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Gleeson JFM, Koval P, Zyphur M, Lederman R, Herrman H, Eleftheriadis D, Bendall S, Cotton SM, Gorelik A, Alvarez-Jimenez M. A randomized controlled trial of moderated online social therapy for family carers of first-episode psychosis patients in a specialist treatment setting. Schizophr Res 2023; 255:203-212. [PMID: 37004332 DOI: 10.1016/j.schres.2023.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/26/2023] [Accepted: 03/11/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Family members, who provide the majority of informal care during the recovery period from first-episode psychosis (FEP), experience high levels of psychological distress. However, there is a lack of effective and accessible interventions for FEP carers. OBJECTIVE To determine the effectiveness of an online intervention ("Altitudes") in relation to the primary outcome of FEP-carer stress at 6 months follow-up. METHODS We conducted a cluster randomized controlled trial in which FEP carers were randomized to Altitudes combined with specialized treatment as usual (STAU) or STAU alone. In addition to questionnaires, we included multiple waves of intensive ecological momentary assessment (EMA) to measure carer stress and family outcomes in 164 carers of young (15-27 years) FEP patients. RESULTS Both groups improved over time on stress and a range of secondary outcomes, including mental health symptoms, self-efficacy, and expressed emotion with no group by time interactions. At 12 months there were significantly fewer visits to emergency departments by FEP patients in the Altitudes group (p = 0.022). Modelling of multiple EMA waves revealed that more time spent by carers with FEP patients predicted greater worry, expressed emotion, and adaptive coping. CONCLUSIONS Engagement and usability findings for Altitudes were positive. Further refinements to our online carer interventions may be needed to engage carers in purposeful skill development for improved management of stress and communication with the young person compared with existing specialist family interventions. TRIAL REGISTRATION ACTRN12616000968471.
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Affiliation(s)
- John F M Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Level 5, Daniel Mannix Building, Young Street, Fitzroy, VIC 3065, Australia.
| | - Peter Koval
- Melbourne School of Psychological Science, The University of Melbourne, Australia
| | - Michael Zyphur
- School of Business, Faculty of Business, Economics and Law, The University of Queensland, St Lucia, QLD, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Herrman
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Dina Eleftheriadis
- School of Behavioural and Health Sciences, Australian Catholic University, Level 5, Daniel Mannix Building, Young Street, Fitzroy, VIC 3065, Australia
| | - Sarah Bendall
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
| | - Alexandra Gorelik
- Musculoskeletal Health and Sustainable Healthcare Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Orygen, Parkville, VIC, Australia
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Livne O, Shmulewitz D, Sarvet AL, Wall MM, Hasin DS. Association of Cannabis Use-Related Predictor Variables and Self-Reported Psychotic Disorders: U.S. Adults, 2001-2002 and 2012-2013. Am J Psychiatry 2022; 179:36-45. [PMID: 34645275 PMCID: PMC8945254 DOI: 10.1176/appi.ajp.2021.21010073] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to determine the association of cannabis indicators with self-reported psychotic disorders in the U.S. general population. METHODS Participants were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002; N=43,093) and NESARC-III (2012-2013; N=36,309). Logistic regression was used to estimate standardized prevalences of past-year self-reported psychotic disorders within each survey and to evaluate the association of past-year self-reported psychotic disorders with indicators of nonmedical cannabis use (any use; frequent use [at least three times/week], daily/near-daily use, and DSM-IV cannabis use disorder) compared with those with no past-year nonmedical cannabis use. Whether the strength of associations differed between surveys was indicated by difference-in-difference tests (between-survey contrasts) and ratios of odds ratios between surveys. RESULTS Self-reported psychotic disorders were significantly more prevalent among participants with any nonmedical cannabis use than those without (2001-2002: 1.65% compared with 0.27%; 2012-2013: 1.89% compared with 0.68%). In 2001-2002, self-reported psychotic disorders were unrelated to either frequent use or daily/near-daily use. However, in 2012 - 2013, compared with nonusers, self-reported psychotic disorders were more common among participants with frequent use and those with daily/near-daily nonmedical cannabis use (2012-2013: 2.79% and 2.52%, respectively, compared with 0.68% among nonusers). Self-reported psychotic disorders were significantly more prevalent among participants with cannabis use disorder than nonusers in both surveys (2001-2002: 2.55% compared with 0.27%; 2012 - 2013: 3.38% compared with 0.68%). The strength of these associations did not change over time. CONCLUSIONS Data from the U.S. general population, especially more recent data, suggest associations between self-reported psychotic disorder and frequent nonmedical cannabis use and cannabis use disorder. Clinicians and policy makers should consider these relationships when monitoring patients and formulating programs.
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Affiliation(s)
- Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Aaron L. Sarvet
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Deborah S. Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY,New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Medical Center, New York, NY
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