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Egan KK, Becker U, M Ller SP, Pisinger V, Tolstrup JS. Effectiveness of proactive video therapy for problematic alcohol use on treatment initiation, compliance, and alcohol intake: a randomised controlled trial in Denmark. Lancet Digit Health 2024; 6:e418-e427. [PMID: 38789142 DOI: 10.1016/s2589-7500(24)00067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 02/26/2024] [Accepted: 03/26/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Few people with problematic alcohol use reach treatment and dropout is frequent. Therapy for problematic alcohol use delivered via video conference (e-alcohol therapy) might overcome treatment barriers. In this randomised study, we tested whether proactive e-alcohol therapy outperformed face-to-face alcohol therapy (standard care) regarding treatment initiation, compliance, and weekly alcohol intake at 3-month and 12-month follow-up. METHODS In this two-arm randomised controlled trial, we recruited individuals who had problematic alcohol use, defined as a score of 8 or more on the Alcohol Use Disorders Identification Test; were 18 years or older; and had access to a personal computer, smartphone, or tablet with internet access in Denmark through online advertisements. Participants were assigned to receive alcohol therapy delivered either face-to-face or via video conference. The number, frequency, and duration of therapy sessions were individualised in both groups. Data analysis was conducted using masked data. Primary analyses were based on an intention-to-treat sample. The study is registered with ClinicalTrials.gov (NCT03116282). FINDINGS Between Jan 22, 2018, and June 29, 2020, 816 individuals signed up for the trial and 502 (63%) were assessed for eligibility. We randomly assigned 379 to proactive e-alcohol therapy (n=187) or standard care (n=192), of which, 170 (48%) participants were female and 186 (52%) were male. In the intervention group, more participants initiated treatment (155 [88%] of 177 vs 96 [54%] of 179; odds ratio [OR] 6·3; 95% CI 2·8 to 13·8; p<0·0001 at 3 months; 151 [85%] of 177 vs 115 [64%] of 179; OR 3·2; 95% CI 1·6 to 6·2; p=0·0007 at 12 months) and complied with treatment (130 [73%] of 177 vs 74 [41%] of 179; OR 4·0; 95% CI 2·2 to 7·2; p<0·0001 at 3 months; 140 [79%] of 177 vs 95 [53%] of 179; OR 3·4; 95% CI 1·8 to 6·3; p=0·0002 at 12 months). Weekly alcohol intake was significantly lower in the intervention group only after 3 months (13·0 standard drinks per week vs 21·3 standard drinks per week; adjusted difference -6·7; 95% CI -12·3 to -1·0; p=0·019). INTERPRETATION Proactive e-alcohol therapy was associated with increased treatment initiation and compliance and is promising as an easily accessible and effective alcohol treatment for individuals with problematic alcohol use. FUNDING TrygFonden.
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Affiliation(s)
- Kia Kejlskov Egan
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Sanne Pagh M Ller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Veronica Pisinger
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Esselink A, Rozema AD, Kools N, Van Den Berk T, Bovens RHLM, Mathijssen JJP. Effectiveness of a self-help guide during a temporary alcohol abstinence challenge: a randomized controlled trial. Alcohol Alcohol 2024; 59:agae034. [PMID: 38798161 PMCID: PMC11128764 DOI: 10.1093/alcalc/agae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/22/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The popularity of temporary abstinence challenges (TACs) concerning alcohol consumption is increasing. Support is found to be essential for participants to help them get through a challenge. This study aimed to evaluate the additional effect of a self-help guide, based on health behaviour theories and behaviour change techniques, on (i) successful completion of a TAC and (ii) changes in drinking refusal self-efficacy (DRSE), behavioural automaticity, craving, and alcohol consumption. METHODS A randomized controlled trial was performed (OSF registries: OSF.IO/B95VU). NoThanks participants received a questionnaire before the TAC (T0) and 8 months after the TAC (T1). Out of a subgroup of 1308 respondents who were interested in additional support, 652 were randomly assigned to receive the guide (experimental group), and 656 did not receive any additional support (control group). Logistic regressions and (generalized) linear mixed model analyses were used. RESULTS After 8 months, all participants showed a significant decrease in behavioural automaticity, craving, and alcohol consumption, irrespective of group assignment. No significant changes were observed in the DRSE. This degree of change over time in behavioural automaticity, craving, and alcohol consumption did not differ between the experimental and control group. Sensitivity analyses with participants in the experimental group, who differed in exposure to the guide, did not show differences either. CONCLUSION The self-help guide, and how it was designed, added no value to the TAC. Future research should focus on more bottom-up, customized support and explore what (different subgroups of) participants think they need as extra support during a TAC.
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Affiliation(s)
- Annelien Esselink
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioural Sciences, Tilburg University, PO box 90153, 5000 LE Tilburg, The Netherlands
| | - Andrea D Rozema
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioural Sciences, Tilburg University, PO box 90153, 5000 LE Tilburg, The Netherlands
| | - Nathalie Kools
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioural Sciences, Tilburg University, PO box 90153, 5000 LE Tilburg, The Netherlands
| | - Tim Van Den Berk
- Gewoontegedrag, Toernooiveld 300, 6525 EC Nijmegen, The Netherlands
| | - Rob H L M Bovens
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioural Sciences, Tilburg University, PO box 90153, 5000 LE Tilburg, The Netherlands
- Positive Lifestyle Foundation, Ringbaan-Oost 298, 5018AL Tilburg, The Netherlands
| | - Jolanda J P Mathijssen
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioural Sciences, Tilburg University, PO box 90153, 5000 LE Tilburg, The Netherlands
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Lang C, Weisel KK, Saur S, Fuhrmann LM, Schoenleber A, Reichl D, Enewoldsen N, Steins-Loeber S, Berking M. Support after return to alcohol use: a mixed-methods study on how abstinence motivation and app use change after return to alcohol use in an app-based aftercare intervention for individuals with alcohol use disorder. Addict Sci Clin Pract 2024; 19:35. [PMID: 38711152 PMCID: PMC11071226 DOI: 10.1186/s13722-024-00457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation. METHODS Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data. RESULTS Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24-96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants' reported use behavior. CONCLUSIONS The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether. TRIAL REGISTRATION The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).
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Affiliation(s)
- Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Lukas M Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Antonie Schoenleber
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
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Jaffe AE, Blayney JA, Graupensperger S, Stappenbeck CA, Bedard-Gilligan M, Larimer M. Personalized normative feedback for hazardous drinking among college women: Differential outcomes by history of incapacitated rape. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:863-874. [PMID: 34435831 PMCID: PMC8881529 DOI: 10.1037/adb0000657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Personalized normative feedback (PNF) interventions are effective at reducing hazardous drinking in college. However, little is known about who is most receptive to PNF. College women with a history of alcohol-related incapacitated rape (IR) are at elevated risk for hazardous drinking, but it is unclear what impact intervention messaging may have on this group and how their outcomes compare to those without past IR. To address this gap, this study involved secondary data analysis of a large web-based clinical trial. METHOD Heavy drinking college women (N = 1,188) were randomized into PNF (n = 895) or control conditions (n = 293). Postintervention, women reported their reactions to intervention messaging. Hazardous drinking outcomes (typical drinking, heavy episodic drinking [HED], peak estimated blood alcohol content [eBAC], blackout frequency) were assessed at baseline and 12 months. RESULTS Past IR was reported by 16.3% (n = 194) of women. Women with a history of IR reported more baseline hazardous drinking and greater readiness to change than women without IR. For those who received PNF, history of IR related to greater perceived impact of the intervention, but no difference in satisfaction with the message. After controlling for baseline drinking, regressions revealed the effect of PNF was moderated by IR for frequency of HED at 12 months. Simple main effects revealed PNF was associated with lower levels of hazardous drinking at follow-up among women with past IR. CONCLUSIONS This initial investigation suggests PNF is a low resource and easily disseminated intervention that can have a positive impact on college women with past IR. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln
| | - Jessica A Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | | | | | - Mary Larimer
- Department of Psychiatry and Behavioral Sciences, University of Washington
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Ribba B, Peck R, Hutchinson L, Bousnina I, Motti D. Digital Therapeutics as a New Therapeutic Modality: A Review from the Perspective of Clinical Pharmacology. Clin Pharmacol Ther 2023; 114:578-590. [PMID: 37392464 DOI: 10.1002/cpt.2989] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023]
Abstract
The promise of transforming digital technologies into treatments is what drives the development of digital therapeutics (DTx), generally known as software applications embedded within accessible technologies-such as smartphones-to treat, manage, or prevent a pathological condition. Whereas DTx solutions that successfully demonstrate effectiveness and safety could drastically improve the life of patients in multiple therapeutic areas, there is a general consensus that generating therapeutic evidence for DTx presents challenges and open questions. We believe there are three main areas where the application of clinical pharmacology principles from the drug development field could benefit DTx development: the characterization of the mechanism of action, the optimization of the intervention, and, finally, its dosing. We reviewed DTx studies to explore how the field is approaching these topics and to better characterize the challenges associated with them. This leads us to emphasize the role that the application of clinical pharmacology principles could play in the development of DTx and to advocate for a development approach that merges such principles from development of traditional therapeutics with important considerations from the highly attractive and fast-paced world of digital solutions.
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Affiliation(s)
- Benjamin Ribba
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Richard Peck
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Lucy Hutchinson
- Roche Information Solutions, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Imein Bousnina
- Genentech, A Member of the Roche Group, Washington, DC, USA
| | - Dario Motti
- Roche Information Solutions, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Razaghi E, Farhoudian A, Pilevari A, Noroozi A, Hooshyari Z, Radfar R, Malekinejad M. Identification of the socio-cultural barriers of drug addiction treatment in Iran. Heliyon 2023; 9:e15566. [PMID: 37131427 PMCID: PMC10149210 DOI: 10.1016/j.heliyon.2023.e15566] [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: 08/18/2022] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023] Open
Abstract
Introduction Socio-cultural norms can either be encouraging or a barrier to addiction treatment. More, rigorous research is needed on nonindigenous models in addiction treatment, to better understand the role of socio-cultural differences. Methods The present qualitative study is part of the project, "The Inclusive Assessment of the Barriers of Drug Addiction Treatment Services in Iran," which was conducted in Tehran from 2018 to 2021. The participants consisted of eight people who used drugs, seven individual family members of the people who used drugs participants, seven service providers, and four policymakers. A purposeful sampling method was used for the selection of the participants, and the process continued until reaching the theoretical saturation of data. Analysis used the Graneheim and Lundman methods, classifying primary codes, the sub-themes, and themes were classified according to the similarities and differences between primary codes. Finding The most important socio-cultural barriers to addiction treatment in Iran are: unrealistic expectations of the family and society from the people who use drugs, addiction stigma, mistrust between various components of the treatment system, perceptions that professional substance use disorder treatment is inefficient and low uptake of that treatment, the disturbed relational boundaries between the people who use drugs and their relatives, the interweaving of treatment and ethical and religious principles, low acceptance of maintenance treatments, treatment focusing on short-term outcomes, and presence of facilitating backgrounds of using drugs. Conclusions The Iranian socio-cultural characteristics play an important role in the addiction treatment of the people who use drugs, so it is necessary for treatment interventions to be sensitive to these characteristics.
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Affiliation(s)
- Emran Razaghi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Farhoudian
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Pilevari
- Department of Sociology, Kharazmi University, Karaj, Iran
- Corresponding author.
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Science, Tehran, Iran
| | - Zahra Hooshyari
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Radfar
- Department of Neuroscience and Addiction, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Malekinejad
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, USA
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Botwright S, Sutawong J, Kingkaew P, Anothaisintawee T, Dabak SV, Suwanpanich C, Promchit N, Kampang R, Isaranuwatchai W. Which interventions for alcohol use should be included in a universal healthcare benefit package? An umbrella review of targeted interventions to address harmful drinking and dependence. BMC Public Health 2023; 23:382. [PMID: 36823618 PMCID: PMC9948368 DOI: 10.1186/s12889-023-15152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND This study aimed to identify targeted interventions for the prevention and treatment of harmful alcohol use. Umbrella review methodology was used to summarise the effectiveness across a broad range of interventions, in order to identify which interventions should be considered for inclusion within universal health coverage schemes in low- and middle-income countries. METHODS AND FINDINGS We included systematic reviews with meta-analysis of randomised controlled trials (RCTs) on targeted interventions addressing alcohol use in harmful drinkers or individuals with alcohol use disorder. We only included outcomes related to alcohol consumption, heavy drinking, binge drinking, abstinence, or alcohol-attributable accident, injury, morbidity or mortality. PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and the International HTA Database were searched from inception to 3 September 2021. Risk of bias of reviews was assessed using the AMSTAR2 tool. After reviewing the abstracts of 9,167 articles, results were summarised narratively and certainty in the body of evidence for each intervention was assessed using GRADE. In total, 86 studies met the inclusion criteria, of which the majority reported outcomes for brief intervention (30 studies) or pharmacological interventions (29 studies). Overall, methodological quality of included studies was low. CONCLUSIONS For harmful drinking, brief interventions, cognitive behavioural therapy, and motivational interviewing showed a small effect, whereas mentoring in adolescents and children may have a significant long-term effect. For alcohol use disorder, social network approaches and acamprosate showed evidence of a significant and durable effect. More evidence is required on the effectiveness of gamma-hydroxybutyric acid (GHB), nalmefene, and quetiapine, as well as optimal combinations of pharmacological and psychosocial interventions. As an umbrella review, we were unable to identify the extent to which variation between studies stemmed from differences in intervention delivery or variation between country contexts. Further research is required on applicability of findings across settings and best practice for implementation. Funded by the Thai Health Promotion Foundation, grant number 61-00-1812.
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Affiliation(s)
- Siobhan Botwright
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand.
| | - Jiratorn Sutawong
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand.
| | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Thunyarat Anothaisintawee
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Saudamini Vishwanath Dabak
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Chotika Suwanpanich
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Nattiwat Promchit
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Roongnapa Kampang
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Shams F, Tai AM, Kim J, Boyd M, Meyer M, Kazemi A, Krausz RM. Adherence to e-health interventions for substance use and the factors influencing it: Systematic Review, meta-analysis, and meta-regression. Digit Health 2023; 9:20552076231203876. [PMID: 37780062 PMCID: PMC10540609 DOI: 10.1177/20552076231203876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Background Substance use disorders affect 36 million people globally, but only a small proportion of them receive the necessary treatment. E-health interventions have been developed to address this issue by improving access to substance use treatment. However, concerns about participant engagement and adherence to these interventions remain. This review aimed to evaluate adherence to e-health interventions targeting substance use and identify hypothesized predictors of adherence. Methods A systematic review of literature published between 2009 and 2020 was conducted, and data on adherence measures and hypothesized predictors were extracted. Meta-analysis and meta-regression were used to analyze the data. The two adherence measures were (a) the mean proportion of modules completed across the intervention groups and (b) the proportion of participants that completed all modules. Four meta-regression models assessed each covariate including guidance, blended treatment, intervention duration and recruitment strategy. Results The overall pooled adherence rate was 0.60 (95%-CI: 0.52-0.67) for the mean proportion of modules completed across 30 intervention arms and 0.47 (95%-CI: 0.35-0.59) for the proportion of participants that completed all modules across 9 intervention arms. Guidance, blended treatment, and recruitment were significant predictors of adherence, while treatment duration was not. Conclusion The study suggests that more research is needed to identify predictors of adherence, in order to determine specific aspects that contribute to better exposure to intervention content. Reporting adherence and predictors in future studies can lead to improved meta-analyses and the development of more engaging interventions. Identifying predictors can aid in designing effective interventions for substance use disorders, with important implications for e-health interventions targeting substance use.
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Affiliation(s)
- Farhud Shams
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andy M.Y. Tai
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jane Kim
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marisha Boyd
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maximilian Meyer
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, University of Basel Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Alireza Kazemi
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Reinhard Michael Krausz
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Beyer FR, Kenny RPW, Johnson E, Caldwell DM, Garnett C, Rice S, Simpson J, Angus C, Craig D, Hickman M, Michie S, Kaner EFS. Practitioner and digitally delivered interventions for reducing hazardous and harmful alcohol consumption in people not seeking alcohol treatment: a systematic review and network meta-analysis. Addiction 2023; 118:17-29. [PMID: 35815387 PMCID: PMC10087505 DOI: 10.1111/add.15999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 06/19/2022] [Indexed: 11/30/2022]
Abstract
AIM To compare the effectiveness of practitioner versus digitally delivered interventions for reducing hazardous and harmful alcohol consumption. DESIGN Systematic review and network meta-analysis comprising comprehensive search for randomised controlled trials, robust screening and selection methods and appraisal with the Cochrane Risk of Bias tool. Network meta-analyses were conducted in Stata using random effects, frequentist models. The confidence in network meta-analysis (CINeMA) tool was used to assess confidence in effect sizes. SETTING Online or community or health settings where the intervention was immediately accessible without referral. PARTICIPANTS Non treatment-seeking hazardous or harmful drinkers. MEASUREMENTS Primary outcome was mean difference in alcohol consumption (g/wk); secondary outcome was number of single high intensity drinking episodes. Baseline consumption was analysed as a covariate. FINDINGS Of 201 included trials (94 753 participants), 152 reported a consumption outcome that could be converted to grams/week; 104 reported number of single high intensity drinking episodes. At 1 and 6 months, practitioner delivered interventions reduced consumption more than digitally delivered interventions (1 month: -23 g/wk (95% CI, -43 to -2); 6 months: -14 g/wk [95% CI, -25 to -3]). At 12 months there was no evidence of difference between practitioner and digitally delivered interventions (-6 g/wk [95% CI, -24 to 12]). There was no evidence of a difference in single high intensity drinking episodes between practitioner and digitally delivered interventions at any time point. Effect sizes were small, but could impact across a population with relatively high prevalence of hazardous and harmful drinking. Heterogeneity was a concern. Some inconsistency was indicated at 1 and 6 months, but little evidence was apparent at 12 months. CONCLUSION Practitioner delivered interventions for reducing hazardous and harmful alcohol consumption are more effective than digitally delivered interventions up to 6 months; at 12 months there is no evidence of a difference.
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Affiliation(s)
- Fiona R Beyer
- Evidence Synthesis Group, Population Health Sciences Institute, The Catalyst, 3 Science Square, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Ryan P W Kenny
- Evidence Synthesis Group, Population Health Sciences Institute, The Catalyst, 3 Science Square, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Eugenie Johnson
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire Garnett
- Department of Behavioural Science and Health, University College London, London, UK
| | - Stephen Rice
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle, UK
| | - Julija Simpson
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Dawn Craig
- Evidence Synthesis Group, Population Health Sciences Institute, The Catalyst, 3 Science Square, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Matt Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Susan Michie
- Director of UCL Centre for Behaviour Change, University College London, London, UK
| | - Eileen F S Kaner
- Population Health Sciences Institute, Faculty of Medical Science, Newcastle University, Newcastle, UK
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10
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Kistner S, Kramer D. Erste Erfahrungen mit einer Selbstmanagement-App in der stationären Suchtbehandlung. SUCHT 2022. [DOI: 10.1024/0939-5911/a000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Zusammenfassung: Zielsetzung: Um die Möglichkeiten smartphonebasierter Interventionen für die stationäre Entwöhnungstherapie in einer Rehabilitationsklinik zu nutzen, wurde die MeinSalus-App entwickelt. Ziel der Studie ist es, (1) die Akzeptanz (Nutzungsabsicht) der App bei Patienten sowie beim therapeutischen Personal zu untersuchen, (2) Prädiktoren der Akzeptanz auf der Grundlage eines erweiterten UTAUT (Unified Theory of Acceptance and Use of Technology-)Modells zu bestimmen und (3) Aufschlüsse über das Nutzungsverhalten zu bekommen. Methodik: 193 von 282 stationären Patienten (68,4 %) sowie 18 von 34 Therapeuten (52,9 %) beantworteten Fragebögen zur Akzeptanz (Nutzungsabsicht) der App und deren einzelnen Funktionen, zu UTAUT- und mHealth-bezogenen Variablen sowie zu ihrem Nutzungsverhalten. Ergebnisse: Die mittlere Nutzungsabsicht (Range 1–5) für die App insgesamt lag für Patienten bei 4.65 ( SD = 0.83) und für Therapeuten bei 4.07 ( SD = 0.62). Alter, mobile Internetnutzung, erwarteter Nutzen sowie Vorbehalte gegenüber der App erwiesen sich als signifikante Prädiktoren der Akzeptanz. Beim Nutzungsverhalten ergab sich ein differenziertes Bild für die unterschiedlichen Funktionen. Schlussfolgerungen: Es zeigte sich sowohl in der Patientenstichprobe als auch beim teilnehmenden therapeutischen Personal eine hohe Akzeptanz der App, was auf eine akzeptable Grundlage für eine Implementierung in der stationären Suchtbehandlung hindeutet. Studien zu Effekten der App sollten sich anschließen.
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Affiliation(s)
- Saskia Kistner
- salus klinik Friedrichsdorf, Deutschland
- MainPVZ, Offenbach, Deutschland
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11
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Villanueva-Blasco VJ, J. MM, Villanueva-Silvestre V, Vázquez-Martínez A. Relationship Between Depression and Risky Alcohol Consumption in Women: the Mediating Role of Coping Styles and Age. Int J Ment Health Addict 2022:1-18. [PMID: 36248266 PMCID: PMC9555268 DOI: 10.1007/s11469-022-00931-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Women are more likely to use alcohol as a coping strategy for psychological distress, with higher rates of comorbidity with depression being found in those with an alcohol use disorder. The objective of this study was to analyze changes in problematic alcohol consumption and depression during the COVID-19 lockdown, and to establish a predictive model based on age. A total of 1889 women aged 18-64 years (M = 36.14) participated. The Patient Health Questionnaire was applied for depression, the Alcohol Use Disorders Identification Test-Short Version for alcohol, and active and avoidant coping were considered. In the period prior to the pandemic, depression and avoidant coping were good predictors of alcohol consumption in women, regardless of age. During lockdown, this predictive capacity was only maintained in women aged 35-64 years. In the mediational models, differences were observed according to age. For women aged 18-34 years, depression was the predictor variable of problematic alcohol consumption, but for women aged 35-64 years it was the avoidant coping style, which is the predominant style in women of this age with clinical depression. The relevance of age in the combined treatments of depression and problematic alcohol consumption is highlighted, and training in active coping strategies is suggested.
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Affiliation(s)
- V. J. Villanueva-Blasco
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group On Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, C/ Pintor Sorolla, 21, 46002 Valencia, Spain
| | - Mateu-Mollá J.
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group On Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, C/ Pintor Sorolla, 21, 46002 Valencia, Spain
| | - V. Villanueva-Silvestre
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group On Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, C/ Pintor Sorolla, 21, 46002 Valencia, Spain
| | - A. Vázquez-Martínez
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group On Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, C/ Pintor Sorolla, 21, 46002 Valencia, Spain
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12
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Leightley D, Williamson C, Rona RJ, Carr E, Shearer J, Davis JP, Simms A, Fear NT, Goodwin L, Murphy D. Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e38991. [PMID: 35724966 PMCID: PMC9254042 DOI: 10.2196/38991] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction intervention that is personalized to support the UK AF. OBJECTIVE To address this gap, we investigated the efficacy of a 28-day brief alcohol intervention delivered via a mobile app in reducing weekly self-reported alcohol consumption among UK veterans seeking help for mental health difficulties. METHODS We performed a 2-arm participant-blinded randomized controlled trial (RCT). We compared a mobile app that included interactive features designed to enhance participants' motivation and personalized messaging (intervention arm) with a version that provided government guidance on alcohol consumption only (control arm). Adults were eligible if they had served in the UK AF, were currently receiving or had received clinical support for mental health symptoms, and consumed 14 units (approximately 112 g of ethanol) or more of alcohol per week. Participants received the intervention or the control mobile app (1:1 ratio). The primary outcome was a change in self-reported weekly alcohol consumption between baseline and day 84 assessed using the validated Timeline Follow Back for Alcohol Consumption (TLFB) (prior 7 days), with a secondary outcome exploring self-reported change in the Alcohol Use Disorder Identification Test (AUDIT) score. RESULTS Between October 2020 and April 2021, 2708 individuals were invited to take part, of which 2531 (93.5%) did not respond, 54 (2%) were ineligible, and 123 (4.5%) responded and were randomly allocated (62, 50.4%, intervention; 61, 49.6%, control). At day 84, 41 (66.1%) participants in the intervention arm and 37 (60.7%) in the control arm completed the primary outcome assessment. Between baseline and day 84, weekly alcohol consumption reduced by -10.5 (95% CI -19.5 to -1.5) units in the control arm and -28.2 (95% CI -36.9 to -19.5) units in the intervention arm (P=.003, Cohen d=0.35). We also found a significant reduction in the AUDIT score of -3.9 (95% CI -6.2 to -1.6) in the intervention arm (Cohen d=0.48). Our primary and secondary effects did not persist over the longer term (day 168). Two adverse events were detected during the trial. CONCLUSIONS This study examined the efficacy of a fully automated 28-day brief alcohol intervention delivered via a mobile app in a help-seeking sample of UK veterans with hazardous alcohol consumption. We found that participants receiving Drinks:Ration reduced their alcohol consumption more than participants receiving guidance only (at day 84). In the short term, we found Drinks:Ration is efficacious in reducing alcohol consumption in help-seeking veterans. TRIAL REGISTRATION ClinicalTrials.gov NCT04494594; https://tinyurl.com/34em6n9f. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/19720.
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Affiliation(s)
- Daniel Leightley
- Institute of Psychiatry, Psychology & Neuroscience, King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Charlotte Williamson
- Institute of Psychiatry, Psychology & Neuroscience, King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Roberto J Rona
- Institute of Psychiatry, Psychology & Neuroscience, King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, King's College London, London, United Kingdom
| | - James Shearer
- King's Health Economics, King's College London, London, United Kingdom
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Amos Simms
- Academic Department of Military Mental Health, King's College London, London, United Kingdom.,British Army, London, United Kingdom
| | - Nicola T Fear
- Institute of Psychiatry, Psychology & Neuroscience, King's Centre for Military Health Research, King's College London, London, United Kingdom.,Academic Department of Military Mental Health, King's College London, London, United Kingdom
| | - Laura Goodwin
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Dominic Murphy
- Institute of Psychiatry, Psychology & Neuroscience, King's Centre for Military Health Research, King's College London, London, United Kingdom.,Combat Stress, Leatherhead, United Kingdom
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13
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Pearson R, Carl E, Creech SK. Computerized Psychological Interventions in Veterans and Service Members: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2022; 24:e30065. [PMID: 35657663 PMCID: PMC9206197 DOI: 10.2196/30065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/07/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Computerized psychological interventions can overcome logistical and psychosocial barriers to the use of mental health care in the Veterans Affairs and Department of Defense settings. OBJECTIVE In this systematic review, we aim to outline the existing literature, with the goal of describing: the scope and quality of the available literature, intervention characteristics, study methods, study efficacy, and study limitations and potential directions for future research. METHODS Systematic searches of two databases (PsycINFO and PubMed) using PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines were conducted from inception until November 15, 2020. The following inclusion criteria were used: the study was published in an English language peer-reviewed journal, participants were randomly allocated to a computerized psychological intervention or a control group (non-computerized psychological intervention active treatment or nonactive control group), an intervention in at least one treatment arm was primarily delivered through the computer or internet with or without additional support, participants were veterans or service members, and the study used validated measures to examine the effect of treatment on psychological outcomes. RESULTS This review included 23 studies that met the predefined inclusion criteria. Most studies were at a high risk of bias. Targeted outcomes, participant characteristics, type of support delivered, adherence, and participant satisfaction were described. Most of the examined interventions (19/24, 79%) yielded positive results. Study limitations included participant characteristics limiting study inference, high rates of attrition, and an overreliance on self-reported outcomes. CONCLUSIONS Relatively few high-quality studies were identified, and more rigorous investigations are needed. Several recommendations for future research are discussed, including the adoption of methods that minimize attrition, optimize use, and allow for personalization of treatment.
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Affiliation(s)
- Rahel Pearson
- Veterans Health Administration Veterans Integrated Service Network 17, Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, Waco, TX, United States
| | - Emily Carl
- Department of Psychology, University of Texas, Austin, TX, United States
| | - Suzannah K Creech
- Veterans Health Administration Veterans Integrated Service Network 17, Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, Waco, TX, United States
- Department of Psychiatry and Behavioral Sciences, Dell Medical School of the University of Texas, Austin, TX, United States
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14
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Melendez-Torres GJ, Meiksin R, Witzel TC, Weatherburn P, Falconer J, Bonell C. eHealth Interventions to Address HIV and Other Sexually Transmitted Infections, Sexual Risk Behavior, Substance Use, and Mental Ill-health in Men Who Have Sex With Men: Systematic Review and Meta-analysis. JMIR Public Health Surveill 2022; 8:e27061. [PMID: 35384845 PMCID: PMC9021948 DOI: 10.2196/27061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/20/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Men who have sex with men experience disproportionately high levels of HIV and other sexually transmitted infections (STIs), sexual risk behavior, substance use, and mental ill-health. These experiences are interrelated, and these interrelations are potentiated by structural conditions of discrimination, stigma, and unequal access to appropriate health services, and they magnify each other and have intersecting causal pathways, worsening both risk for each condition and risk for the negative sequelae of each condition. eHealth interventions could address these issues simultaneously and thus have wide-ranging and greater effects than would be for any 1 outcome alone. Objective We systematically reviewed the evidence for the effectiveness of eHealth interventions in addressing these outcomes separately or together. Methods We searched 19 databases for randomized trials of interactive or noninteractive eHealth interventions delivered via mobile phone apps, internet, or other electronic media to populations consisting entirely or principally of men who have sex with men to prevent HIV, STIs, sexual risk behavior, alcohol and drug use, or common mental illnesses. We extracted data and appraised each study, estimated meta-analyses where possible by using random effects and robust variance estimation, and assessed the certainty of our findings (closeness of the estimated effect to the true effect) by using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results We included 14 trials, of which 13 included active versus control comparisons; none reported mental health outcomes, and all drew from 12 months or less of follow-up postintervention. Findings for STIs drew on low numbers of studies and did not suggest consistent short-term (<3 months postintervention; d=0.17, 95% CI –0.18 to 0.52; I2=0%; 2 studies) or midterm (3-12 months postintervention, no meta-analysis, 1 study) evidence of effectiveness. Eight studies considering sexual risk behavior outcomes suggested a short-term, nonsignificant reduction (d=–0.14, 95% CI –0.30 to 0.03) with very low certainty, but 6 studies reporting midterm follow-ups suggested a significant impact on reducing sexual risk behavior (d=–0.12, 95% CI –0.19 to –0.05) with low certainty. Meta-analyses could not be undertaken for alcohol and drug use (2 heterogeneous studies) or for HIV infections (1 study for each of short-term or midterm follow-up), and alcohol outcomes alone were not captured in the included studies. Certainty was graded as low to very low for most outcomes, including all meta-analyses. Conclusions To create a comprehensive eHealth intervention that targets multiple outcomes, intervention evaluations should seek to generalize both mechanisms and components that are successfully used to achieve change in 1 outcome over multiple outcomes. However, additional evaluations of interventions seeking to address outcomes other than sexual risk behavior are needed before development and evaluation of a joined-up intervention.
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Affiliation(s)
| | - Rebecca Meiksin
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - T Charles Witzel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Peter Weatherburn
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Falconer
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Bonell
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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Guillén V, Fonseca-Baeza S, Fernández-Felipe I, Botella C, Baños R, García-Palacios A, Marco J. Effectiveness of family connections intervention for family members of persons with personality disorders in two different formats: Online vs face-to-face. Internet Interv 2022; 28:100532. [PMID: 35646607 PMCID: PMC9136357 DOI: 10.1016/j.invent.2022.100532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Personality disorders (PD) have a serious impact on the lives of individuals who suffer from them and those around them. It is common for family members to experience high levels of burden, anxiety, and depression, and deterioration in their quality of life. It is curious that few interventions have been developed for family members of people with PD. However, Family Connections (FC) (Hoffman and Fruzzetti, 2005) is the most empirically supported intervention for family members of people with Borderline Personality Disorder (BPD). AIM The aim of this study is to explore the effectiveness of online vs face-to-face FC. Given the current social constraints resulting from SARS-CoV-2, interventions have been delivered online and modified. METHOD This was a non-randomized pilot study with a pre-post evaluation and two conditions: The sample consisted of 45 family members distributed in two conditions: FC face-to-face (20) performed by groups before the pandemic, and FC online (25), performed by groups during the pandemic. All participants completed the evaluation protocol before and after the intervention. RESULTS There is a statistically significant improvement in levels of burden (η 2 = 0.471), depression, anxiety, and stress (η 2 = 0.279), family empowerment (η 2 = 0.243), family functioning (η 2 = 0.345), and quality of life (μ2 η 2 = 0.237). There were no differences based on the application format burden (η 2 = 0.134); depression, anxiety, and stress (η 2 = 0.087); family empowerment (η 2 = 0,27), family functioning (η 2 = 0.219); and quality of life (η 2 = 0.006), respectively). CONCLUSIONS This study provides relevant data about the possibility of implementing an intervention in a sample of family members of people with PD in an online format without losing its effectiveness. During the pandemic, and despite the initial reluctance of family members and the therapists to carry out the interventions online, this work shows the effectiveness of the results and the satisfaction of the family members. These results are particularly relevant in a pandemic context, where there was no possibility of providing help in other ways. All of this represents a great step forward in terms of providing psychological treatment.
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Affiliation(s)
- V. Guillén
- Universidad de Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain,Corresponding author at: Dep. of Personality, Evaluation and Psychological Treatments, University of Valencia, Av. Blasco Ibañez 21, 46010, Spain.
| | | | - I. Fernández-Felipe
- Universitat Jaume I de Castellón, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain
| | - C. Botella
- Universitat Jaume I de Castellón, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain
| | - R. Baños
- Universidad de Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain
| | - A. García-Palacios
- Universitat Jaume I de Castellón, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain
| | - J.H. Marco
- Universidad de Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03 Instituto Salud Carlos III), Spain
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16
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Vangrunderbeek A, Raveel A, Matheï C, Claeys H, Aertgeerts B, Bekkering G. Effectiveness of guided and unguided online alcohol help: A real-life study. Internet Interv 2022; 28:100523. [PMID: 35330980 PMCID: PMC8938279 DOI: 10.1016/j.invent.2022.100523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/18/2022] [Accepted: 03/09/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Online interventions reduce the treatment gap between the number of people with alcohol misuse and people who actually receive help. This study investigated the effectiveness and predictors of success of a Belgian online help programme. METHODS A real-life retrospective open cohort study evaluating the guided and unguided internet intervention on the Belgian online platform alcoholhulp.be. The intervention consisted of a 12-week programme based upon cognitive behaviour therapy, motivational interviewing and acceptance and commitment therapy. Inclusion criteria are age above 18 years, recording of alcohol consumption in the daily journal for at least 2 weeks, and minimum 2 chat sessions in the guided group.Outcomes were weekly alcohol consumption after 6 and 12 weeks and treatment response (drinking less than 10 or 20 standard units (SU) per week). Additional analysis was done on predictors of success. RESULTS A total of 460 participants in the guided group and 968 in the self-help group met the inclusion criteria. Average baseline alcohol consumption in the two groups was 40 SU per week. Alcohol consumption decreased by 31 SU (Cohen's d 1.17, p < 0.001) after 12 weeks in the guided group and 23 SU (Cohen's d 0.83, p < 0.001) in the self-help group. The treatment response below 20 SU per week was 88% for the guided group and 73% for the self-help group. Significantly better results were obtained in the guided group compared to the self-help group (p < 0.005). Participants with a higher baseline alcohol consumption had a higher decrease in alcohol consumption in both groups. The personal goal to quit, the absence of drug use, a lower baseline alcohol consumption and a higher number of completed assignments predict a higher chance of treatment response. Attrition at 6 weeks was 26% in the guided group and 63% in the self-help group and increased to 59% and 82% respectively at 12 weeks. CONCLUSIONS Both guided and unguided internet interventions are effective in reducing alcohol consumption and achieving the guideline for participants motivated to use the platform on a regular base, with better results in guided intervention.
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Affiliation(s)
- Ans Vangrunderbeek
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 7 bus 7001 blok h, 3000 Leuven, Belgium
| | - Ann Raveel
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 7 bus 7001 blok h, 3000 Leuven, Belgium
| | - Catharina Matheï
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 7 bus 7001 blok h, 3000 Leuven, Belgium
| | - Herwig Claeys
- Zorggroep Zin (Centre for Mental Health and Addiction), Salvatorstraat 25, 3500 Hasselt, Belgium
| | - Bert Aertgeerts
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 7 bus 7001 blok h, 3000 Leuven, Belgium
| | - Geertruida Bekkering
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 7 bus 7001 blok h, 3000 Leuven, Belgium,Corresponding author.
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17
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Meiksin R, Melendez-Torres GJ, Miners A, Falconer J, Witzel TC, Weatherburn P, Bonell C. E-health interventions targeting STIs, sexual risk, substance use and mental health among men who have sex with men: four systematic reviews. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/brwr6308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Human immunodeficiency virus/sexually transmitted infections, sexual risk, substance (alcohol and other legal and illegal drugs) use and mental ill health constitute a ‘syndemic’ of mutually reinforcing epidemics among men who have sex with men. Electronic health (e-health) interventions addressing these epidemics among men who have sex with men might have multiplicative effects. To our knowledge, no systematic review has examined the effectiveness of such interventions on these epidemics among men who have sex with men.
Objective
The objective was to synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective?
Data sources
A total of 24 information sources were searched initially (October–November 2018) [the following sources were searched: ProQuest Applied Social Sciences Index and Abstracts; Campbell Library; EBSCO Cumulative Index to Nursing and Allied Health Literature Plus, Wiley Online Library The Cochrane Library; Centre for Reviews and Dissemination databases (the Database of Abstracts of Reviews of Effects and the NHS Economic Evaluation Database); the Health Technology Assessment database; Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) database of health promotion research (Bibliomap); ProQuest Dissertations & Theses Global; OvidSP EconLit; OvidSP EMBASE; OvidSP Global Health; OvidSP Health Management Information Consortium; ProQuest International Bibliography of the Social Sciences; Ovid MEDLINE ALL; OvidSP PsycINFO; Web of Science Science Citation Index Expanded; Elsevier Scopus; OvidSP Social Policy & Practice; Web of Science Social Sciences Citation Index Expanded; ProQuest Sociological Abstracts; ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform; EPPI-Centre Trials Register of Promoting Health Interventions; and the OpenGrey database], and an updated search of 19 of these was conducted in April 2020. Reference lists of included reports were searched and experts were contacted.
Review methods
Eligible reports presented theories of change and/or process, outcome and/or economic evaluations of e-health interventions offering ongoing support to men who have sex with men to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk behaviour, alcohol/drug use and/or common mental illnesses. References were screened by title/abstract, then by full text. Data extraction and quality assessments used existing tools. Theory and process reports were synthesised using qualitative methods. Outcome and economic data were synthesised narratively; outcome data were meta-analysed.
Results
Original searches retrieved 27 eligible reports. Updated searches retrieved 10 eligible reports. Thirty-seven reports on 28 studies of 23 interventions were included: 33 on theories of change, 12 on process evaluations, 16 on outcome evaluations and one on an economic evaluation. Research question 1: five intervention types were identified – ‘online modular’, ‘computer games’ and ‘non-interactive’ time-limited/modular interventions, and open-ended interventions with ‘content organised by assessment’ and ‘general content’. Three broad types of intervention theories of change were identified, focusing on ‘cognitive/skills’, ‘self-monitoring’ and ‘cognitive therapy’. Research question 2: individual tailoring based on participant characteristics was particularly acceptable, and participants valued intervention content reflecting their experiences. Research question 3: little evidence was available of effects on human immunodeficiency virus or sexually transmitted infections. The analysis did not suggest that interventions were effective in reducing instances of human immunodeficiency virus or sexually transmitted infections. The overall meta-analysis for sexually transmitted infections reported a small non-significant increase in sexually transmitted infections in the intervention group, compared with the control group. Meta-analyses found a significant impact on sexual risk behaviour. The findings for drug use could not be meta-analysed because of study heterogeneity. Studies addressing this outcome did not present consistent evidence of effectiveness. Trials did not report effects on alcohol use or mental health. Research question 4: evidence on cost-effectiveness was limited.
Limitations
The quality of the eligible reports was variable and the economic synthesis was limited to one eligible study.
Conclusions
There is commonality in intervention theories of change and factors affecting receipt of e-health interventions. Evidence on effectiveness is limited.
Future work
Future trials should assess the impact of interventions on multiple syndemic factors, among them sexual risk, substance use and mental health; incorporate sufficient follow-up and sample sizes to detect the impact on human immunodeficiency virus/sexually transmitted infections; and incorporate rigorous process and economic evaluations.
Study registration
This study is registered as PROSPERO CRD42018110317.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rebecca Meiksin
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jane Falconer
- Library, Archive and Open Research Services, London School of Hygiene & Tropical Medicine, London, UK
| | - T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Weatherburn
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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18
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Hoy N, Newton N, Kochan NA, Sunderland M, Baillie A, Chapman C, Winter V, Sachdev P, Teesson M, Mewton L. Rethink My Drink: study protocol for a 12-month randomised controlled trial comparing a brief internet-delivered intervention to an online patient information booklet in reducing risky alcohol consumption among older adults in Australia. Addiction 2022; 117:815-825. [PMID: 34426994 DOI: 10.1111/add.15672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Alcohol consumption is increasing among older adults. Rethink My Drink is a brief internet-delivered intervention to reduce alcohol consumption and related harms, adapted specifically for older adults. This protocol for a large-scale randomised controlled trial will evaluate whether Rethink My Drink is effective in reducing alcohol consumption and cognitive decline in a sample of older risky drinkers, compared with an active control. DESIGN 1:1 parallel group, randomised controlled trial. SETTING Online trial in Australia. PARTICIPANTS Hazardous or harmful drinkers (defined as those scoring ≥5 on the Alcohol Use Disorders Identification Test [AUDIT]) age 60 to 75 years old (n = 842). Participants will be recruited from August 2021 to August 2022 through online social media advertisements and community networks. INTERVENTION AND COMPARATOR Participants will be randomly allocated to receive access to Rethink My Drink (intervention) or Alcohol: The Facts (comparator), an online patient information booklet provided by New South Wales (NSW) Health. MEASUREMENTS Primary outcomes include (i) average weekly standard drinks and (ii) rate of cognitive decline. Secondary outcomes include (i) typical quantity of drinks per drinking day; (ii) heavy episodic drinking; (iii) age-specific risky drinking; (iv) alcohol-related harms; (v) subjective cognitive complaints; and (vi) quality of life. All primary and secondary outcomes will be assessed at baseline, post-intervention (4 weeks) and 12 months. Effectiveness will be evaluated using multilevel linear regression, adjusting for baseline demographic differences. Bonferroni adjustments will be used to control for multiple comparisons. Multiple imputation, regression weighting and sensitivity analyses will assess the effect of attrition. COMMENTS This will be the first large-scale trial, internationally, to examine whether a brief internet-delivered intervention is effective in reducing alcohol consumption and cognitive decline among older adults. If successful, the intervention will provide an accessible and highly scalable treatment to reduce risky alcohol consumption in older adulthood.
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Affiliation(s)
- Nicholas Hoy
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Andrew Baillie
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Virginia Winter
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Louise Mewton
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
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Mujcic A, Blankers M, Boon B, Berman AH, Riper H, van Laar M, Engels R. Effectiveness, Cost-effectiveness, and Cost-Utility of a Digital Alcohol Moderation Intervention for Cancer Survivors: Health Economic Evaluation and Outcomes of a Pragmatic Randomized Controlled Trial. J Med Internet Res 2022; 24:e30095. [PMID: 35103605 PMCID: PMC8848232 DOI: 10.2196/30095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Alcohol moderation (AM) interventions may contribute to better treatment outcomes and the general well-being of cancer survivors. OBJECTIVE This study evaluates the effectiveness, cost-effectiveness, and cost-utility of MyCourse, a digital AM intervention, compared with a noninteractive digital information brochure for cancer survivors. METHODS A health economic evaluation alongside a pragmatic 2-arm parallel-group randomized controlled trial was conducted with follow-ups at 3, 6, and 12 months after randomization. The study was conducted on the web in the Netherlands from 2016 to 2019. Participants were adult 10-year cancer survivors drinking over the Dutch-recommended drinking guidelines (≤7 standard units [10 g of alcohol] per week) with the intention to moderate or quit drinking. Overall, 103 participants were randomized and analyzed: 53 (51.5%) in the MyCourse group and 50 (48.5%) in the control group. In the MyCourse group, participants had access to a newly developed, digital, minimally guided AM intervention, MyCourse-Moderate Drinking. The primary outcome was the self-reported number of standard drinks (10 g of ethanol) consumed in the past 7 days at the 6-month follow-up. The secondary outcome measures were alcohol-related problems as measured by the Alcohol Use Disorders Identification Test (AUDIT) and treatment satisfaction. For the health economic evaluation, health care costs, costs because of productivity losses, and intervention costs were assessed over a 12-month horizon. RESULTS Alcohol use at the 6-month follow-up decreased by 38% in the MyCourse group and by 33% in the control group. No difference in 7-day alcohol use was found between the groups (B=2.1, 95% CI -7.6 to 3.1; P=.22) at any of the follow-ups. AUDIT scores for alcohol-related problems decreased over time in both groups, showing no significant difference between the groups (Cohen d=0.3, 95% CI -0.1 to 0.6; P=.21). Intervention costs per participant were estimated at US $279 for the MyCourse group and US $74 for the control group. The mean societal costs were US $18,092 (SD 25,662) and US $23,496 (SD 34,327), respectively. The MyCourse group led to fewer gained quality-adjusted life years at lower societal costs in the cost-utility analysis. In the cost-effectiveness analysis, the MyCourse group led to a larger reduction in drinking units over time at lower societal costs (incremental cost-effectiveness ratio per reduced drink: US $ -1158, 95% CI -1609 to -781). CONCLUSIONS At 6 months, alcohol use was reduced by approximately one-third in both groups, with no significant differences between the digital intervention MyCourse and a noninteractive web-based brochure. At 12 months, cost-effectiveness analyses showed that MyCourse led to a larger reduction in drinking units over time, at lower societal costs. The MyCourse group led to marginally fewer gained quality-adjusted life years, also at lower societal costs. TRIAL REGISTRATION Netherlands Trial Register NTR6010; https://www.trialregister.nl/trial/5433. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12885-018-4206-z.
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Affiliation(s)
- Ajla Mujcic
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
- Trimbos Institute, Utrecht, Netherlands
| | - Matthijs Blankers
- Trimbos Institute, Utrecht, Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Brigitte Boon
- Academy het Dorp, Arnhem, Netherlands
- Siza, Arnhem, Netherlands
- Tranzo, Tilburg University, Tilburg, Netherlands
| | - Anne H Berman
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Heleen Riper
- Section Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Medical University, University of Turku, Turku, Finland
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | - Rutger Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
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20
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Wray TB, Chan PA, Guigayoma JP, Kahler CW. Game Plan-a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis. JMIR Form Res 2022; 6:e30408. [PMID: 34989679 PMCID: PMC8771347 DOI: 10.2196/30408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/18/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP’s effectiveness is closely linked with consistent use, and a variety of individual-level barriers, including alcohol use, could impede optimal uptake and use. Web-based interventions can encourage medication adherence, HIV prevention behaviors, and responsible drinking and may help support PrEP care, particularly in resource-limited settings. Objective We previously developed a web application called Game Plan that was designed to encourage heavy drinking GBM to use HIV prevention methods and reduce their alcohol use and was inspired by brief motivational interventions. This paper aims to describe the web-based content we designed for integration into Game Plan to help encourage PrEP uptake and consistent use among GBM. In this paper, we also aim to describe this content and its rationale. Methods Similar to the original site, these components were developed iteratively, guided by a thorough user-centered design process involving consultation with subject-matter experts, usability interviews and surveys, and user experience surveys. Results In addition to Game Plan’s pre-existing content, the additional PrEP components provide specific, personal, and digestible feedback to users about their level of risk for HIV without PrEP and illustrate how much consistent PrEP use could reduce it; personal feedback about their risk for common sexually transmitted infections to address low-risk perceptions; content challenging common beliefs and misconceptions about PrEP to reduce stigma; content confronting familiar PrEP and alcohol beliefs; and a change planning module that allows users to select specific goals for starting and strategies for consistent PrEP use. Users can opt into a weekly 2-way SMS text messaging program that provides similar feedback over a 12-week period after using Game Plan and follows up on the goals they set. Conclusions Research preliminarily testing the efficacy of these components in improving PrEP outcomes, including uptake, adherence, sexually transmitted infection rates, and alcohol use, is currently ongoing. If supported, these components could provide a scalable tool that can be used in resource-limited settings in which face-to-face intervention is difficult.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Philip A Chan
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - John P Guigayoma
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
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21
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Augsburger M, Kaal E, Ülesoo T, Wenger A, Blankers M, Haug S, Ebert DD, Riper H, Keough M, Noormets H, Schaub MP, Kilp K. Effects of a minimal-guided on-line intervention for alcohol misuse in Estonia: a randomized controlled trial. Addiction 2022; 117:108-117. [PMID: 34184795 PMCID: PMC9292731 DOI: 10.1111/add.15633] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/09/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Estonia has one of the highest alcohol-attributable mortality rates within the European Union. The aim of this study was to estimate the efficacy of an on-line self-help intervention to reduce problem drinking at the population level. DESIGN On-line open randomized controlled trial with an 8-week intervention and an active control group (intervention n = 303, control n = 286). Assessments took place at baseline and at 6 months follow-up. SETTING On- and offline channels were used for population-based recruitment within a nation-wide prevention campaign in Estonia. PARTICIPANTS Inclusion criteria were age ≥ 18 years, heavy drinking [Alcohol Use Disorders Identification (AUDIT) test score ≥ 8], literacy in Estonian and at least weekly access to the internet; n = 589 participants were randomized (50% male, 1% other; mean age 37.86 years; 45% with higher level of education). INTERVENTION AND COMPARATOR The intervention consisted of 10 modules based on principles of cognitive-behavioral therapy and motivational interviewing. The active control group received access to a website with a self-test including personalized normative feedback and information for standard alcohol treatment. MEASUREMENTS The primary outcome was AUDIT scores at 6 months follow-up adjusted for baseline scores. FINDINGS Intention-to-treat analyses were applied. Missing data were addressed by using baseline observation carried forward (BOCF) and multiple imputation by chained equations (MI); 175 completed follow-up in the intervention group and 209 in the control group. AUDIT score at follow-up was significantly smaller in the intervention [BOCF mean = 13.91, standard deviation (SD) = 7.61, MI mean = 11.03, SD = 6.55] than control group (BOCF mean = 15.30, SD = 7.31; MI mean = 14.30, SD = 7.21), with a group difference of -1.38 [95% confidence interval (CI) = -2.58, -0.18], P = 0.02 for BOCF and -3.26 (95% CI = -2.01, -4.51), P < 0.001 for MI. CONCLUSIONS A randomized controlled trial has found that an on-line self-help intervention with minimal guidance was effective at reducing problem drinking in Estonia.
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Affiliation(s)
- Mareike Augsburger
- University of Zurich; Swiss Research Institute for Public Health and Addiction ISGFZurichSwitzerland
| | - Esta Kaal
- National Institute for Health Development; Centre for Health MarketingTallinnEstonia,Tallinn UniversityTallinnEstonia
| | - Triin Ülesoo
- National Institute for Health Development; Centre for Health MarketingTallinnEstonia
| | - Andreas Wenger
- University of Zurich; Swiss Research Institute for Public Health and Addiction ISGFZurichSwitzerland
| | - Matthijs Blankers
- Department of ResearchArkin Mental Health CareAmsterdamthe Netherlands,Academic Medical Centre, Department of PsychiatryUniversity of AmsterdamAmsterdamthe Netherlands
| | - Severin Haug
- University of Zurich; Swiss Research Institute for Public Health and Addiction ISGFZurichSwitzerland
| | - David D. Ebert
- Department of Clinical, Neuro and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental PsychologyVrije Universiteit AmsterdamAmsterdamthe Netherlands,GGZ inGeest, Research and InnovationAmsterdamthe Netherlands
| | - Matthew Keough
- Department of PsychologyYork UniversityTorontoOntarioCanada
| | - Helen Noormets
- National Institute for Health Development; Centre for Health MarketingTallinnEstonia
| | - Michael P. Schaub
- University of Zurich; Swiss Research Institute for Public Health and Addiction ISGFZurichSwitzerland
| | - Karin Kilp
- National Institute for Health Development; Centre for Health MarketingTallinnEstonia
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22
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Leung C, Pei J, Hudec K, Shams F, Munthali R, Vigo D. The effects of non-clinician guidance on effectiveness and process outcomes of digital mental health interventions: A systematic review and meta-analysis (Preprint). J Med Internet Res 2021; 24:e36004. [PMID: 35511463 PMCID: PMC9244656 DOI: 10.2196/36004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 01/22/2023] Open
Abstract
Background Digital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (ie, psychologists and physicians) into digital mental health interventions has become common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other nonclinicians) can help reduce costs and increase accessibility. Objective This systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of nonclinician-guided digital mental health interventions. Methods Four databases (MEDLINE, Embase, CINAHL, and PsycINFO) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals that focus on digital intervention were hand searched; gray literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane risk-of-bias tool version 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Nonclinician-guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions. Results Thirteen studies qualified for inclusion. Nonclinician-guided interventions yielded higher posttreatment effectiveness outcomes when compared to conditions involving control programs (eg, online psychoeducation and monitored attention control) or wait-list controls (k=7, Hedges g=–0.73; 95% CI –1.08 to –0.38). There were also significant differences between nonclinician-guided interventions and unguided interventions (k=6, Hedges g=–0.17; 95% CI –0.23 to –0.11). In addition, nonclinician-guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08; 95% CI –0.01 to 0.17). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualifications of the individual performing the intervention, and that the presence of a nonclinician guide improves effectiveness outcomes compared to having no guide. Nonclinician-guided interventions did not yield significantly different adherence outcomes when compared with unguided interventions (k=3, odds ratio 1.58; 95% CI 0.51 to 4.92), although a general trend of improved adherence was observed within nonclinician-guided interventions. Conclusions Integrating paraprofessionals and nonclinicians appears to improve the outcomes of digital mental health interventions, and may also enhance adherence outcomes (though this trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (ie, psychosocial support, therapeutic alliance, and technical augmentation) and their associated outcomes. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020191226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=191226
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Affiliation(s)
- Calista Leung
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Pei
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kristen Hudec
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Farhud Shams
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Munthali
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Vigo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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23
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Hadjistavropoulos HD, Chadwick C, Beck CD, Edmonds M, Sundström C, Edwards W, Ouellette D, Waldrop J, Adlam K, Bourgeault L, Nugent M. Improving internet-delivered cognitive behaviour therapy for alcohol misuse: Patient perspectives following program completion. Internet Interv 2021; 26:100474. [PMID: 34722165 PMCID: PMC8536539 DOI: 10.1016/j.invent.2021.100474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022] Open
Abstract
Although Internet-delivered cognitive behaviour therapy (ICBT) for alcohol misuse is efficacious in research trials, it is not routinely available in practice. Moreover, there is considerable variability in engagement and outcomes of ICBT for alcohol misuse across studies. The Alcohol Change Course (ACC) is an ICBT program that is offered free of charge by an online clinic in Saskatchewan, Canada, which seeks to fill this service gap, while also conducting research to direct future improvements of ICBT. As there is limited qualitative patient-oriented research designed to improve ICBT for alcohol misuse, in this study, we describe patient perceptions of the ACC post-treatment. Specifically, post-treatment feedback was obtained from 191 of 312 patients who enrolled in the ACC. Qualitative thematic analysis was used to examine post-treatment written comments related to what patients liked and disliked about the course, which skills were most helpful for them, and their suggestions for future patients. The majority of patients endorsed being very satisfied or satisfied with the course (n = 133, 69.6%) and 94.2% (n = 180) perceived the course as being worth their time. Worksheets (n = 61, 31.9%) and reflections of others (n = 40, 20.9%) received the most praise. Coping with cravings (n = 63, 33.0%), and identifying and managing risky situations (n = 46, 24.1%) were reported as the most helpful skills. Several suggestions for refining the course were provided with the most frequent recommendation being a desire for increased personal interaction (n = 24, 12.6%) followed by a desire for wanting more information (n = 22, 11.5%). Many patients offered advice for future ACC patients, including suggestions to make a commitment (n = 47, 24.6%), do all of the work (n = 29, 15.2%), and keep a consistent approach to the course (n = 24, 12.6%). The results provide valuable patient-oriented directions for improving ICBT for alcohol misuse.
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Affiliation(s)
| | - Carly Chadwick
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Cynthia D. Beck
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Michael Edmonds
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | | | - Wendy Edwards
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Dianne Ouellette
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Justin Waldrop
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Kelly Adlam
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Lee Bourgeault
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
| | - Marcie Nugent
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina S4S 0A2, SK, Canada
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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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25
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Stappenbeck CA, Gulati NK, Jaffe AE, Blayney JA, Kaysen D. Initial efficacy of a web-based alcohol and emotion regulation intervention for college women with sexual assault histories. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:852-865. [PMID: 34291957 PMCID: PMC8578151 DOI: 10.1037/adb0000762] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE College women with sexual assault histories report greater heavy drinking relative to those without histories of assault. Moreover, individuals with sexual assault histories often have difficulty regulating emotions and tolerating distress, which can lead to a problematic pattern of drinking to cope. Thus, we evaluated the initial efficacy of a web-based alcohol intervention that included strategies to reduce drinking and improve regulatory skills for heavy drinking college women with sexual assault histories. METHOD The sample comprised college women (N = 200) who were 20.9 (SD = 2.8) years old and primarily White (69%). They were randomized to an assessment-only control or intervention and completed 14 daily diary assessments, pre- and posttreatment surveys, and 1- and 6-month follow-up surveys. During daily diary, the intervention group received a brief (5-10 min) alcohol reduction or regulatory skill module each day. RESULTS Reductions in drinking quantity and heavy episodic drinking were found for the intervention group at posttreatment and 1-month follow-up relative to controls. Improved regulatory skills and reduced posttraumatic stress disorder (PTSD) symptoms were reported at posttreatment for women who received the intervention compared to controls. Although gains were maintained, the intervention group no longer differed from controls by 6-month follow-up. CONCLUSIONS Results suggest this web-based intervention may result in short-term reductions in drinking and PTSD symptoms as well as improvements in regulatory abilities for college women with sexual assault histories. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences
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26
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Theurer C, Wilz G, Lechner-Meichsner F. Clients' and therapists' experiences of five general change mechanisms during an Internet-based cognitive behavioral intervention for family caregivers. J Clin Psychol 2021; 77:2798-2816. [PMID: 34599844 DOI: 10.1002/jclp.23253] [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: 03/27/2021] [Revised: 07/15/2021] [Accepted: 09/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Despite its efficacy, little is known about what makes Internet-based cognitive behavioral therapy (iCBT) effective. We, therefore, analyze participants' and therapists' experiences of Grawe's five general change mechanisms (alliance, resource activation, clarification, problem actuation, mastery) during an iCBT intervention for family dementia caregivers, and how their experiences were related to treatment outcomes. METHOD Participants (N = 30) exchanged eight weekly messages with a therapist via an Internet platform. We used the Bern Post Session Report to assess participants' and therapists' experiences of the general change mechanisms after each session. RESULTS Treatment outcomes were associated with therapists' overall experiences of alliance, clarification, and mastery. Participants experienced more problem actuation than therapists. Only participants' and therapists' experiences of clarification over time differed. CONCLUSIONS Grawe's general change mechanisms are also relevant for iCBT. We recommend considering Grawe's framework when designing Internet-based therapeutic interventions and when training therapists to deliver such interventions.
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Affiliation(s)
- Christina Theurer
- Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Gabriele Wilz
- Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
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27
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Buntrock C, Kählke F, Smit F, Ebert DD. A systematic review of trial-based economic evaluations of internet- and mobile-based interventions for substance use disorders. Eur J Public Health 2021; 31:i19-i28. [PMID: 31298687 PMCID: PMC8266535 DOI: 10.1093/eurpub/ckz022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Substance use disorders (SUDs) contribute significantly to global rates of morbidity and mortality. Internet- and mobile-based interventions (IMIs) have been suggested as an adjunct to face-to-face health services. However, the evidence for the cost-effectiveness of IMIs for SUDs is scant. METHODS A comprehensive literature search in PubMed, PsycINFO, the Cochrane Central Register of Controlled Trials, NHS Economic Evaluations Database, NHS Health Technology Assessment Database, Office of Health Economics Evaluations Database and EconLit was conducted. We included economic evaluations alongside randomized controlled trials of IMIs for SUDs compared with a control group. RESULTS Of 1687 abstracts identified, 11 studies met the inclusion criteria. Targeted conditions were alcohol use disorder (four studies) and tobacco smoking (five studies) whereas two studies included any SUD. Cost-effectiveness results demonstrated that IMIs had a firm probability of being more cost-effective than TAU (e.g. less costs per additional abstinent person). Compared with (online) psycho-education, evidence towards an additional benefit of IMIs was less clear. Regarding cost-utility (e.g. costs per quality-adjusted life year gained), except for one study, results suggested that TAU and online psycho-education would probably be more preferable than IMIs. Quality of study reporting was at least adequate. CONCLUSIONS The likelihood of IMIs being more cost-effective than TAU looks promising but more economic evaluations are needed in order to determine the economic merit of IMIs. With an increasing pressure on health care budgets, strategies to disseminate effective interventions at affordable costs are required. This review suggests that IMIs might carry that promise and have potential as a cost-effective strategy to scale-up existing evidence-based treatments for SUDs. SYSTEMATIC REVIEW REGISTRATION The systematic review has been registered in the PROSPERO database (no. CRD42018099486).
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Affiliation(s)
- Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Fanny Kählke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Filip Smit
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.,Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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28
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Taylor CB, Graham AK, Flatt RE, Waldherr K, Fitzsimmons-Craft EE. Current state of scientific evidence on Internet-based interventions for the treatment of depression, anxiety, eating disorders and substance abuse: an overview of systematic reviews and meta-analyses. Eur J Public Health 2021; 31:i3-i10. [PMID: 32918448 PMCID: PMC8495688 DOI: 10.1093/eurpub/ckz208] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND ICare represents a consortium of European Investigators examining the effects of online mental health care for a variety of common mental health disorders provided in a variety of settings. This article provides an overview of the evidence of effectiveness for Internet-based treatment for four common mental health disorders that are the focus of much of this work: depression, anxiety, substance abuse and eating disorders. METHODS The overview focused primarily on systematic reviews and meta-analyses identified through PubMed (Ovid) and other databases and published in English. Given the large number of reviews specific to depression, anxiety, substance abuse and/or eating disorders, we did not focus on reviews that examined the effects of Internet-based interventions on mental health disorders in general. Each article was reviewed and summarized by one of the senior authors, and this review was then reviewed by the other senior authors. We did not address issues of prevention, cost-effectiveness, implementation or dissemination, as these are addressed in other reviews in this supplement. RESULTS Across Internet-based intervention studies addressing depression, anxiety, substance abuse and eating disorders primarily among adults, almost all reviews and meta-analyses found that these interventions successfully reduce symptoms and are efficacious treatments. Generally, effect sizes for Internet-based interventions treating eating disorders and substance abuse are lower compared with interventions for depression and anxiety. CONCLUSIONS Given the effectiveness of Internet-based interventions to reduce symptoms of these common mental health disorders, efforts are needed to examine issues of how they can be best disseminated and implemented in a variety of health care and other settings.
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Affiliation(s)
- C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Rachael E Flatt
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Karin Waldherr
- FernFH Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
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29
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Baumgartner C, Schaub MP, Wenger A, Malischnig D, Augsburger M, Lehr D, Blankers M, Ebert DD, Haug S. "Take Care of You" - Efficacy of integrated, minimal-guidance, internet-based self-help for reducing co-occurring alcohol misuse and depression symptoms in adults: Results of a three-arm randomized controlled trial. Drug Alcohol Depend 2021; 225:108806. [PMID: 34171823 DOI: 10.1016/j.drugalcdep.2021.108806] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and harmful alcohol use are two of the top five leading causes of years of life lost to disability in high-income countries. Integrated treatment targeting both at the same time is often considered more complicated and difficult and, therefore, more expensive. Consequently, integrated internet-based interventions could be a valuable addition to traditional care. METHODS A three-arm randomized controlled trial was conducted comparing the effectiveness of (1) an integrated, minimal-guidance, adherence-focused self-help intervention designed to reduce both alcohol use and depression symptoms (AFGE-AD); (2) a similar intervention designed to reduce alcohol use only (AFGE-AO), and (3) internet access as usual (IAU) as a control condition, in at least moderately depressed alcohol misusers from February 2016-March 2020. We recruited 689 alcohol misusers (51.6 % males, mean age = 42.8 years) with at least moderate depression symptoms not otherwise in treatment from the general population. Six months after baseline, 288 subjects (41.8 %) were reachable for the final assessment. RESULTS All interventions yielded reduced alcohol-use after six months (AFGE-AD: -16.6; AFGE-AO: -19.8; IAU: -13.2). Those who undertook active-interventions reported significantly fewer standard drinks than controls (AFGE-AD: p = .048, d=0.10; AFGE-AO: p = .004, d=0.20). The two active-intervention groups also reported significantly less severe depression symptoms than controls (AFGE-AD: p = .006, d=0.41; AFGE-AO: p = .008, d=0.43). Testing revealed noninferiority between the two interventions. CONCLUSIONS This study documented sustained effectiveness of the first integrated, fully internet-based self-help intervention developed for the reduction of both alcohol use and depression symptoms in at least moderately depressed adult alcohol misusers recruited from the general population.
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Affiliation(s)
- Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland.
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Doris Malischnig
- Institute for Addiction Prevention, Addiction and Drug Coordination Vienna, Vienna, Austria
| | - Mareike Augsburger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Dirk Lehr
- Division of Online Health Training, Leuphana University Lueneburg, Germany
| | - Matthijs Blankers
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - David D Ebert
- Department for Sport and Health Sciences, Chair for Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
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30
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Thørrisen MM, Bonsaksen T, Skogen JC, Skarpaas LS, Sevic A, van Mechelen W, Aas RW. Willingness to Participate in Alcohol Prevention Interventions Targeting Risky Drinking Employees. The WIRUS Project. Front Public Health 2021; 9:692605. [PMID: 34249850 PMCID: PMC8267363 DOI: 10.3389/fpubh.2021.692605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/31/2021] [Indexed: 01/10/2023] Open
Abstract
Background: The extent to which eligible individuals in a target population are willing to participate in interventions is important when evaluating the efficacy of public health interventions. Objectives: As part of a process evaluation of an ongoing randomized controlled trial, this study aimed to identify the proportion of risky drinkers who were willing to participate in an alcohol prevention intervention in an occupational health setting, and correlates for such willingness. Methods: Risky drinking employees from 22 companies in Norway were identified through an alcohol screening survey. Risky drinkers' (N = 779) willingness to complete a health examination and to be randomized into an alcohol prevention intervention (digital or face-to-face intervention, or control) was recorded by personnel from occupational health services. The proportion of employees who were willing to participate was assessed on 31 potential correlates (sociodemographic, alcohol-related, work-related, and lifestyle/daily activity). Adjusted (multiple logistic regression) analyses were utilized to explore associations between potential correlates and willingness to participate. Results: Altogether, 38.1% of employees were willing to participate in prevention interventions. In the adjusted analysis, only 5 out of 31 potential correlates were significantly associated with willingness to participate. Managers were more than twice as willing to participate than workers (OR = 2.17, p < 0.01). Willing employees had less workplace decision latitude (perceived control over workplace decisions and less possibility of utilizing personal skills in the job) (OR = 0.62, p < 0.05), and were more overcommitted with exorbitant work ambition and need for approval (OR = 1.49, p < 0.05). Willing employees had to some extent less alcohol-related impaired work performance (presenteeism, OR = 0.78, p < 0.05), and they spent less time on care activities (OR = 0.84, p < 0.05). Conclusions: Reaching four out of ten with risky drinking habits for prevention interventions strengthens the rationale for targeting this public health problem in occupational health care settings. In particular, this study suggests the importance of ensuring secure commitment among workers, who were less willing til participate than managers. Nevertheless, tailoring recruitment and implementation strategies based on easily identifiable correlates may be onerous.
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Affiliation(s)
- Mikkel Magnus Thørrisen
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Tore Bonsaksen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.,Faculty of Health Sciences, VID Specialized University, Sandnes, Norway
| | - Jens Christoffer Skogen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Department of Health Promotion, Norwegian Institute of Public Health, Sandnes, Norway.,Center for Alcohol & Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Lisebet Skeie Skarpaas
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Aleksandra Sevic
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Willem van Mechelen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (Location VUmc), Amsterdam, Netherlands.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioral Sciences, University of Queensland, Brisbane, QLD, Australia.,Division of Exercise and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
| | - Randi Wågø Aas
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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31
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Crouse JJ, Morley KC, Buckley N, Dawson A, Seth D, Monds LA, Tickell A, Kay-Lambkin F, Chitty KM. Online interventions for people hospitalized for deliberate self-harm and problematic alcohol use: Lessons learned from the iiAIM trial. Bull Menninger Clin 2021; 85:123-142. [PMID: 34032460 DOI: 10.1521/bumc.2021.85.2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Deliberate self-harm and suicide affect all age groups, sexes, and regions, and their prevention is a global health priority. Acute alcohol misuse and chronic alcohol misuse are strong, modifiable risk factors, and Internet interventions aiming to reduce alcohol misuse and comorbid mental health problems (e.g., depression) are a promising and effective treatment modality. The research team aimed to evaluate the feasibility and effectiveness of an Internet-based comorbidity intervention primarily aiming to reduce alcohol consumption, and secondarily to reduce readmission for deliberate self-harm and improve psychological outcomes among people hospitalized for deliberate self-harm who also engage in problematic alcohol use. However, due to several barriers to recruitment, the trial could not be completed and was discontinued. The authors present a "Lessons Learned" discussion and describe the Internet Intervention for Alcohol Improvement (iiAIM) trial, discuss the key barriers experienced by the research team, and recommend potential solutions that may help future trials in this area.
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Affiliation(s)
- Jacob J Crouse
- University of Sydney, Youth Mental Health and Technology Team, Brain & Mind Centre, Central Clinical School, Sydney, NSW, Australia
| | - Kirsten C Morley
- University of Sydney, Discipline of Addiction Medicine, Central Clinical School, Sydney, NSW, Australia
| | - Nicholas Buckley
- University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, Australia
| | - Andrew Dawson
- University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
| | - Devanshi Seth
- Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia.,University of Sydney, Centenary Institute of Cancer Medicine and Cell Biology, Sydney, NSW, Australia, and the University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Lauren A Monds
- University of Sydney, Discipline of Addiction Medicine, Central Clinical School, Sydney, NSW, Australia
| | - Ashleigh Tickell
- University of Sydney, Youth Mental Health and Technology Team, Brain & Mind Centre, Central Clinical School, Sydney, NSW, Australia
| | - Frances Kay-Lambkin
- University of Newcastle, Centre for Brain and Mental Health Priority Research Centre, Newcastle, Australia
| | - Kate M Chitty
- University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, Australia
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32
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Mohr DC, Azocar F, Bertagnolli A, Choudhury T, Chrisp P, Frank R, Harbin H, Histon T, Kaysen D, Nebeker C, Richards D, Schueller SM, Titov N, Torous J, Areán PA. Banbury Forum Consensus Statement on the Path Forward for Digital Mental Health Treatment. Psychiatr Serv 2021; 72:677-683. [PMID: 33467872 PMCID: PMC8822332 DOI: 10.1176/appi.ps.202000561] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A major obstacle to mental health treatment for many Americans is accessibility: the United States faces a shortage of mental health providers, resulting in federally designated shortage areas. Although digital mental health treatments (DMHTs) are effective interventions for common mental disorders, they have not been widely adopted by the U.S. health care system. National and international expert stakeholders representing health care organizations, insurance companies and payers, employers, patients, researchers, policy makers, health economists, and DMHT companies and the investment community attended two Banbury Forum meetings. The Banbury Forum reviewed the evidence for DMHTs, identified the challenges to successful and sustainable implementation, investigated the factors that contributed to more successful implementation internationally, and developed the following recommendations: guided DMHTs should be offered to all patients experiencing common mental disorders, DMHT products and services should be reimbursable to support integration into the U.S. health care landscape, and an evidence standards framework should be developed to support decision makers in evaluating DMHTs.
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Affiliation(s)
- David C Mohr
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Francisca Azocar
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Andrew Bertagnolli
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Tanzeem Choudhury
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Paul Chrisp
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Richard Frank
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Henry Harbin
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Trina Histon
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Debra Kaysen
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Camille Nebeker
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Derek Richards
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Stephen M Schueller
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Nickolai Titov
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - John Torous
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Patricia A Areán
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
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- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
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Schouten MJE, Dekker JJM, de Bruijn TQ, Ebert DD, Koomen LM, Kosterman SLA, Riper H, Schaub MP, Goudriaan AE, Blankers M. Effectiveness of a digital alcohol moderation intervention as an add-on to depression treatment for young adults: study protocol of a multicentre pragmatic randomized controlled trial. BMC Psychiatry 2021; 21:265. [PMID: 34022840 PMCID: PMC8140318 DOI: 10.1186/s12888-021-03222-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depressive disorders and problematic drinking often co-occur, also among young adults. These co-occurring conditions are associated with various negative health outcomes compared to both conditions alone. Early intervention by addressing alcohol use and depressive symptoms simultaneously in the same treatment might improve both conditions. However, evidence on the (cost-) effectiveness of digital combined depression and alcohol interventions for young adults is currently insufficient. We therefore developed an add-on digital alcohol moderation adherence-focussed guided intervention to complement treatment as usual (TAU) for depressive disorders. The digital intervention is a web-app, including 6 modules based on motivational interviewing and cognitive behavioural therapy. This study aims to evaluate the (cost-)effectiveness of a digital alcohol moderation intervention + TAU compared to TAU on alcohol and depression outcomes among young adults with co-occurring depressive disorders and problematic alcohol use. METHODS One hundred fifty-six participants, aged 18-35 years, with problematic alcohol use and a diagnosed depressive disorder will participate in a pragmatic multicentre two-arm randomized controlled trial. Problematic alcohol use is operationalised as scoring ≥5 for women and ≥ 8 for men on the Alcohol Use Disorder Identification Test (AUDIT). Participants will be randomized to either the experimental group (digital alcohol intervention + TAU) or control group (TAU only). Participants will be recruited at three Dutch mental health care centres and through social media. Assessments take place at baseline and after 3, 6 and 12 months post-randomization. The primary outcome is treatment response at 6-month follow-up, operationalized as a composite score that combines alcohol use and depression measures and indicates whether treatment has been successful or not. Secondary outcomes are depressive symptoms and alcohol use (i.e. number of weekly standard drinks and AUDIT score). An economic evaluation will be conducted alongside the trial. DISCUSSION This study evaluates the (cost-) effectiveness of an add-on digital alcohol moderation intervention for young adults who are in treatment for depressive disorders. If proven effective, the digital intervention could be implemented in mental health care and improve treatment for people with co-occurring depressive disorders and problematic alcohol use. TRIAL REGISTRATION Pre-registered on October 29, 2019 in The Netherlands Trial Register ( NL8122 ).
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Affiliation(s)
- Maria J E Schouten
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Tamara Q de Bruijn
- Department of Prevention, Jellinek, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - David D Ebert
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisanne M Koomen
- Arkin BasisGGZ, Arkin Mental Health Care, Roetersstraat 210, Amsterdam, The Netherlands
| | - Sjoerd L A Kosterman
- Department of Outpatient Treatment of Common Mental Health Disorders, PuntP, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, 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, Amsterdam, The Netherlands
- Research Unit for Telepsychiatry and e-Mental Health, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Anna E Goudriaan
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Addiction Research and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Addiction Research and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Trimbos Institute-The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Gold N, Yau A, Rigby B, Dyke C, Remfry EA, Chadborn T. Effectiveness of Digital Interventions for Reducing Behavioral Risks of Cardiovascular Disease in Nonclinical Adult Populations: Systematic Review of Reviews. J Med Internet Res 2021; 23:e19688. [PMID: 33988126 PMCID: PMC8164125 DOI: 10.2196/19688] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/05/2020] [Accepted: 02/03/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Digital health interventions are increasingly being used as a supplement or replacement for face-to-face services as a part of predictive prevention. They may be offered to those who are at high risk of cardiovascular disease and need to improve their diet, increase physical activity, stop smoking, or reduce alcohol consumption. Despite the popularity of these interventions, there is no overall summary and comparison of the effectiveness of different modes of delivery of a digital intervention to inform policy. OBJECTIVE This review aims to summarize the effectiveness of digital interventions in improving behavioral and health outcomes related to physical activity, smoking, alcohol consumption, or diet in nonclinical adult populations and to identify the effectiveness of different modes of delivery of digital interventions. METHODS We reviewed articles published in the English language between January 1, 2009, and February 25, 2019, that presented a systematic review with a narrative synthesis or meta-analysis of any study design examining digital intervention effectiveness; data related to adults (≥18 years) in high-income countries; and data on behavioral or health outcomes related to diet, physical activity, smoking, or alcohol, alone or in any combination. Any time frame or comparator was considered eligible. We searched MEDLINE, Embase, PsycINFO, Cochrane Reviews, and gray literature. The AMSTAR-2 tool was used to assess review confidence ratings. RESULTS We found 92 reviews from the academic literature (47 with meta-analyses) and 2 gray literature items (1 with a meta-analysis). Digital interventions were typically more effective than no intervention, but the effect sizes were small. Evidence on the effectiveness of digital interventions compared with face-to-face interventions was mixed. Most trials reported that intent-to-treat analysis and attrition rates were often high. Studies with long follow-up periods were scarce. However, we found that digital interventions may be effective for up to 6 months after the end of the intervention but that the effects dissipated by 12 months. There were small positive effects of digital interventions on smoking cessation and alcohol reduction; possible effectiveness in combined diet and physical activity interventions; no effectiveness for interventions targeting physical activity alone, except for when interventions were delivered by mobile phone, which had medium-sized effects; and no effectiveness observed for interventions targeting diet alone. Mobile interventions were particularly effective. Internet-based interventions were generally effective. CONCLUSIONS Digital interventions have small positive effects on smoking, alcohol consumption, and in interventions that target a combination of diet and physical activity. Small effects may have been due to the low efficacy of treatment or due to nonadherence. In addition, our ability to make inferences from the literature we reviewed was limited as those interventions were heterogeneous, many reviews had critically low AMSTAR-2 ratings, analysis was typically intent-to-treat, and follow-up times were relatively short. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42019126074; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=126074.
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Affiliation(s)
- Natalie Gold
- Public Health England, London, United Kingdom.,Centre for Philosophy of Natural and Social Science, London School of Economics and Political Science, London, United Kingdom
| | - Amy Yau
- Public Health England, London, United Kingdom.,Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin Rigby
- Public Health England, London, United Kingdom.,Department of Sociology, University of Durham, Durham, United Kingdom
| | - Chris Dyke
- Public Health England, London, United Kingdom.,Department of Social Science, Institute of Education, University College London, London, United Kingdom
| | - Elizabeth Alice Remfry
- Public Health England, London, United Kingdom.,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Diestelkamp S, Schulz AL, Thomasius R. [Technology-based interventions for alcohol prevention among children and adolescents]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:714-721. [PMID: 33950365 PMCID: PMC8187222 DOI: 10.1007/s00103-021-03338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early onset and excessive alcohol use in childhood and adolescence is associated with an elevated risk of experiencing short-, mid-, and long-term negative consequences caused by, e.g., accidents, violent acts, and conflicts. Face-to-face prevention approaches show significant effects on the reduction of alcohol use. However, service utilization is often low among children and adolescents. Technology-based alcohol prevention has the potential to reach this target group with potentially cost-effective, standardized, and low-threshold measures. AIM AND METHOD This narrative review provides an overview of different approaches of technology-based interventions for the prevention and early intervention of risky alcohol use among children and adolescents, their effectiveness, and settings for implementation. RESULTS Technology-based alcohol prevention can be implemented in a variety of settings, e.g., school, community, primary care, or hospital. Implementation is often realized via websites with or without embedding face-to-face modules, apps, or SMS messages. While the cumulative evidence of the effectiveness of technology-based alcohol prevention is strong for adults and young adults, evidence for the effectiveness among children and adolescents is heterogeneous. DISCUSSION Technology-based alcohol prevention has great theoretical potential with regards to reach, cost-effectiveness, and user engagement. Study replications are needed and evaluations of the effects of single elements, such as the individualization of content, user engagement through multiple contacts, and the use of multimedia elements and functions, should be addressed by future research.
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Affiliation(s)
- Silke Diestelkamp
- DZSKJ - Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Anna-Lena Schulz
- DZSKJ - Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Rainer Thomasius
- DZSKJ - Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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So R, Furukawa TA, Matsushita S, Baba T, Matsuzaki T, Furuno S, Okada H, Higuchi S. Unguided Chatbot-Delivered Cognitive Behavioural Intervention for Problem Gamblers Through Messaging App: A Randomised Controlled Trial. J Gambl Stud 2021; 36:1391-1407. [PMID: 32162075 DOI: 10.1007/s10899-020-09935-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Internet-delivered intervention may be an acceptable alternative for the more than 90% of problem gamblers who are reluctant to seek face-to-face support. Thus, we aimed to (1) develop a low-dropout unguided intervention named GAMBOT integrated with a messaging app; and (2) investigate its effect. The present study was a randomised, quadruple-blind, controlled trial. We set pre-to-post change in the Problem Gambling Severity Index (PGSI) as the primary outcome and pre-to-post change in the Gambling Symptom Assessment Scale (G-SAS) as a secondary outcome. Daily monitoring, personalised feedback, and private messages based on cognitive behavioural theory were offered to participants in the intervention group through a messaging app for 28 days (GAMBOT). Participants in the control group received biweekly messages only for assessments for 28 days (assessments only). A total of 197 problem gamblers were included in the primary analysis. We failed to demonstrate a significant between-group difference in the primary outcome (PGSI - 1.14, 95% CI - 2.75 to 0.47, p = 0.162) but in the secondary outcome (G-SAS - 3.14, 95% CI - 0.24 to - 6.04, p = 0.03). Only 6.7% of the participants dropped out during follow-up and 77% of the GAMBOT group participants (74/96) continued to participate in the intervention throughout the 28-day period. Integrating intervention into a chatbot feature on a frequently used messaging app shows promise in helping to overcome the high dropout rate of unguided internet-delivered interventions. More effective and sophisticated contents delivered by a chatbot should be sought to engage over 90% of problem gamblers who are reluctant to seek face-to-face support.
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Affiliation(s)
- Ryuhei So
- Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915, Japan. .,Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Sachio Matsushita
- Department of Psychiatry, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Toshiaki Baba
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takanobu Matsuzaki
- Department of Psychiatry, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Satoshi Furuno
- Department of Psychiatry, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Hitomi Okada
- Department of Psychiatry, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Susumu Higuchi
- Department of Psychiatry, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan
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Meiksin R, Melendez-Torres GJ, Falconer J, Witzel TC, Weatherburn P, Bonell C. eHealth Interventions to Address Sexual Health, Substance Use, and Mental Health Among Men Who Have Sex With Men: Systematic Review and Synthesis of Process Evaluations. J Med Internet Res 2021; 23:e22477. [PMID: 33890855 PMCID: PMC8105760 DOI: 10.2196/22477] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/05/2020] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background Men who have sex with men (MSM) face disproportionate risks concerning HIV and other sexually transmitted infections, substance use, and mental health. These outcomes constitute an interacting syndemic among MSM; interventions addressing all 3 together could have multiplicative effects. eHealth interventions can be accessed privately, and evidence from general populations suggests these can effectively address all 3 health outcomes. However, it is unclear how useable, accessible, or acceptable eHealth interventions are for MSM and what factors affect this. Objective We undertook a systematic review of eHealth interventions addressing sexual risk, substance use, and common mental illnesses among MSM and synthesized evidence from process evaluations. Methods We searched 19 databases, 3 trials registers, OpenGrey, and Google, and supplemented this by reference checks and requests to experts. Eligible reports were those that discussed eHealth interventions offering ongoing support to MSM aiming to prevent sexual risk, substance use, anxiety or depression; and assessed how intervention delivery or receipt varied with characteristics of interventions, providers, participants, or context. Reviewers screened citations on titles, abstracts, and then full text. Reviewers assessed quality of eligible studies, and extracted data on intervention, study characteristics, and process evaluation findings. The analysis used thematic synthesis. Results A total of 12 reports, addressing 10 studies of 8 interventions, were eligible for process synthesis. Most addressed sexual risk alone or with other outcomes. Studies were assessed as medium and high reliability (reflecting the trustworthiness of overall findings) but tended to lack depth and breadth in terms of the process issues explored. Intervention acceptability was enhanced by ease of use; privacy protection; use of diverse media; opportunities for self-reflection and to gain knowledge and skills; and content that was clear, interactive, tailored, reflective of MSM’s experiences, and affirming of sexual-minority identity. Technical issues and interventions that were too long detracted from acceptability. Some evidence suggested that acceptability varied by race or ethnicity and educational level; findings on variation by socioeconomic status were mixed. No studies explored how intervention delivery or receipt varied by provider characteristics. Conclusions Findings suggest that eHealth interventions targeting sexual risk, substance use, and mental health are acceptable for MSM across sociodemographic groups. We identified the factors shaping MSM’s receipt of such interventions, highlighting the importance of tailored content reflecting MSM’s experiences and of language affirming sexual-minority identities. Intervention developers can draw on these findings to increase the usability and acceptability of integrated eHealth interventions to address the syndemic of sexual risk, substance use, and mental ill health among MSM. Evaluators of these interventions can draw on our findings to plan evaluations that explore the factors shaping usability and acceptability.
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Affiliation(s)
- Rebecca Meiksin
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Jane Falconer
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - T Charles Witzel
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peter Weatherburn
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chris Bonell
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Livingston N, Ameral V, Hocking E, Leviyah X, Timko C. Interventions to Improve Post-Detoxification Treatment Engagement and Alcohol Recovery: Systematic Review of Intervention Types and Effectiveness. Alcohol Alcohol 2021; 57:136-150. [PMID: 33791782 DOI: 10.1093/alcalc/agab021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/15/2021] [Accepted: 03/09/2021] [Indexed: 01/28/2023] Open
Abstract
AIMS Most inpatient alcohol detoxification patients do not seek treatment post-discharge, which increases the risk of relapse and re-hospitalization. To date, there have been no efforts to synthesize the evidence supporting the broad range of available interventions for this critical transition. The current study is a systematic review and evaluation of interventions designed to promote treatment engagement and recovery following alcohol detoxification. METHODS The initial literature search yielded 6419 articles, published since 1999, from PubMed, CINAHL, PsycINFO, Psychology & Behavioral Sciences Collection and PsycARTICLES databases, 49 of which were eligible for full review. Data extraction included in-depth evaluation of intervention types, study and research design features, reported outcomes and study quality/bias indicators. All articles were coded by independent raters and final results were obtained through consensus. RESULTS Interventions included medical/medication, psychological/psychosocial, technological, mutual-help and combined approaches. On average, medical/medication interventions were less, and psychological/psychosocial and technological interventions were more likely to demonstrate efficacy with respect to treatment engagement and recovery. There was significant variability in study quality/bias but no significant differences across intervention types. Studies differed considerably across measured outcomes, internal and external validity, in/exclusion criteria and documentation of co-occurring psychiatric disorders. CONCLUSION Over half of studies reviewed reported empirical support for the intervention(s) evaluated. Although findings slightly favor non-medical interventions, the variability in study design and quality/bias requires more rigorous follow-up research. Recommendations from this review may guide future implementation and intervention development, which are critically needed to improve post-detoxification care and outcomes for patients with alcohol use disorder.
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Affiliation(s)
- Nicholas Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Room 906 Boston, MA 02118, USA
| | - Victoria Ameral
- Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road Bedford, MA 01730, USA
| | - Elise Hocking
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Room 906 Boston, MA 02118, USA
| | - Xenia Leviyah
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA
| | - Christine Timko
- VA Palo Alto Health Care System, 3801 Miranda AvenuePalo Alto, CA 94304, USA.,Stanford University School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA
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Mellentin AI, Behrendt S, Bilberg R, Blankers M, Folker MP, Tarp K, Uffelmann J, Nielsen AS. BLEND-A: blending internet treatment into conventional face-to-face treatment for alcohol use disorder - a study protocol. BMC Psychiatry 2021; 21:131. [PMID: 33676429 PMCID: PMC7937233 DOI: 10.1186/s12888-021-03122-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A major challenge to psychological treatment for alcohol use disorder (AUD) is patient non-compliance. A promising new treatment approach that is hypothesized to increase patient compliance is blended treatment, consisting of face-to-face contact with a therapist combined with modules delivered over the internet within the same protocol. While this treatment concept has been developed and proven effective for a variety of mental disorders, it has not yet been examined for AUD. AIMS The study described in this protocol aims to examine and evaluate patient compliance with blended AUD treatment as well as the clinical and cost effectiveness of such treatment compared to face-to-face treatment only. METHODS The study design is a pragmatic, stepped-wedge cluster randomized controlled trial. The included outpatient institutions (planned number of patients: n = 1800) will be randomized in clusters to implement either blended AUD treatment or face-to-face treatment only, i.e. treatment as usual (TAU). Both treatment approaches consist of motivational interviewing and cognitive behavioral therapy. Data on sociodemographics, treatment (e.g. intensity, duration), type of treatment conclusion (compliance vs. dropout), alcohol consumption, addiction severity, consequences of drinking, and quality of life, will be collected at treatment entry, at treatment conclusion, and 6 months after treatment conclusion. The primary outcome is compliance at treatment conclusion, and the secondary outcomes include alcohol consumption and quality of life at six-months follow-up. Data will be analyzed with an Intention-to-treat approach by means of generalized linear mixed models with a random effect for cluster and fixed effect for each step. Also, analyses evaluating cost-effectiveness will be conducted. DISCUSSION Blended treatment may increase treatment compliance and thus improve treatment outcomes due to increased flexibility of the treatment course. Since this study is conducted within an implementation framework it can easily be scaled up, and when successful, blended treatment has the potential to become an alternative offer in many outpatient clinics nationwide and internationally. TRIAL REGISTRATION Clinicaltrials.gov .: NCT04535258 , retrospectively registered 01.09.20.
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Affiliation(s)
- Angelina Isabella Mellentin
- Department of Clinical Research, Unit of Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark. .,Psychiatric University Hospital, University Function, Region of Southern Denmark, Odense, Denmark. .,Research Unit for Telepsychiatry and E-mental Health, Centre for Telepsychiatry in the Mental Health Services in the Region of Southern Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Department of Clinical Research, I BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark.
| | - Silke Behrendt
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, Unit of Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Institute for Psychology, University of Southern Denmark, Odense, Denmark
| | - Randi Bilberg
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, Unit of Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark ,Psychiatric University Hospital, University Function, Region of Southern Denmark Odense, Denmark
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands ,grid.416017.50000 0001 0835 8259Trimbos Institute – The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Marie Paldam Folker
- grid.10825.3e0000 0001 0728 0170Research Unit for Telepsychiatry and E-mental Health, Centre for Telepsychiatry in the Mental Health Services in the Region of Southern Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristine Tarp
- grid.10825.3e0000 0001 0728 0170Research Unit for Telepsychiatry and E-mental Health, Centre for Telepsychiatry in the Mental Health Services in the Region of Southern Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Anette Søgaard Nielsen
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, Unit of Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark ,Psychiatric University Hospital, University Function, Region of Southern Denmark Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, I BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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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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Shams F, Wong JSH, Nikoo M, Outadi A, Moazen-Zadeh E, Kamel MM, Song MJ, Jang KL, Krausz RM. Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review. J Med Internet Res 2021; 23:e20557. [PMID: 33475520 PMCID: PMC7861997 DOI: 10.2196/20557] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/10/2020] [Accepted: 12/05/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is a growing body of evidence regarding eHealth interventions that target substance use disorders. Development and funding decisions in this area have been challenging, due to a lack of understanding of what parts of an intervention work in which context. OBJECTIVE We conducted a realist review of the literature on electronic cognitive behavioral therapy (eCBT) programs for substance use with the goal of answering the following realist question: "How do different eCBT interventions for substance use interact with different contexts to produce certain outcomes?" METHODS A literature search of published and gray literature on eHealth programs targeting substance use was conducted. After data extraction, in order to conduct a feasible realist review in a timely manner, the scope had to be refined further and, ultimately, only included literature focusing on eCBT programs targeting substance use. We synthesized the available evidence from the literature into Context-Mechanism-Outcome configurations (CMOcs) in order to better understand when and how programs work. RESULTS A total of 54 papers reporting on 24 programs were reviewed. Our final results identified eight CMOcs from five unique programs that met criteria for relevance and rigor. CONCLUSIONS Five strategies that may be applied to future eCBT programs for substance use are discussed; these strategies may contribute to a better understanding of mechanisms and, ultimately, may help design more effective solutions in the future. Future research on eCBT programs should try to understand the mechanisms of program strategies and how they lead to outcomes in different contexts.
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Affiliation(s)
- Farhud Shams
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - James S H Wong
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ava Outadi
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Ehsan Moazen-Zadeh
- Addiction Institute of Mount Sinai, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Mostafa M Kamel
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, Tanta University, Tanta, Egypt
| | - Michael Jae Song
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry L Jang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Reinhard Michael Krausz
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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Meiksin R, Melendez-Torres GJ, Falconer J, Witzel TC, Weatherburn P, Bonell C. Theories of change for e-health interventions targeting HIV/STIs and sexual risk, substance use and mental ill health amongst men who have sex with men: systematic review and synthesis. Syst Rev 2021; 10:21. [PMID: 33423693 PMCID: PMC7798186 DOI: 10.1186/s13643-020-01523-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sexual risk, substance use, and mental ill health constitute a syndemic of co-occurring, mutually reinforcing epidemics amongst men who have sex with men (MSM). Developed since 1995, e-health interventions offer accessible, anonymous support and can be effective in addressing these outcomes, suggesting the potential value of developing e-health interventions that address these simultaneously amongst MSM. We conducted a systematic review of e-health interventions addressing one or more of these outcomes amongst MSM and in this paper describe the theories of change underpinning relevant interventions, what these offer and how they might complement each other. METHODS We identified eligible reports via expert requests, reference-checking and database and Google searches. Results were screened for reports published in 1995 or later; focused on MSM; reporting on e-health interventions providing ongoing support to prevent HIV/STIs, sexual risk behaviour, substance use, anxiety or depression; and describing intervention theories of change. Reviewers assessed report quality, extracted intervention and theory of change data, and developed a novel method of synthesis using diagrammatic representations of theories of change. RESULTS Thirty-three reports on 22 intervention theories of change were included, largely of low/medium-quality. Inductively grouping these theories according to their core constructs, we identified three distinct groupings of theorised pathways. In the largest, the 'cognitive/skills' grouping, interventions provide information and activities which are theorised to influence behaviour via motivation/intention and self-efficacy/perceived control. In the 'self-monitoring' grouping, interventions are theorised to trigger reflection, self-reward/critique and self-regulation. In the 'cognitive therapy' grouping, the theory of change is rooted in cognitive therapy techniques, aiming to reframe negative emotions to improve mental health. CONCLUSIONS The synthesised theories of change provide a framework for developing e-health interventions that might holistically address syndemic health problems amongst MSM. Improving reporting on theories of change in primary studies of e-health interventions would enable a better understanding of how they are intended to work and the evidence supporting this. The novel diagrammatic method of theory of change synthesis used here could be used for future reviews where interventions are driven by existing well-defined behaviour and behaviour change theories. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018110317.
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Affiliation(s)
- Rebecca Meiksin
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - G J Melendez-Torres
- South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2 LU, UK
| | - Jane Falconer
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - T Charles Witzel
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Peter Weatherburn
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Chris Bonell
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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43
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File D, Bőthe B, Kapitány-Fövény M, Demetrovics Z. Efficacy of a complex smartphone application for reducing hazardous alcohol consumption: Study protocol for a randomized controlled trial with analysis of in-app user behavior in relation to outcome. Int J Methods Psychiatr Res 2020; 29:1-10. [PMID: 32896955 PMCID: PMC7723194 DOI: 10.1002/mpr.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The efficacy of alcohol reduction applications is variable, and the underlying factors are largely unknown. The aim of this study is threefold: evaluate the relationship between user engagement and intervention efficacy, investigate the efficacy of the different functions applied, and investigate the efficacy of the intervention application compared to control groups. METHODS A randomized controlled trial will be conducted to determine the efficacy of a newly developed smartphone application compared to the controls in reducing alcohol consumption at a 30, 60, 90, 120, 150, and 180 days follow-up. Hazardous drinkers, aged 18 years or older, will be recruited through web articles and will be randomized (blinded to their allocation), to receive one of the two versions of the application (educational or control application) for 30 days, or will be allocated to a wait-list control group. Function usage times will be recorded on a single-user level to determine the association between application usage and efficacy. RESULTS Data collection will be completed by July 2020, and follow-up will be completed by January 2021. CONCLUSIONS The evaluation of intervention efficacy as a function of user behavior will hopefully contribute to the science of developing more efficient alcohol intervention applications in the future.
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Affiliation(s)
- Domonkos File
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Beáta Bőthe
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Département de Psychologie, Université de Montréal, Montreal, Canada
| | - Máté Kapitány-Fövény
- Department of Addiction, Semmelweis University Faculty of Health Sciences, Budapest, Hungary.,Drug Outpatient Centre, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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Smith KA, Bradbury K, Essery R, Pollet S, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Kelly J, Somerville J, Zhang J, Grey E, Western M, Ferrey AE, Krusche A, Stuart B, Mutrie N, Robinson S, Yao GL, Griffiths G, Robinson L, Rossor M, Gallacher J, Griffin S, Kendrick T, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. The Active Brains Digital Intervention to Reduce Cognitive Decline in Older Adults: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18929. [PMID: 33216010 PMCID: PMC7718093 DOI: 10.2196/18929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/04/2020] [Accepted: 08/16/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Increasing physical activity, improving diet, and performing brain training exercises are associated with reduced cognitive decline in older adults. OBJECTIVE In this paper, we describe a feasibility trial of the Active Brains intervention, a web-based digital intervention developed to support older adults to make these 3 healthy behavior changes associated with improved cognitive health. The Active Brains trial is a randomized feasibility trial that will test how accessible, acceptable, and feasible the Active Brains intervention is and the effectiveness of the study procedures that we intend to use in the larger, main trial. METHODS In the randomized controlled trial (RCT), we use a parallel design. We will be conducting the intervention with 2 populations recruited through GP practices (family practices) in England from 2018 to 2019: older adults with signs of cognitive decline and older adults without any cognitive decline. Trial participants were randomly allocated to 1 of 3 study groups: usual care, the Active Brains intervention, or the Active Brains website plus brief support from a trained coach (over the phone or by email). The main outcomes are performance on cognitive tasks, quality of life (using EuroQol-5D 5 level), Instrumental Activities of Daily Living, and diagnoses of dementia. Secondary outcomes (including depression, enablement, and health care costs) and process measures (including qualitative interviews with participants and supporters) will also be collected. The trial has been approved by the National Health Service Research Ethics Committee (reference 17/SC/0463). RESULTS Results will be published in peer-reviewed journals, presented at conferences, and shared at public engagement events. Data collection was completed in May 2020, and the results will be reported in 2021. CONCLUSIONS The findings of this study will help us to identify and make important changes to the website, the support received, or the study procedures before we progress to our main randomized phase III trial. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number 23758980; http://www.isrctn.com/ISRCTN23758980. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18929.
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Affiliation(s)
- Kirsten Ailsa Smith
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Katherine Bradbury
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Rosie Essery
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Sebastien Pollet
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Fiona Mowbray
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Joanna Slodkowska-Barabasz
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - James Denison-Day
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Victoria Hayter
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Jo Kelly
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jane Somerville
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Elisabeth Grey
- Department for Health, University of Bath, Bath, United Kingdom
| | - Max Western
- Department for Health, University of Bath, Bath, United Kingdom
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Adele Krusche
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Beth Stuart
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Sian Robinson
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Louise Robinson
- Institute of Population Health Sciences, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Martin Rossor
- Dementia Research Centre, University College London, London, United Kingdom
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Tony Kendrick
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
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Elling DL, Wilson M, Carlbring P, Wennberg P, Sundqvist K. Effectiveness of Combining Organizational Alcohol Policy and Skills Training for Managers to Reduce Hazardous Alcohol Consumption in Swedish Workplaces: Study Protocol for a Cluster Randomized Study. JMIR Res Protoc 2020; 9:e17145. [PMID: 32784185 PMCID: PMC7450387 DOI: 10.2196/17145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/12/2020] [Accepted: 06/02/2020] [Indexed: 01/19/2023] Open
Abstract
Background High alcohol consumption poses risks to individual health and society. Previous alcohol interventions have mainly focused on high-risk consumers or young adults in school-based settings. Since the majority of the adult population is in the workforce, the workplace can be considered a favorable arena for implementing interventions. Objective This protocol describes a project aimed at increasing knowledge of the effectiveness of combining the implementation of an organizational alcohol policy with skills training for managers as a workplace alcohol prevention program, by evaluating the intervention and exploring managers’ perceptions of the intervention. Methods Organizations with at least 100 employees were invited to take part in the project. A total of 11 organizations (744 managers and 11,761 employees) were included in the project. Data are collected through self-administered online surveys at baseline, 12 months, and 24 months. The primary outcome is managers’ inclination to initiate an early alcohol intervention (eg, by initiating a dialogue) when concern regarding employees’ hazardous alcohol consumption arises. The secondary outcomes of interest are managers’ and employees’ organizational alcohol policy knowledge and changes in alcohol consumption, as measured using the Alcohol Use Disorder Identification Test (AUDIT) score. A linear mixed-model framework will be used to model variability on different levels. Primary analysis will follow an intention-to-treat approach. Additionally, managers’ responses from semistructured interviews will be analyzed using thematic analysis to explore managers’ experiences regarding the prevention program. Results This study is ongoing. The overall study start was on January 2018, and the study is planned to end in December 2020. Baseline and 12-month follow-up measurements have been collected. Conclusions This project is designed to evaluate the effectiveness of an alcohol prevention program regarding higher inclination to initiate early alcohol interventions after policy implementation and skills training among managers, compared to the usual practices in the workplace. The results from this study can contribute to increased knowledge about alcohol interventions and future prevention programs in the workplace. Trial Registration ISRCTN17250048; http://www.isrctn.com/ISRCTN17250048 International Registered Report Identifier (IRRID) DERR1-10.2196/17145
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Affiliation(s)
| | - Martina Wilson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Peter Wennberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Sundqvist
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Department of Psychology, Stockholm University, Stockholm, Sweden
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Ilagan GS, Iliakis EA, Wilks CR, Vahia IV, Choi-Kain LW. Smartphone applications targeting borderline personality disorder symptoms: a systematic review and meta-analysis. Borderline Personal Disord Emot Dysregul 2020; 7:12. [PMID: 32549987 PMCID: PMC7296633 DOI: 10.1186/s40479-020-00127-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Smartphone applications could improve symptoms of borderline personality disorder (BPD) in a scalable and resource-efficient manner in the context limited access to specialized care. OBJECTIVE This systematic review and meta-analysis aims to evaluate the effectiveness of applications designed as treatment interventions for adults with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD. DATA SOURCES Search terms for BPD symptoms, smartphone applications, and treatment interventions were combined on PubMed, MEDLINE, and PsycINFO from database inception to December 2019. STUDY SELECTION Controlled and uncontrolled studies of smartphone interventions for adult participants with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD were included. STUDY APPRAISAL AND SYNTHESIS METHODS Comprehensive Meta-Analysis v3 was used to compute between-groups effect sizes in controlled designs. The primary outcome was BPD-related symptoms such as anger, suicidality, and impulsivity; and the secondary outcome was general psychopathology. An average dropout rate across interventions was computed. Study quality, target audiences, therapeutic approach and targets, effectiveness, intended use, usability metrics, availability on market, and downloads were assessed qualitatively from the papers and through internet search. RESULTS Twelve studies of 10 applications were included, reporting data from 408 participants. Between-groups meta-analyses of RCTs revealed no significant effect of smartphone applications above and beyond in-person treatments or a waitlist on BPD symptoms (Hedges' g = - 0.066, 95% CI [-.257, .125]), nor on general psychopathology (Hedges' g = 0.305, 95% CI [- 0.14, 0.75]). Across the 12 trials, dropout rates ranged from 0 to 56.7% (M = 22.5, 95% CI [0.15, 0.46]). A majority of interventions studied targeted emotion dysregulation and behavioral dyscontrol symptoms. Half of the applications are commercially available. CONCLUSIONS The effects of smartphone interventions on symptoms of BPD are unclear and there is currently a lack of evidence for their effectiveness. More research is needed to build on these preliminary findings in BPD to investigate both positive and adverse effects of smartphone applications and identify the role these technologies may provide in expanding mental healthcare resources.
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Affiliation(s)
| | | | | | - Ipsit V. Vahia
- McLean Hospital, 115 Mill St, Belmont, MA 02478 USA
- Harvard Medical School, Boston, USA
| | - Lois W. Choi-Kain
- McLean Hospital, 115 Mill St, Belmont, MA 02478 USA
- Harvard Medical School, Boston, USA
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Yonkers KA, Dailey JI, Gilstad-Hayden K, Ondersma SJ, Forray A, Olmstead TA, Martino S. Abstinence outcomes among women in reproductive health centers administered clinician or electronic brief interventions. J Subst Abuse Treat 2020; 113:107995. [PMID: 32359666 PMCID: PMC8372233 DOI: 10.1016/j.jsat.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Treatment of substance use in women seeking reproductive healthcare is crucial for the health of both women and their offspring. Although abstinence from all substance use during pregnancy is optimal, it is difficult to achieve. This secondary analysis reports abstinence outcomes from a randomized clinical trial of screening, brief intervention, and referral to treatment (SBIRT) for substance use among women seeking reproductive healthcare services. Women who screened positive for substance use were randomly assigned to either clinician-administered SBIRT, an electronically-administered brief intervention (e-SBIRT), or an enhanced usual care condition. At a 6-month follow-up assessment, compared to enhanced usual care, the clinician-administered SBIRT increased 1-month point prevalence of abstinence from the primary substance by 7.7%, and e-SBIRT increased abstinence by 12.8%. Both brief interventions were more useful than enhanced usual care and could increase substance use abstinence rates among women in reproductive healthcare clinics. The electronic brief intervention is particularly attractive given that it appears as efficacious as, but requires fewer resources than, clinician-delivered brief interventions.
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Affiliation(s)
- Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06510, USA.
| | - Jason I Dailey
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Steven J Ondersma
- Wayne State University, Merrill Palmer Skillman Institute, 71 E. Ferry Ave, Detroit, MI 48202, USA.
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA.
| | - Todd A Olmstead
- University of Texas at Austin, PO Box Y, Austin, TX 78713, USA.
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Kvillemo P, Strandberg AK, Gripenberg J, Berman AH, Skoglund C, Elgán TH. Effects of an automated digital brief prevention intervention targeting adolescents and young adults with risky alcohol and other substance use: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e034894. [PMID: 32404390 PMCID: PMC7228518 DOI: 10.1136/bmjopen-2019-034894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Adolescence and young adulthood is a period in life when individuals may be especially vulnerable to harmful substance use. Several critical developmental processes are occurring in the brain, and substance use poses both short-term and long-term risks with regard to mental health and social development. From a public health perspective, it is important to prevent or delay substance use to reduce individual risk and societal costs. Given the scarcity of effective interventions targeting substance use among adolescents and young adults, cost-effective and easily disseminated interventions are warranted. The current study will test the effectiveness of a fully automated digital brief intervention aimed at reducing alcohol and other substance use in adolescents and young adults aged 15 to 25 years. METHODS AND ANALYSIS A two-arm, double-blind, randomised controlled trial design is applied to assess the effectiveness of the intervention. Baseline assessment, as well as 3-month and 6-month follow-up, will be carried out. The aim is to include 800 participants with risky substance use based on the screening tool CRAFFT (Car,Relax, Alone, Forget, Friends, Trouble). Recruitment, informed consent, randomisation, intervention and follow-up will be implemented online. The primary outcome is reduction in alcohol use, measured by Alcohol Use Disorders Identification Test total score. Secondary outcomes concern binge drinking, frequency of alcohol consumption, amount of alcohol consumed a typical day when alcohol is consumed, average daily drinks per typical week, other substance use, mental health, sexual risk behaviours and perceived peer pressure. Moreover, the study involves analyses of potential moderators including perfectionism, openness to parents, help-seeking and background variables. ETHICS AND DISSEMINATION The study was approved by the Swedish Ethical Review Authority (no. 2019-03249). The trial is expected to expand the knowledge on digital preventive interventions for substance using adolescents and young adults. Results will be disseminated in research journals, at conferences and via the media. TRIAL REGISTRATION NUMBER 24 September 2019, ISRCTN91048246; Pre-results.
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Affiliation(s)
- Pia Kvillemo
- STAD (Stockholm Prevents Alcohol and Drug Problems), Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anna K Strandberg
- STAD (Stockholm Prevents Alcohol and Drug Problems), Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Johanna Gripenberg
- STAD (Stockholm Prevents Alcohol and Drug Problems), Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Charlotte Skoglund
- STAD (Stockholm Prevents Alcohol and Drug Problems), Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Tobias H Elgán
- STAD (Stockholm Prevents Alcohol and Drug Problems), Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Lindner P, Johansson M, Gajecki M, Berman AH. Using alcohol consumption diary data from an internet intervention for outcome and predictive modeling: a validation and machine learning study. BMC Med Res Methodol 2020; 20:111. [PMID: 32393245 PMCID: PMC7212621 DOI: 10.1186/s12874-020-00995-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 04/27/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent and presents a large treatment gap. Self-help internet interventions are an attractive approach to lowering thresholds for seeking help and disseminating evidence-based programs at scale. Internet interventions for AUD however suffer from high attrition and since continuous outcome measurements are uncommon, little is known about trajectories and processes. The current study investigates whether data from a non-mandatory alcohol consumption diary, common in internet interventions for AUD, approximates drinks reported at follow-up, and whether data from the first half of the intervention predict treatment success. METHODS N = 607 participants enrolled in a trial of online self-help for AUD, made an entry in the non-mandatory consumption diary (total of 9117 entries), and completed the follow-up assessment. Using multiple regression and a subset of calendar data overlapping with the follow-up, scaling factors were derived to account for missing entries per participant and week. Generalized estimating equations with an inverse time predictor were then used to calculate point-estimates of drinks per week at follow-up, the confidence intervals of which were compared to that from the measurement at follow-up. Next, calendar data form the first half of the intervention were retained and summary functions used to create 18 predictors for random forest machine learning models, the classification accuracies of which were ultimately estimated using nested cross-validation. RESULTS While the raw calendar data substantially underestimated drinks reported at follow-up, the confidence interval of the trajectory-derived point-estimate from the adjusted data overlapped with the confidence interval of drinks reported at follow-up. Machine learning models achieved prediction accuracies of 64% (predicting non-hazardous drinking) and 48% (predicting AUD severity decrease), in both cases with higher sensitivity than specificity. CONCLUSIONS Data from a non-mandatory alcohol consumption diary, adjusted for missing entries, approximates follow-up data at a group level, suggesting that such data can be used to reveal trajectories and processes during treatment and possibly be used to impute missing follow-up data. At an individual level, however, calendar data from the first half of the intervention did not have high predictive accuracy, presumable due to a high rate of missing data and unclear missing mechanisms.
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Affiliation(s)
- Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
- Center for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
- Department of Psychology, Stockholm University, Stockholm, Sweden.
| | - Magnus Johansson
- Center for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Gajecki
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Center for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Stice E, Rohde P, Shaw H, Gau JM. Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: Effectiveness of these delivery modalities through 4-year follow-up. J Consult Clin Psychol 2020; 88:481-494. [PMID: 32091226 PMCID: PMC7810349 DOI: 10.1037/ccp0000493] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Independent trials have found that the dissonance-based Body Project eating disorder prevention program is efficacious and effective; the present trial provided the first test of whether delivery could be task-shifted from clinician-delivery to peer educator-delivery or Internet-delivery without loss of effectiveness through 4-year follow-up. METHOD Young women at high-risk for eating disorders because of body image concerns (N = 680, Mage = 22.2) recruited at 3 colleges were randomized to clinician-led Body Project groups, peer-led Body Project groups, the Internet-based eBody Project, or educational video control. RESULTS Participants in clinician- and peer-led Body Project groups and the eBody Project generally showed larger reductions in risk factors and eating disorder symptoms versus controls through 1- and 2-year follow-up (d = .16-.59), with some effects persisting through 3- and 4-year follow-ups (d = .28-.58). Peer-led Body Project participants showed greater reductions in some risk factors than eBody Project participants (d = .18-.19), but no other contrasts between Body Project interventions differed. Eating disorder onset over 4-year follow-up was significantly lower for peer-led Body Project participants (8.1%) than control participants (17.6%) and clinician-led Body Project participants (19.3%), and marginally lower than eBody Project participants (15.5%). CONCLUSIONS The evidence that all three Body Project interventions outperformed educational video controls, peer-led groups outperformed the Internet-based intervention, and peer-led groups showed lower eating disorder onset over 4-year follow-up than the other conditions are novel. Results imply that it might be optimal to task-shift Body Project delivery to peer-leaders to address implementation barriers associated with clinician-led delivery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Eric Stice
- Department of Psychiatry and Behavioral Sciences
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