1
|
Mills L, Meiser B, Ahmad R, Schofield PR, Peate M, Levitan C, Trevena L, Barlow-Stewart K, Dobbins T, Christensen H, Sherman KA, Dunlop K, Mitchell PB. A cluster randomized controlled trial of an online psychoeducational intervention for people with a family history of depression. BMC Psychiatry 2019; 19:29. [PMID: 30654777 PMCID: PMC6337794 DOI: 10.1186/s12888-018-1994-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/19/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND People with a family history of major depressive disorder (MDD) or bipolar disorder (BD) report specific psychoeducational needs that are unmet by existing online interventions. This trial aimed to test whether an interactive website for people at familial risk for depression (intervention) would improve intention to adopt, or actual adoption of, depression prevention strategies (primary outcome) and a range of secondary outcome measures. METHODS In this cluster randomised trial, primary care practises were randomised to either provide the link to the intervention or the control website. Primary health care attendees were invited by letter to opt into this study if they had at least one first-degree relative with MDD or BD and were asked to complete online questionnaires at baseline and 2-week follow-up. RESULTS Twenty general practices were a randomized, and 202 eligible patients completed both questionnaires. Thirty-nine (19.3%) of participants were male and 163 (80.7%) female. At follow-up, compared to controls, the intervention group: (i) were more likely to intend to undergo, or to have actually undergone, psychological therapies (OR = 5.83, 95% CI: 1.58-21.47, p = .008); (ii) had better knowledge of depression risk factors and prevention strategies (mean difference = 0.47, 95% CI: 0.05-0.88, p = .029); and (iii) were more likely to accurately estimate their lifetime risk of developing BD (mean difference = 11.2, 95% CI: -16.52- -5.73, p < .001). There were no statistically significant between-group differences in change from baseline to follow up for any of the remaining outcome measures (Patient Health Questionnaire, Perceived Devaluation-Discrimination Questionnaire and Perceived Risk of Developing MDD). CONCLUSION The opt-in nature of the study may have led to participation bias, e.g. underrepresentation of males, and hence may limit generalisability to the broader population at familial risk for depression. This is the first website internationally focusing specifically on informational needs of those at familial risk of depression. Our interactive website can play an important role in improving the outcomes of individuals at familial risk for depression. Testing the intervention in other settings (e.g. psychology, psychiatry, genetic counselling) appears warranted. TRIAL REGISTRATION The study was prospectively registered with the Australian and New Zealand Clinical Trials Group (Registration no: ACTRN12613000402741 ).
Collapse
Affiliation(s)
- Llewellyn Mills
- 0000 0004 4902 0432grid.1005.4Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, Australia.
| | - Raghib Ahmad
- 0000 0004 4902 0432grid.1005.4Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, Australia
| | - Peter R. Schofield
- 0000 0000 8900 8842grid.250407.4Neuroscience Research Australia, Sydney, Australia ,0000 0004 4902 0432grid.1005.4School of Medical Sciences, UNSW, Sydney, Australia
| | - Michelle Peate
- 0000 0004 4902 0432grid.1005.4Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, Australia ,Department of Obstetrics and Oncology, Royal Women’s Hospital, University of Melbourne, Melbourne, VIC 3052 Australia
| | - Charlene Levitan
- 0000 0004 4902 0432grid.1005.4Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, Australia ,0000 0004 4902 0432grid.1005.4School of Psychiatry, UNSW, Sydney, Australia
| | - Lyndal Trevena
- 0000 0004 1936 834Xgrid.1013.3School of Public Health, University of Sydney, Sydney, Australia
| | - Kristine Barlow-Stewart
- 0000 0004 1936 834Xgrid.1013.3Sydney Medical School – Northern, University of Sydney, Sydney, Australia
| | - Timothy Dobbins
- 0000 0004 4902 0432grid.1005.4National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Helen Christensen
- 0000 0001 0640 7766grid.418393.4Black Dog Institute, Sydney, Australia
| | - Kerry A. Sherman
- 0000 0001 2158 5405grid.1004.5Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Kate Dunlop
- 0000 0001 0753 1056grid.416088.3Centre for Genetics Education NSW Health, Sydney, Australia
| | - Philip B. Mitchell
- 0000 0004 4902 0432grid.1005.4School of Psychiatry, UNSW, Sydney, Australia
| |
Collapse
|
2
|
Davison J, Scott J. Should we intervene at stage 0? A qualitative study of attitudes of asymptomatic youth at increased risk of developing bipolar disorders and parents with established disease. Early Interv Psychiatry 2018; 12:1112-1119. [PMID: 28188672 DOI: 10.1111/eip.12421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/08/2016] [Accepted: 11/13/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies of potential interventions for asymptomatic individuals at risk of severe mental disorders (ie, clinical stage 0) have focused on genetic counselling or the views of adults with established disease. No study has interviewed youth at risk of bipolar disorders (BD). METHODS Qualitative analysis of interviews with asymptomatic adolescent offspring of adults with BD (OSBD = 7) and unrelated parents with bipolar disorders (PBD = 6) to examine manifest and latent themes in the dialogue. RESULTS Core themes in both groups were ignorance regarding the magnitude of risk of BD onset in offspring and greater concerns for the health of other family members than for oneself. Parents expressed anxieties in coping with the uncertainty about whether their children would inherit BD and their desire to reduce this risk was partly driven by guilt and their sense of responsibility; PBD favoured the introduction of specialized clinical OSBD services. In contrast, the priority for OSBD was advice on coping with a parent with BD; OSBD favoured access to generic non-clinical peer group support, which they perceived as less stigmatizing than specialist services. CONCLUSION The study highlights that youth at risk of BD should be allowed to express their ideas on what interventions they believe are likely to be most beneficial for them, as their views may differ from other advocates who are routinely consulted, such as PBD. A noteworthy finding was that OSBD thought that being included in the clinical dialogue about their parents' BD would decrease rather than increase their stress levels.
Collapse
Affiliation(s)
- Jo Davison
- Newcastle Early Intervention in Psychosis Service, NTW NHS Trust, Newcastle, UK
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| |
Collapse
|
3
|
Meiser B, Peate M, Levitan C, Mitchell PB, Trevena L, Barlow-Stewart K, Dobbins T, Christensen H, Sherman KA, Dunlop K, Schofield PR. A Psycho-Educational Intervention for People with a Family History of Depression: Pilot Results. J Genet Couns 2016; 26:312-321. [PMID: 27688164 DOI: 10.1007/s10897-016-0011-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 08/23/2016] [Indexed: 01/02/2023]
Abstract
We developed and pilot-tested the first online psycho-educational intervention that specifically targets people with a family history of depression ('LINKS'). LINKS provides genetic risk information and evidence-rated information on preventive strategies for depression and incorporates a risk assessment tool and several videos using professional actors. LINKS was pilot-tested in the general practitioner (GP) setting. The patient sample included people with a family history of at least one first-degree relative (FDR) with major depressive disorder (MDD) or bipolar disorder (BD). Patients attending participating GP practices were invited to enroll in the study by letter from their GP. Patients who self-identified as having at least one first-degree relative (FDR) with MDD or BD were eligible. Patients completed questionnaires, pre-post viewing LINKS, with measures assessing satisfaction, relevance, emotional impact and perceived improvement of understanding. Six GP practices participated, and 24 patients completed both questionnaires. Of these, all reported that they were satisfied or very satisfied with LINKS, and 74 % reported that LINKS met their expectations, and 21 % that it exceeded their expectations. LINKS was judged highly acceptable by this sample of GP attendees, and results indicate that an assessment of its effectiveness in a larger controlled trial is warranted.
Collapse
Affiliation(s)
- Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia.
| | - Michelle Peate
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia
- Department of Obstetrics and Oncology, Royal Women's Hospital, University of Melbourne, Victoria, Australia
| | - Charlene Levitan
- Psychosocial Research Group, Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia
| | | | - Lyndal Trevena
- School of Public Health and Community Medicine, University of Sydney, Sydney, NSW, Australia
| | | | - Timothy Dobbins
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Kerry A Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Kate Dunlop
- Centre for Genetics Education, NSW Health, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia
- School of Medical Sciences, UNSW, Sydney, NSW, Australia
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
McAllister M, Dearing A. Patient reported outcomes and patient empowerment in clinical genetics services. Clin Genet 2014; 88:114-21. [PMID: 25307491 DOI: 10.1111/cge.12520] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 12/20/2022]
Abstract
Evaluation of clinical genetics services (CGS), including genetic counseling and genetic testing, has been problematic. Patient mortality and morbidity are unlikely to be directly improved by interventions offered in CGS. Patient-reported outcomes (PROs) are not routinely measured in CGS evaluation, but this may change as patient-reported outcome measures (PROMs) become a key part of how healthcare services are managed and funded across the world. However, there is no clear consensus about which PROMs are most useful for CGS evaluation. This review summarizes the published research on how PROs from CGS have been measured and how patients may benefit from using those services, with a focus on patient empowerment. Many patient benefits (PROs) identified repeatedly in the research literature can be re-interpreted within a patient empowerment framework. Other important PROs identified include family functioning, social functioning, altruism, sense of purpose, enabling development of future research and treatment/participating in research. Well-validated measures are available to capture (dimensions of) patient empowerment. Although generic measures of family functioning are available, suitable measures capturing social functioning, development of future treatments, and altruism were not identified in this review. Patient empowerment provides one useful approach to measuring PROs from CGS.
Collapse
Affiliation(s)
- M McAllister
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - A Dearing
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|