Feasibility and Acceptability of a Novel Online Program for Mental Health Carers

Objective

To evaluate the feasibility and acceptability of a new online program (Minds Together ) for carers of a person with depressive or anxiety symptoms.

Methods

Using a two-arm randomised controlled trial design, 108 carers of a person with depressive or anxiety symptomology aged 16 years or over (89% female; mean age 50 years) received immediate or delayed access to the Minds Together program. Feasibility was measured using program activation and survey completion rates. Acceptability was measured using a project-specific satisfaction scale, semi-structured interviews, and program completion metadata. The study used intention-to-treat (ITT) analysis for participant-reported outcomes (carer burden, coping self-efficacy) across groups.

Results

Feasibility and acceptability thresholds were consistent with similar studies: 59% activated their program account, 47% met the program completion threshold, and almost all reported satisfaction with the program. The ITT indicated trends in increased coping self-efficacy and reduced carer burden for the Intervention group, compared to the Waitlist control.

Conclusions

The Minds Together program is a feasible and acceptable program for carers supporting a person with depressive or anxiety symptomology. Results support exploration of the program's efficacy in a full-scale RCT.

Screening, assessment and diagnosis in the eating disorders: findings from a rapid review

BACKGROUND

Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems.

METHODS

This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for studies published between 2009 and mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review.

RESULTS

Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males.

CONCLUSIONS

A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many. Limited screening in healthcare settings and low rates of eating disorder training in the healthcare professions are just some of the barriers to help-seeking which may contribute to delayed intervention and diagnosis in the eating disorders. This has significant impacts, prolonging treatment when it is finally received, and increasing healthcare costs for both the individual and the healthcare system. The current review is part of a larger Rapid Review series conducted to inform the development of Australia's National Eating Disorders Research and Translation Strategy 2021-2031. A Rapid Review is designed to comprehensively summarise a body of literature in a short timeframe, often to guide policy-making and address urgent health concerns. The Rapid Review synthesises the current evidence-base and identifies gaps in eating disorder research and care, in order to guide decision making and address urgent health concerns. This paper gives a critical overview of the scientific literature relating to the current state of screening, assessment, and diagnosis of eating disorders within Western healthcare systems that may inform health policy and research in an Australian context. It covers screening initiatives in both general and high-risk populations; personal, clinician and healthcare system challenges relating to help-seeking; and obstacles to accurate and timely clinical diagnosis across the eating disorders.

Cracks in the ice: a digital health initiative disseminating evidence-based information about ‘ice’

Background

Crystal methamphetamine (‘ice') causes significant societal harm and attracts a high level of concern in Australia. Cracks in the Ice (CITI: cracksintheice.org.au) is a digital public health initiative that was developed as part of a national response to concerns about ice. CITI is the first centralised national online portal for evidence-based information and resources about ice in Australia. It provides targeted information and resources for health workers, people who use ice, their family and friends, community groups and schools. CITI was developed collaboratively with input from drug and alcohol experts and over 500 Australian community members, including people with lived experience. A national online survey was conducted to evaluate whether CITI is meeting the needs of the Australian community.

Methods

Eligible participants were Australian residents aged 18 years and over, and were recruited via the CITI website, email direct marketing, and social media. The survey assessed participants' perceptions of CITI (e.g., usability, navigation, utility) and their knowledge and attitudes about ice.

Results

2110 participants completed the survey, including people who use ice, affected family members, health workers, and general community members. Participants' response to CITI was overall positive and their knowledge of ice was generally good, but many held negative or stigmatising attitudes towards ice and people who use it.

Conclusions

Digital public health initiatives stand to overcome structural, geographical, and attitudinal barriers to alcohol and other drug (AOD) prevention efforts. CITI ensures evidence-based information about the drug ice is readily available across all of Australia. Community evaluations have shown that CITI is meeting the needs of the Australian community.

Key messages

Crystal methamphetamine (‘ice’) attracts a high level of concern in Australia. CITI is the first centralised national online portal for evidence-based information and resources about ice. Digital health initiatives stand to overcome structural, geographical, and attitudinal barriers to AOD prevention. Community evaluations ensure these initiatives meet the needs of their end-users.

Use of Smartphones, Computers and Social Media Among People with SMI: Opportunity for Intervention

Mobile technology provides a unique opportunity to expand access to evidence-based interventions. The objective of this study was to provide an update regarding use of technology in people with serious mental illness (SMI). In 2017, 403 people in treatment for SMI were surveyed. Technology use was common: 65.8% used a smartphone, 53.6% used the Internet on a computer or tablet in the past 6 months, and over two thirds (67.9%) used social media. Rates of technology and Facebook use were similar to rates among low-income Americans. Approximately three quarters were willing to use a device to access interventions for stress, health and mental health. Younger adults were more likely to use most forms of technology and social media compared to older adults, but willingness to try technology-delivered interventions did not vary by age. This survey supports the rationale for ongoing development and testing of digital interventions for people with SMI.

Supporting men through their transition to fatherhood with messages delivered to their smartphones: a feasibility study of SMS4dads

Background

The transition to parenthood can be a challenging time, in which both mothers and fathers experience increased risk of distress and depression. Mothers are more likely than fathers to engage with services and have their mental health monitored and attended to during the perinatal period. The present study aimed to explore whether smartphone technology could be used to address fathers’ needs across their transition to fatherhood.

Methods

A corpus of messages, including linked information and mood tracking software, was designed to support and enhance paternal relationships with their babies, their partners and themselves across the perinatal period. Messages were sent to project participants (N = 520) from 12-weeks’ gestation to 24-weeks after birth.

Results

Of those fathers enrolled (N = 520), 21.5% scored >13 on K6 and completion rate (85%) was similar between these and other fathers. Most fathers (63.1%) clicked at least one link and responses were received for 20.5% of mood tracker questions. The probability of reporting worse mood scores decreased over time. Fathers completing post study surveys (N = 101) reported that messages helped them in their experience of becoming a new dad (92.8%), as well as helping them develop a strong relationship with their new child (54.9%), and in their relationship with their partner (79%).

Conclusions

The present study has demonstrated that it is both feasible and acceptable to support new fathers with SMS4dads, a relationship-focused messaging system designed to be delivered to smartphones across fathers’ transition to parenthood.