania and 2) randomized controlled trials (RCT) evaluating electronic mood self-monitoring tools in patients with bipolar disorder. RESULTS A total of 13 published articles were included. Seven articles were RCTs and six were longitudinal studies. Electronic self-monitoring of mood was considered valid compared to clinical rating scales for depression in six out of six studies, and in two out of seven studies compared to clinical rating scales for mania. The included RCTs primarily investigated the effect of heterogeneous electronically delivered interventions; none of the RCTs investigated the sole effect of electronic mood self-monitoring tools. Methodological issues with risk of bias at different levels limited the evidence in the majority of studies. CONCLUSIONS Electronic self-monitoring of mood in depression appears to be a valid measure of mood in contrast to self-monitoring of mood in mania. There are yet few studies on the effect of electronic self-monitoring of mood in bipolar disorder. The evidence of electronic self-monitoring is limited by methodological issues and by a lack of RCTs. Although the idea of electronic self-monitoring of mood seems appealing, studies using rigorous methodology investigating the beneficial as well as possible harmful effects of electronic self-monitoring are needed.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen, DK- 2100, Denmark.
| | - Klaus Munkholm
- Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen, DK- 2100, Denmark.
| | - Mads Frost
- The Pervasive Interaction Laboratory (PIT Lab), IT University of Copenhagen, Copenhagen, Denmark.
| | - Jakob E. Bardram
- DTU Compute Copenhagen Center for Health Technology, DTU, Lymgby, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen, DK- 2100, Denmark.
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11
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Hidalgo-Mazzei D, Mateu A, Reinares M, Matic A, Vieta E, Colom F. Internet-based psychological interventions for bipolar disorder: Review of the present and insights into the future. J Affect Disord 2015; 188:1-13. [PMID: 26342885 DOI: 10.1016/j.jad.2015.08.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/12/2015] [Accepted: 08/05/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the last decade, there has been an increasing advent of innovative concepts in psychological interventions aimed at empowering bipolar patients by means of technological advancements and taking advantage of the proliferation of the Internet. Since the adoption of these technologies for behavioral monitoring and intervention is not trivial in clinical practice, the main objective of this review is to provide an overview and to discuss the several initiatives published so far in the literature related to the Internet-based technologies aimed to deliver evidence-based psychological interventions for bipolar disorder patients. METHODS We conducted a comprehensive systematic review of the literature from multiple technological, psychiatric and psychological domains. The search was conducted by applying the Boolean algorithm "BIPOLAR AND DISORDER AND (treatment OR intervention) AND (online OR Internet OR web-based OR smartphone OR mobile)" at MEDLINE, SCOPUS, EMBASE, ClinicalTrials, ISI Web of Science and Google Scholar. RESULTS We identified over 251 potential entries matching the search criteria and after a thorough manual review, 29 publications pertaining to 12 different projects, specifically focusing on psychological interventions for bipolar patients through diverse Internet-based methods, were selected. LIMITATIONS Taking into consideration the diversity of the initiatives and the inconclusive main outcome results of the studies, there is still limited evidence available to draw firm conclusions about the efficacy of interventions using Internet-based technologies for bipolar disorder. CONCLUSIONS However, considering the high rates of retention and compliance reported, they represent a potential highly feasible and acceptable method of delivering this kind of interventions to bipolar patients.
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Affiliation(s)
- Diego Hidalgo-Mazzei
- Bipolar Disorder Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Ainoa Mateu
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - María Reinares
- Bipolar Disorder Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | | | - Eduard Vieta
- Bipolar Disorder Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Francesc Colom
- Bipolar Disorder Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
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12
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Fernandez ID, Groth SW, Reschke JE, Graham ML, Strawderman M, Olson CM. eMoms: Electronically-mediated weight interventions for pregnant and postpartum women. Study design and baseline characteristics. Contemp Clin Trials 2015; 43:63-74. [PMID: 25957183 DOI: 10.1016/j.cct.2015.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/22/2015] [Accepted: 04/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The influence of childbearing in the development of obesity is situated within two different but related contexts: pregnancy-related weight gain and weight gain prevention and control in young adult women. Pregnancy related weight gain contributes to long-term weight retention in childbearing women. OBJECTIVE To present the study design, data collection procedures, recruitment challenges, and the baseline characteristics for the eMoms of Rochester study, a randomized clinical trial testing the effect of electronically-mediated behavioral interventions to prevent excessive gestational weight gain (GWG) and postpartum weight retention among women aged 18-35 years of diverse income and racial/ethnic backgrounds in an urban setting. DESIGN Randomized double blind clinical trial. A total of 1722 women at or below 20 weeks of gestation were recruited primarily from obstetric practices and randomized to 3 treatment groups: control arm; intervention arm with access to intervention during pregnancy and control at postpartum (e-intervention 1); and intervention arm with access to intervention during pregnancy and postpartum (e-intervention 2). Enrollment and consent were completed via study staff or online. Data were collected via online surveys, medical charts, and measurement of postpartum weights. The primary endpoints are gaining more weight than recommended by the Institution of Medicine guidelines and weight retained at 12 months postpartum. CONCLUSION This study will provide evidence on the efficacy of behavioral interventions in the prevention of excessive GWG and postpartum weight retention with potential dissemination to obstetric practices and/or health insurances. ClinicalTrials.gov #NCT01331564.
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Affiliation(s)
- Isabel Diana Fernandez
- Department of Public Health Sciences, Division of Epidemiology, University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd., CU 420644, Rochester, NY 14642-0644, United States.
| | - Susan W Groth
- School of Nursing, University of Rochester, United States
| | - Jennifer E Reschke
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, United States
| | | | - Myla Strawderman
- Division of Nutritional Sciences, Cornell University, United States
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13
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Holländare F, Eriksson A, Lövgren L, Humble MB, Boersma K. Internet-Based Cognitive Behavioral Therapy for Residual Symptoms in Bipolar Disorder Type II: A Single-Subject Design Pilot Study. JMIR Res Protoc 2015; 4:e44. [PMID: 25908235 PMCID: PMC4424320 DOI: 10.2196/resprot.3910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 11/13/2022] Open
Abstract
Background Bipolar disorder is a chronic condition with recurring episodes that often lead to suffering, decreased functioning, and sick leave. Pharmacotherapy in the form of mood stabilizers is widely available, but does not eliminate the risk of a new depressive or (hypo)manic episode. One way to reduce the risk of future episodes is to combine pharmacological treatment with individual or group psychological interventions. However, access to such interventions is often limited due to a shortage of trained therapists. In unipolar depression there is now robust evidence of the effectiveness of Internet-based psychological interventions, usually comprising psychoeducation and cognitive behavioral therapy (CBT). Internet-based interventions for persons suffering from bipolar disorder could increase access to psychological treatment. Objective The aim of this study was to investigate the feasibility of an Internet-based intervention, as well as its effect on residual depressive symptoms in persons diagnosed with bipolar disorder type II (BP-II). The most important outcomes were depressive symptoms, treatment adherence, and whether the patient perceived the intervention as helpful. Methods A total of 7 patients diagnosed with bipolar disorder type II at a Swedish psychiatric outpatient clinic were offered the opportunity to participate. Of the 7 patients, 3 (43%) dropped out before treatment began, and 4 (57%) were treated by means of an online, Internet-based intervention based on CBT (iCBT). The intervention was primarily aimed at psychoeducation, treatment of residual depressive symptoms, emotion regulation, and improved sleep. All patients had ongoing pharmacological treatment at recruitment and established contact with a psychiatrist. The duration of BP-II among the treated patients was between 6 and 31 years. A single-subject design was used and the results of the 4 participating patients were presented individually. Results Initiating treatment was perceived as too demanding under current life circumstances for 3 patients who consequently dropped out during baseline assessment. Self-ratings using the Montgomery-Åsberg Depression Rating Scale—Self-rated (MADRS-S) showed symptom reduction in 3 (75%) of the 4 treated cases during iCBT. In the evaluation of the treatment, 2 patients reported that they perceived that the treatment had reduced symptoms a little, 1 that it had reduced symptoms very much, and 1 not at all. Treatment adherence (ie, module completion) was fairly high in 3 cases. In general, the modules were perceived as fairly helpful or very helpful by the patients. In one case, there was a reliable change—according to the Reliable Change Index—in self-rated symptoms of depression and perseverative thinking. Conclusions The treatment seemed to have acceptable feasibility. The iCBT intervention could be an effective way to treat residual symptoms in some patients with bipolar disorder type II. This should be investigated in a larger study. Trial Registration ClinicalTrials.gov NCT01742351; https://clinicaltrials.gov/ct2/show/NCT01742351 (Archived by WebCite at http://www.webcitation.org/6XnVpv4C3).
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Affiliation(s)
- Fredrik Holländare
- Psychiatric Research Centre, School of Health and Medical Science, Örebro University, Örebro, Sweden.
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14
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Barnes CW, Hadzi-Pavlovic D, Wilhelm K, Mitchell PB. A web-based preventive intervention program for bipolar disorder: outcome of a 12-months randomized controlled trial. J Affect Disord 2015; 174:485-92. [PMID: 25554993 DOI: 10.1016/j.jad.2014.11.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Internet is used to deliver information on many psychiatric disorders such as bipolar disorder. This paper reports on the results of a 12-months randomised controlled trial, which examined the efficacy of an Internet-based preventive program for bipolar disorder, adjunctive to usual pharmacological management. METHODS Participants were recruited by completing an online screening questionnaire accessed through the Black Dog Institute and Sentiens websites based in Australia. The treatment was predominantly psycho-educational with cognitive behavioral therapy optional elements. The attention control treatment comprised directing subjects to a variety of websites focused on 'healthy living'. Time to recurrence was determined using Kaplan-Meier survival analysis. The main outcome measures were recurrence as defined by: (i) depressive and/or hypomanic symptomatology and functional capacity (using Beck Depression Inventory, Internal State Scale and Sheehan Disability Scale) and (ii) hospitalization. RESULTS Two-hundred-and-thirty-three subjects were randomized to the active or control treatment groups. There were no significant differences between the active and control treatment groups on any of the definitions of recurrence. LIMITATIONS Reliance on an online self-report tool to confirm diagnosis and hospitalization rates may have potentially allowed for inclusion of individuals with other diagnoses such as borderline personality disorder. The 'attention control' treatment may have included more 'active' components than intended. CONCLUSIONS This is the first report examining the efficacy of a randomized controlled web-based psychological intervention in a large sample of subjects with bipolar disorder. The potential reasons for failing to demonstrate a significant difference compared to the active control are discussed.
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Affiliation(s)
- Caryl W Barnes
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia.
| | - Dusan Hadzi-Pavlovic
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
| | - Kay Wilhelm
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Black Dog Institute, Sydney, NSW, Australia
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15
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Leitan ND, Michalak EE, Berk L, Berk M, Murray G. Optimizing delivery of recovery-oriented online self-management strategies for bipolar disorder: a review. Bipolar Disord 2015; 17:115-27. [PMID: 25238632 DOI: 10.1111/bdi.12258] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 06/27/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Self-management is emerging as a viable alternative to difficult-to-access psychosocial treatments for bipolar disorder (BD), and has particular relevance to recovery-related goals around empowerment and personal meaning. This review examines data and theory on BD self-management from a recovery-oriented perspective, with a particular focus on optimizing low-intensity delivery of self-management tools via the web. METHODS A critical evaluation of various literatures was undertaken. Literatures on recovery, online platforms, and self-management in mental health and BD are reviewed. RESULTS The literature suggests that the self-management approach aligns with the recovery framework. However, studies have identified a number of potential barriers to the utilization of self-management programs for BD and it has been suggested that utilizing an online environment may be an effective way to surmount many of these barriers. CONCLUSIONS Online self-management programs for BD are rapidly developing, and in parallel the recovery perspective is becoming the dominant paradigm for mental health services worldwide, so research is urgently required to assess the efficacy and safety of optimization methods such as professional and/or peer support, tailoring and the development of 'online communities'.
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Affiliation(s)
- Nuwan D Leitan
- Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Vic., Australia
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16
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Lobban F, Dodd AL, Dagnan D, Diggle PJ, Griffiths M, Hollingsworth B, Knowles D, Long R, Mallinson S, Morriss RM, Parker R, Sawczuk AP, Jones S. Feasibility and acceptability of web-based enhanced relapse prevention for bipolar disorder (ERPonline): trial protocol. Contemp Clin Trials 2015; 41:100-9. [PMID: 25602581 DOI: 10.1016/j.cct.2015.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/09/2015] [Accepted: 01/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Relapse prevention interventions for Bipolar Disorder are effective but implementation in routine clinical services is poor. Web-based approaches offer a way to offer easily accessible access to evidence based interventions at low cost, and have been shown to be effective for other mood disorders. METHODS/DESIGN This protocol describes the development and feasibility testing of the ERPonline web-based intervention using a single blind randomised controlled trial. Data will include the extent to which the site was used, detailed feedback from users about their experiences of the site, reported benefits and costs to mental health and wellbeing of users, and costs and savings to health services. We will gain an estimate of the likely effect size of ERPonline on a range of important outcomes including mood, functioning, quality of life and recovery. We will explore potential mechanisms of change, giving us a greater understanding of the underlying processes of change, and consequently how the site could be made more effective. We will be able to determine rates of recruitment and retention, and identify what factors could improve these rates. DISCUSSION The findings will be used to improve the site in accordance with user needs, and inform the design of a large scale evaluation of the clinical and cost effectiveness of ERPonline. They will further contribute to the growing evidence base for web-based interventions designed to support people with mental health problems.
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Affiliation(s)
- F Lobban
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK.
| | - A L Dodd
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - D Dagnan
- Cumbria Partnership NHS Foundation Trust, UK
| | - P J Diggle
- Faculty of Medicine, Lancaster University, UK; Institution for Infection and Global Health, University of Liverpool, UK
| | - M Griffiths
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - B Hollingsworth
- Division of Health Research, Lancaster University, Lancaster, UK
| | - D Knowles
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - R Long
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | | | - R M Morriss
- School of Medicine, University of Nottingham, UK
| | - R Parker
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - A P Sawczuk
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - S Jones
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
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17
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Lauder S, Chester A, Castle D, Dodd S, Gliddon E, Berk L, Chamberlain J, Klein B, Gilbert M, Austin DW, Berk M. A randomized head to head trial of MoodSwings.net.au: an Internet based self-help program for bipolar disorder. J Affect Disord 2015; 171:13-21. [PMID: 25282145 DOI: 10.1016/j.jad.2014.08.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 07/25/2014] [Accepted: 08/06/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adjunctive psychosocial interventions are efficacious in bipolar disorder, but their incorporation into routine management plans are often confounded by cost and access constraints. We report here a comparative evaluation of two online programs hosted on a single website (www.moodswings.net.au). A basic version, called MoodSwings (MS), contains psychoeducation material and asynchronous discussion boards; and a more interactive program, MoodSwings Plus (MS-Plus), combined the basic psychoeducation material and discussion boards with elements of Cognitive Behavioral Therapy. These programs were evaluated in a head-to-head study design. METHOD Participants with Bipolar I or II disorder (n=156) were randomized to receive either MoodSwings or MoodSwings-Plus. Outcomes included mood symptoms, the occurrence of relapse, functionality, Locus of Control, social support, quality of life and medication adherence. RESULTS Participants in both groups showed baseline to endpoint reductions in mood symptoms and improvements in functionality, quality of life and medication adherence. The MoodSwings-Plus group showed a greater number of within-group changes on symptoms and functioning in depression and mania, quality of life and social support, across both poles of the illness. MoodSwings-Plus was superior to MoodSwings in improvement on symptoms of mania scores at 12 months (p=0.02) but not on the incidence of recurrence. LIMITATIONS The study did not have an attention control group and therefore could not demonstrate efficacy of the two active arms. There was notable (81%) attrition by 12 months from baseline. CONCLUSION This study suggests that both CBT and psychoeducation delivered online may have utility in the management of bipolar disorder. They are feasible, readily accepted, and associated with improvement.
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Affiliation(s)
- Sue Lauder
- The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Level 1 North, Main Block, Victoria 3050, Australia; DVC-Research and Innovation Portfolio & School of Health Sciences, and the Collaborative Research Network Federation University, Ballarat, Victoria, Australia.
| | - Andrea Chester
- RMIT University, Building 6, Level 5 Bowen Street, Melbourne 3000, Australia
| | - David Castle
- The University of Melbourne, Department of Psychiatry, St Vincent׳s Hospital, P.O. Box, 2900, Fitzroy 3065, Australia
| | - Seetal Dodd
- The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Level 1 North, Main Block, Victoria 3050, Australia; IMPACT Strategic Research Center, School of Medicine, Deakin University, Barwon Health, P.O. Box 291, Geelong 3220, Australia
| | - Emma Gliddon
- The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Level 1 North, Main Block, Victoria 3050, Australia; IMPACT Strategic Research Center, School of Medicine, Deakin University, Barwon Health, P.O. Box 291, Geelong 3220, Australia
| | - Lesley Berk
- The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Level 1 North, Main Block, Victoria 3050, Australia; Orygen Youth Health Research Center, 35 Poplar Road, Parkville 3052, Australia
| | | | - Britt Klein
- DVC-Research and Innovation Portfolio & School of Health Sciences, and the Collaborative Research Network Federation University, Ballarat, Victoria, Australia; National Institute for Mental Health Research, The Australian National University, Building 63, Canberra 2000, Australia; National eTherapy Center, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Monica Gilbert
- Healthmaps Pty Ltd, PO Box 2501, Fitzroy, 3065 Melbourne, Australia
| | - David W Austin
- Deakin University, School of Psychology, Faculty of Health, Burwood Campus, 221 Burwood Highway, Burwood 3125, Victoria Australia
| | - Michael Berk
- The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Level 1 North, Main Block, Victoria 3050, Australia; IMPACT Strategic Research Center, School of Medicine, Deakin University, Barwon Health, P.O. Box 291, Geelong 3220, Australia; Orygen Youth Health Research Center, 35 Poplar Road, Parkville 3052, Australia; Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Kenneth Myer Building, 30 Royal Parade, 3052 Parkville, Victoria, Australia
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18
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Hidalgo-Mazzei D, Mateu A, Undurraga J, Rosa AR, Pacchiarotti I, Bonnin CDM, Sánchez-Moreno J, Colom F, Vieta E. e-HCL-32: a useful, valid and user friendly tool in the screening of bipolar II disorder. Compr Psychiatry 2015; 56:283-8. [PMID: 25261889 DOI: 10.1016/j.comppsych.2014.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/20/2014] [Accepted: 09/03/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Bipolar type II (BDII) is a frequent disorder with high morbidity and mortality, characterized by depressive and hypomanic episodes. Early diagnosis can be effective in improving long-term prognosis. However, diagnosing BDII is challenging due to the difficulty in detecting past hypomanic episodes. The HCL-32 is a widely used and reliable screening instrument for the detection of past hypomanic episodes. Making this tool available to more patients could help diagnose and treat undetected cases of BDII earlier. New technologies such as the Internet have been previously used for this purpose with favorable outcomes. Accordingly, the objective of this study is to evaluate the acceptability, validity, reliability and equivalence of an online version of this questionnaire. METHODS From May 2012 to March 2013, 52 participants attending an outpatient mental health clinic completed a paper version of the HCL-32 (HCL-32) and its online version (e-HCL-32) within two weeks. After its completion, they were asked to answer a brief satisfaction survey. RESULTS No differences were found (HCL-32 mean total score=17.73 (SD=7.37), e-HCL-32 mean total score=18.28 (SD=7.09). T=-1.720, p=0.092, 95% CI=-1.21 to 0.09) between the results of the paper and pencil HCL-32 compared to its online version (e-HCL-32). The psychometric properties of the online version of the hypomania checklist (e-HCL-32) were good and comparable to the paper and pencil version. 80% of participants found online questionnaires to be easier to answer and more user-friendly. CONCLUSION The results of this study support the use of an online screening tool for the detection of previous hypomanic episodes (necessary for BDII diagnosis) as it showed to have a similar validity and reliability to the traditional paper and pencil method.
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Affiliation(s)
- Diego Hidalgo-Mazzei
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Catalonia, Spain
| | - Ainoa Mateu
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Catalonia, Spain
| | - Juan Undurraga
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Catalonia, Spain; Departament of Psychiatry, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Adriane R Rosa
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine - CNPq, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Medicine: Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Isabella Pacchiarotti
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Catalonia, Spain
| | - Caterina del Mar Bonnin
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Catalonia, Spain
| | - José Sánchez-Moreno
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Catalonia, Spain
| | - Francesc Colom
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clínic Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Catalonia, Spain.
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19
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Todd NJ, Jones SH, Hart A, Lobban FA. A web-based self-management intervention for Bipolar Disorder 'living with bipolar': a feasibility randomised controlled trial. J Affect Disord 2014; 169:21-9. [PMID: 25129531 DOI: 10.1016/j.jad.2014.07.027] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Bipolar Disorder (BD) is a severe mental health problem. Psychological interventions are recommended by the National Institute for Health and Care Excellence (NICE) but patients experience severe inequalities in access. This study assessed the feasibility and potential effectiveness of a recovery informed web-based self-management intervention for people with BD. METHODS An online randomised controlled trial (n=122) compared treatment as usual (TAU) plus the 'Living with Bipolar' (LWB) intervention with a waiting list control (WLC) group. RESULTS The study recruited to target and the retention rates were high. Participants engaged with the approach. Compared with the WLC, those receiving LWB showed the most robust improvement in psychological and physical domains of quality of life, wellbeing and recovery at the end of the intervention. LIMITATIONS The trial was not definitive and requires further investigation. CONCLUSIONS There is preliminary evidence that a web-based treatment approach in BD is feasible and potentially effective. Such interventions could form part of the Improving Access to Psychological Therapy (IAPT) initiative in severe mental health.
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Affiliation(s)
- Nicholas J Todd
- Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom.
| | - Steven H Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom
| | - Anna Hart
- Combining Health Information, Computation & Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom
| | - Fiona A Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom
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Abstract
This review provides clinicians and individuals with bipolar disorder (BD) with an overview of evidence-based skills shown to be effective in BD and amenable to self-management including psychoeducation; monitoring moods, medications, and social function; sleep hygiene; setting goals and relapse plans; and healthy lifestyles (physical activity, healthy eating, weight loss and management, medical comorbidities). Currently available self-management resources for BD are summarized by mode of delivery (workbooks, mobile technologies, internet, and peer-led interventions). Regardless of the self-management intervention/topic, the research suggests that personally tailored interventions of longer duration and greater frequency may be necessary to achieve the maximal benefit among individuals with BD. Means to support these self-management interventions as self-sustaining identities are critically needed. Hopefully, the recent investment in patient-centered research and care will result in best practices for the self-management of BD by mode of delivery. Since self-management of BD should complement rather than replace medical care, clinicians need to partner with their patients to incorporate and support advances in self-management for individuals with BD.
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Karasouli E, Adams A. Assessing the Evidence for e-Resources for Mental Health Self-Management: A Systematic Literature Review. JMIR Ment Health 2014; 1:e3. [PMID: 26543903 PMCID: PMC4607376 DOI: 10.2196/mental.3708] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/23/2014] [Accepted: 11/04/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In a climate which recognizes mental health as a key health improvement target, but where mental health services are increasingly over-stretched, self-management e-resources can play a potentially important role in helping to ensure people get the care and support they need. They have the potential to enable individuals to learn more about, and to exercise active involvement in, their care, and thus we see a growing interest in this area for both research and practice. However, for e-resources to become important adjuncts to clinical care, it is necessary to understand if and how they impact on patients and care outcomes. OBJECTIVE The objective of this study was to review systematically the research evidence for theory-driven and evidence-based mental health self-management e-resources; and make recommendations about strengthening the future evidence base. METHODS A comprehensive literature search in MEDLINE, EMBASE, AMED, PsycINFO, Scopus, and Cochrane Library was conducted. No limits to study design were applied. We did not restrict the types of Web-based technologies included, such as websites and mobile applications, so long as they met the study inclusion criteria. A narrative synthesis of data was performed to elaborate both the development and effectiveness of online resources. RESULTS In total, 2969 abstracts were identified. Of those, 8 papers met the inclusion criteria. Only one randomized controlled trial was identified. The e-resources were aimed at self-management of bipolar disorder, depression, or general mental health problems. Some of the e-resources were intended to be used as prevention aids, whereas others were recovery orientated. CONCLUSIONS Mental health self-management e-resources have the potential to be widely effective, but our review shows it is early days in terms of development of the evidence base for them. To build robust evidence, clear guidelines are needed on the development and reporting of e-resources, so that both developers and researchers maximize the potential of a new, but rapidly evolving area.
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Affiliation(s)
- Eleni Karasouli
- Institute of Digital Healthcare International Digital Laboratory University of Warwick Coventry United Kingdom
| | - Ann Adams
- Division of Mental Health and Wellbeing Warwick Medical School University of Warwick Coventry United Kingdom
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Latalova K, Prasko J, Kamaradova D, Jelenova D, Ociskova M, Sedlackova Z. Internet psychoeducation for bipolar affective disorder: basis for preparation and first experiences. Psychiatr Q 2014; 85:241-55. [PMID: 24307178 DOI: 10.1007/s11126-013-9286-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There is growing evidence that patients with bipolar affective disorder (BAD), who use medication, respond well to further psychotherapeutic interventions. Internet-based psychoeducation is typically centered on the interaction between a client and therapist via the Internet. Multiple methods were required to investigate existing psychoeducational and psychotherapeutic strategies used on patients suffering from BAD. Systematic reviews and original reports of all trials of psychoeducation in BAD patients were retrieved. Patients with BAD, who were hospitalized in a psychiatric department or attended a day hospital program, were exposed to the first version of the program during the treatment, and then questioned about understandability, comprehensibility, and usefulness of each lecture. Twelve modules of the Internet E-Program for BAD were developed and the intervention was a pilot tested with twelve patients. Internet psychoeducation program for BAD is an intervention designed for universal implementation that addresses heightened learning needs of patients suffering from BAD. It is designed to promote confidence and reduce the number of episodes of the disorder by providing skills in monitoring warning signs, planning daily activities and practicing communication skills.
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Affiliation(s)
- Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic,
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Nicholas A, Bailey JV, Stevenson F, Murray E. The Sexunzipped trial: young people's views of participating in an online randomized controlled trial. J Med Internet Res 2013; 15:e276. [PMID: 24334198 PMCID: PMC3868966 DOI: 10.2196/jmir.2647] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/14/2013] [Accepted: 09/06/2013] [Indexed: 11/13/2022] Open
Abstract
Background Incidence of sexually transmitted infections (STIs) among young people in the United Kingdom is increasing. The Internet can be a suitable medium for delivery of sexual health information and sexual health promotion, given its high usage among young people, its potential for creating a sense of anonymity, and ease of access. Online randomized controlled trials (RCTs) are increasingly being used to evaluate online interventions, but while there are many advantages to online methodologies, they can be associated with a number of problems, including poor engagement with online interventions, poor trial retention, and concerns about the validity of data collected through self-report online. We conducted an online feasibility trial that tested the effects of the Sexunzipped website for sexual health compared to an information-only website. This study reports on a qualitative evaluation of the trial procedures, describing participants’ experiences and views of the Sexunzipped online trial including methods of recruitment, incentives, methods of contact, and sexual health outcome measurement. Objective Our goal was to determine participants’ views of the acceptability and validity of the online trial methodology used in the pilot RCT of the Sexunzipped intervention. Methods We used three qualitative data sources to assess the acceptability and validity of the online pilot RCT methodology: (1) individual interviews with 22 participants from the pilot RCT, (2) 133 emails received by the trial coordinator from trial participants, and (3) 217 free-text comments from the baseline and follow-up questionnaires. Interviews were audio-recorded and transcribed verbatim. An iterative, thematic analysis of all three data sources was conducted to identify common themes related to the acceptability and feasibility of the online trial methodology. Results Interview participants found the trial design, including online recruitment via Facebook, online registration, email communication with the researchers, and online completion of sexual health questionnaires to be highly acceptable and preferable to traditional methods. Incentives might assist in recruiting those who would not otherwise participate. Participants generally enjoyed taking part in sexual health research online and found the questionnaire itself thought-provoking. Completing the sexual health questionnaires online encouraged honesty in responding that might not be achieved with other methods. The majority of interview participants also thought that receiving and returning a urine sample for chlamydia testing via post was acceptable. Conclusions These findings provide strong support for the use of online research methods for sexual health research, emphasizing the importance of careful planning and execution of all trial procedures including recruitment, respondent validation, trial related communication, and methods to maximize follow-up. Our findings suggest that sexual health outcome measurement might encourage reflection on current behavior, sometimes leading to behavior change. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 55651027; http://www.controlled-trials.com/isrctn/pf/55651027 (Archived by WebCite at http://www.webcitation.org/6LbkxdPKf).
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Affiliation(s)
- Angela Nicholas
- e-Health Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
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Kilbourne AM, Goodrich DE, O’Donnell AN, Miller CJ. Integrating bipolar disorder management in primary care. Curr Psychiatry Rep 2012; 14:687-95. [PMID: 23001382 PMCID: PMC3492519 DOI: 10.1007/s11920-012-0325-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is growing realization that persons with bipolar disorder may exclusively be seen in primary (general medical) care settings, notably because of limited access to mental health care and stigma in seeking mental health treatment. At least two clinical practice guidelines for bipolar disorder recommend collaborative chronic care models (CCMs) to help integrate mental health care to better manage this illness. CCMs, which include provider guideline support, self-management support, care management, and measurement-based care, are well-established in primary care settings, and may help primary care practitioners manage bipolar disorder. However, further research is required to adapt CCMs to support complexities in diagnosing persons with bipolar disorder, and integrate decision-making processes regarding medication safety and tolerability in primary care. Additional implementation studies are also needed to adapt CCMs for persons with bipolar disorder in primary care, especially those seen in smaller practices with limited infrastructure and access to mental health care.
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Affiliation(s)
- Amy M. Kilbourne
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - David E. Goodrich
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | | | - Christopher J. Miller
- Center for Organization, Leadership, & Management Research, VA Boston Healthcare System, Boston, MA
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25
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Todd NJ, Jones SH, Lobban FA. What do service users with bipolar disorder want from a web-based self-management intervention? A qualitative focus group study. Clin Psychol Psychother 2012; 20:531-43. [PMID: 22715161 DOI: 10.1002/cpp.1804] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 05/09/2012] [Accepted: 05/11/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic and recurrent severe mental health problem. A web-based self-management intervention provides the opportunity to widen access to psychological interventions. This qualitative study aims to identify what an ideal web-based intervention would look like for service users with BD. METHODS Twelve service users with BD were recruited in the UK and took part in a series of focus groups to inform and refine the development of a web-based self-management intervention. Reported here is a subset analysis of data gathered with the primary aim of identifying the needs and desires of service users for such an intervention for BD. We analysed service users' responses to questions about content, outcomes, format, barriers and support. Focus groups were transcribed verbatim, and thematic analysis was employed. RESULTS The data were ordered into four key themes: (1) gaining an awareness of and managing mood swings; (2) not just about managing mood swings: the importance of practical and interpersonal issues; (3) managing living within mood swings without losing the experience; (4) internet is the only format: freely accessible, instant and interactive; (5) professional and peer support to overcome low motivation and procrastination difficulties. LIMITATIONS The small group of participants are not representative of those living with BD. CONCLUSIONS These findings have significantly enhanced our understanding of what service users with BD want from a web-based self-management intervention and have clear implications for the future development of such approaches. KEY PRACTITIONER MESSAGE Service users desire a web-based self-management approach that gives them the techniques they need to not only manage their moods but also manage their lives alongside the disorder, including interpersonal and practical issues. Service users describe their primary outcome, not as a cure or reduction in their symptoms, but instead being able to live a fulfilling life alongside their condition. Service users see the internet as their preferred format because of the increased accessibility to evidence-based intervention. Service users discussed the potential barriers to web-based interventions including motivation and procrastination. Effective and acceptable content and low-level support provide potential solutions to these issues.
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Affiliation(s)
- Nicholas J Todd
- Spectrum Centre for Mental Health Research, Department of Health Research, Faculty of Health and Medicine, Lancaster University, UK.
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