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Godinho A, Schell C, Cunningham JA. Remaining Between the Cracks - The Long-Term Effect of Different Suicide Risk Exclusion Criterion on Outcomes of an Online Intervention for Depression. CRISIS 2024; 45:100-107. [PMID: 37605900 DOI: 10.1027/0227-5910/a000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Background: Previous studies have demonstrated that excluding individuals at risk of suicide from online depression interventions can impact recruited sample characteristics. Aim: To determine if a small change in suicide risk exclusion criterion led to differences in the usage and effectiveness of an Internet depression intervention at 6 months of follow-up. Method: A partial sample of a recently completed online depression intervention trial was divided into two groups: those with no risk of suicide versus those with some risk. The two groups were compared for baseline demographic and clinical measures, as well as intervention uptake and treatment success across 6 months. Results: Overall, individuals with less risk of suicide at baseline reported significantly less severe clinical symptoms. Both groups interacted with the intervention at the same rate, but specific use of modules was different. Finally, the impact of intervention usage on outcomes over time did not vary by group. Limitations: While different suicide risk exclusion criteria can change recruited sample characteristics, it remains unclear how these differences impact intervention uptake and success. Conclusion: Overall, the findings suggest that researchers should exercise caution when excluding individuals at risk of suicide, as they greatly benefit from web-based interventions.
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Affiliation(s)
- Alexandra Godinho
- Humber River Health Research Institute, Humber River Health, Toronto, ON, Canada
| | - Christina Schell
- Centre for Addiction and Mental Health, Institute of Mental Health and Policy Research, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - John A Cunningham
- Centre for Addiction and Mental Health, Institute of Mental Health and Policy Research, Toronto, ON, Canada
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- Department of Psychiatry, University of Toronto, ON, Canada
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Schell C, Godinho A, Cunningham JA. Examining Changes in Quality of Life as an Outcome Measure in Three Randomized Controlled Trials of Online Interventions That Included an Intervention for Hazardous Alcohol Use. Subst Use Misuse 2023; 59:50-57. [PMID: 37735801 DOI: 10.1080/10826084.2023.2259453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Quality of life (QOL) summarizes an individual's perceived satisfaction across multiple life domains. Many factors can impact this measure, but research has demonstrated that individuals with addictions, physical, and mental health concerns tend to score lower than general population samples. While QOL is often important to individuals, it is rarely used by researchers as an outcome measure when evaluating treatment efficacy. METHODS This secondary analysis used data collected during three separate randomized controlled trials testing the efficacy of different online interventions to explore change in QOL over time between treatment conditions. The first project was concerned with only alcohol interventions. The other two combined either a gambling or mental health intervention with a brief alcohol intervention. Males and females were analyzed separately. RESULTS This analysis found treatment effects among female participants in two projects. In the project only concerning alcohol, female quality of life improved more among those who received an extensive intervention for hazardous alcohol use compared to a brief intervention (p = .029). QOL among females who received only the mental health intervention improved more than those who also received a brief alcohol intervention (p = .049). CONCLUSION Poor QOL is often cited as a reason individuals decide to make behavior changes, yet treatment evaluations do not typically consider this patient-important outcome. This analysis found some support for different treatment effects on QOL scores in studies involving at least one intervention for hazardous alcohol use.
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Affiliation(s)
- Christina Schell
- Centre for Addiction and Mental Health, Institute for Mental Health and Policy Research, Toronto, Canada
| | - Alexandra Godinho
- Centre for Addiction and Mental Health, Institute for Mental Health and Policy Research, Toronto, Canada
- Research Office, Humber River Hospital, Toronto, Canada
| | - John A Cunningham
- Centre for Addiction and Mental Health, Institute for Mental Health and Policy Research, Toronto, Canada
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Psychiatry, University of Toronto, Toronto, Canada
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O'Donnell A, Schmidt CS, Beyer F, Schrietter M, Anderson P, Jane-Llopis E, Kaner E, Schulte B. Effectiveness of digital interventions for people with comorbid heavy drinking and depression: A systematic review and narrative synthesis. J Affect Disord 2022; 298:10-23. [PMID: 34801605 DOI: 10.1016/j.jad.2021.11.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Heavy drinking and depression frequently co-occur and make a substantial contribution to the global non-communicable disease burden. Positive evidence exists for the use of digital interventions with these conditions alone, but there has been limited assessment of combined approaches. OBJECTIVE A systematic review of the effectiveness of combined digital interventions for comorbid heavy drinking and major depression in community-dwelling populations. METHODS AND ANALYSIS Electronic databases were searched to October 2021 for randomised controlled trials that evaluated any personalised digital intervention for comorbid heavy drinking and depression. Primary outcomes were changes in quantity of alcohol consumed and depressive symptoms. Two reviewers independently assessed study eligibility, extracted data, and undertook risk of bias assessment. Due to the limited number and heterogeneity of studies identified, meta-analysis was not possible, therefore data were synthesised narratively. RESULTS Of 898 articles identified, 24 papers were reviewed in full, five of which met the inclusion criteria (N = 1503 participants). Three utilised web-based intervention delivery; two computer programmes delivered in a clinic setting. All involved multi-component interventions; treatment length varied from one to ten sessions. Four studies found no evidence for the superiority of combined digital interventions for comorbid heavy drinking and depression over therapist-delivered approaches, single condition interventions (including online), or assessment-only controls. Positive impacts of integrated online therapy compared to generalist online health advice were reported in a fifth study, but not maintained beyond the 1-month follow-up. LIMITATIONS Few eligible, heterogeneous studies prevented meta-analysis. CONCLUSION Limited evidence exists of the effectiveness of combined digital interventions for comorbid heavy drinking and depression in community dwelling populations.
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Affiliation(s)
- Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, England NE2 4AX, UK.
| | - Christiane Sybille Schmidt
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, England NE2 4AX, UK
| | - Margret Schrietter
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Peter Anderson
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, England NE2 4AX, UK; Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, Maastricht, MD 6200, The Netherlands
| | - Eva Jane-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, Maastricht, MD 6200, The Netherlands; Institute for Mental Health Policy Research, CAMH (The Centre for Addiction and Mental Health), 33 Russell Street, Toronto, ON M5S 2S1, Canada; Ramon Llull University, ESADE, Barcelona, Spain
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, England NE2 4AX, UK
| | - Bernd Schulte
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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Cunningham JA, Godinho A, Hendershot CS, Kay-Lambkin F, Neighbors C, Griffiths KM, Schell C. Randomized controlled trial of online interventions for co-occurring depression and hazardous alcohol consumption: Primary outcome results. Internet Interv 2021; 26:100477. [PMID: 34786350 PMCID: PMC8579144 DOI: 10.1016/j.invent.2021.100477] [Citation(s) in RCA: 1] [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: 09/22/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIMS The current trial tested the benefits of offering a brief online intervention for hazardous alcohol consumption along with one for depression among people experiencing both conditions. METHODS Online advertisements were used to recruit people with persistent low mood. Those who also had current hazardous alcohol consumption were identified and invited to take part in the trial (those not eligible were offered access to the online depression intervention). Participants were randomized to an established intervention for depression (MoodGYM; M-only) or to receive MoodGYM plus a brief personalized feedback intervention for hazardous drinking (Check Your Drinking; M + CYD). Participants were followed-up at three and six months. RESULTS While levels of depression symptoms (p < .001) and hazardous alcohol consumption (p < .001) reduced in both the M-only and the M + CYD groups, there was no difference between groups on drinking (p = .374) or depression outcomes (p = .752). Further, participants who were provided both interventions logged into the intervention website less often (M = 4.1, SD = 3.9) compared to participants only offered the depression intervention (M = 4.9, SD = 5.2), t (986) = 2.47, p = .014. However, there was no significant difference (p > .05) in the number of MoodGYM modules completed between the two groups. DISCUSSION AND CONCLUSION The current trial found no benefit to providing a brief online intervention for hazardous alcohol consumption alongside one for depression among people experiencing these co-occurring disorders. Further, the finding that adding an online intervention for drinking to one for depression led to a small reduction in the number of times the interventions were accessed implies the need for caution when deciding how best to provide online help to those with co-occurring depression and hazardous alcohol consumption.Trial Registration: ClinicalTrials.govNCT03421080.
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Affiliation(s)
- John A. Cunningham
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Corresponding author at: National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
| | | | - Christian S. Hendershot
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry and Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, USA
| | | | | | - Kathleen M. Griffiths
- Research School of Public Health, Australian National University, Canberra, Australia
| | - Christina Schell
- Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Schouten MJE, Christ C, Dekker JJM, Riper H, Goudriaan AE, Blankers M. Digital Interventions for People With Co-Occurring Depression and Problematic Alcohol Use: A Systematic Review and Meta-Analysis. Alcohol Alcohol 2021; 57:113-124. [PMID: 33588432 PMCID: PMC8753780 DOI: 10.1093/alcalc/agaa147] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Aims This systematic review and meta-analysis assessed the effectiveness of digital interventions addressing depressive symptoms and alcohol use simultaneously among people with co-occurring depression and problematic alcohol use. Methods Seven databases were searched for trials evaluating digital interventions aimed at depression and alcohol use. Random-effects meta-analyses were conducted to pool effects on depressive symptoms and alcohol use up to 3-month and 6-month follow-up. Overall quality for every outcome was assessed with GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results The pooled effect of digital interventions compared to their comparators was in favour of digital interventions. Small but significant effects on depressive symptoms at 3-month follow-up were found (g = 0.34, 95% confidence interval (CI): 0.06–0.62, P = 0.02, k = 6) and non-significant effects at 6-month follow-up (g = 0.29, 95% CI: −0.16 to 0.73, P = 0.15, k = 5). For alcohol use, the pooled effect of digital interventions was small and non-significant at 3-month follow-up (g = 0.14, 95% CI: −0.02 to 0.30, P = 0.07, k = 6) and significant at 6-month follow-up (g = 0.14, 95% CI: 0.07–0.20, P = 0.005, k = 5). Sensitivity analysis indicated the latter finding to be sensitive to statistical estimator choice. Quality of evidence was moderate, except for depressive symptoms at 6-month follow-up for which it was low. Conclusion Based on the literature, digital interventions are effective in reducing depressive symptoms at 3-month follow-up and alcohol use at 6-month follow-up among people with comorbid depression and problematic alcohol use. More high-quality trials are needed to confirm the current findings.
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Affiliation(s)
- Maria J E Schouten
- Department of Research, Arkin Mental Health Care, 1033 NN Amsterdam, The Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands
| | - Carolien Christ
- Department of Research, Arkin Mental Health Care, 1033 NN Amsterdam, The Netherlands.,Department of Psychiatry, Department of Research and Innovation, VU University Medical Centre, GGZ InGeest Specialized Mental Health Care, Amsterdam Public Health research institute, 1081 HV Amsterdam, The Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, 1033 NN Amsterdam, The Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 1081 BT Amsterdam, The Netherlands.,Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health research institute, 1081 HV Amsterdam, The Netherlands.,Research Unit for Telepsychiatry and e-Mental Health, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark.,University of Turku, Faculty of Medicine, 20500 Turku, Finland
| | - Anna E Goudriaan
- Department of Research, Arkin Mental Health Care, 1033 NN Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Addiction Research and Amsterdam Public Health research institute, 1105 AZ Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, 1033 NN Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Addiction Research and Amsterdam Public Health research institute, 1105 AZ Amsterdam, The Netherlands.,Trimbos Institute- The Netherlands Institute of Mental Health and Addiction, 3500 AS Utrecht, The Netherlands
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Godinho A, Schell C, Cunningham JA. Out damn bot, out: Recruiting real people into substance use studies on the internet. Subst Abus 2019; 41:3-5. [DOI: 10.1080/08897077.2019.1691131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Alexandra Godinho
- Centre for Addiction and Mental Health, Institute of Mental Health and Policy Research, Toronto, Canada
| | - Christina Schell
- Centre for Addiction and Mental Health, Institute of Mental Health and Policy Research, Toronto, Canada
| | - John A. Cunningham
- Centre for Addiction and Mental Health, Institute of Mental Health and Policy Research, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Australian National University, Canberra, Australia
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