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Nolan H, O'Donoghue B, Simmons M, Zbukvic I, Ratcliff S, Milton A, Hughes E, Thompson A, Brown E. The development of a novel sexual health promotion intervention for young people with mental ill-health: the PROSPEct project. BMC Health Serv Res 2024; 24:262. [PMID: 38429748 PMCID: PMC10905889 DOI: 10.1186/s12913-024-10734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 02/15/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Young people with mental ill-health experience higher rates of high-risk sexual behaviour, have poorer sexual health outcomes, and lower satisfaction with their sexual wellbeing compared to their peers. Ensuring good sexual health in this cohort is a public health concern, but best practice intervention in the area remains under-researched. This study aimed to co-design a novel intervention to address the sexual health needs of young people with mental ill-health to test its effectiveness in a future trial undertaken in youth mental health services in Melbourne, Australia. METHODS We followed the 2022 Medical Research Council (MRC) guidelines for developing and evaluating complex interventions. This involved synthesising evidence from the 'top down' (published evidence) and 'bottom up' (stakeholder views). We combined systematic review findings with data elicited from qualitative interviews and focus groups with young people, carers, and clinicians and identified critical cultural issues to inform the development of our intervention. RESULTS Existing evidence in the field of sexual health in youth mental health was limited but suggested the need to address sexual wellbeing as a concept broader than an absence of negative health outcomes. The Information-Motivation-Belief (IMB) model was chosen as the theoretical Framework on which to base the intervention. Interviews/focus groups were conducted with 29 stakeholders (18 clinicians, three carers, and eight young people). Synthesis of the evidence gathered resulted in the co-design of a novel intervention consisting of an initial consultation and four 60-90-minute sessions delivered individually by a young 'sex-positive' clinician with additional training in sexual health. Barriers and supports to intervention success were also identified. CONCLUSIONS Using the MRC Framework has guided the co-design of a potentially promising intervention that addresses the sexual health needs of young people with mental ill-health. The next step is to test the intervention in a one-arm feasibility trial.
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Affiliation(s)
- Hayley Nolan
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- University College Dublin, Dublin, Ireland
- Department of Psychiatry, Royal College of Surgeons, Ireland, Ireland
| | - Magenta Simmons
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Isabel Zbukvic
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Sophia Ratcliff
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
| | - Alyssa Milton
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Elizabeth Hughes
- Research Centre for Applied Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Andrew Thompson
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Ellie Brown
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia.
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.
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Bryce S, Cheng N, Dalton A, Ojinnaka A, Stainton A, Zbukvic I, Ratheesh A, O'Halloran C, Uren J, Gates J, Daglas-Georgiou R, Wood SJ, Allott K. Cognitive health treatment priorities and preferences among young people with mental illness: The your mind, your choice survey. Early Interv Psychiatry 2024; 18:94-101. [PMID: 37198726 DOI: 10.1111/eip.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
AIM Cognitive impairments negatively impact the everyday functioning of young people with mental illness. However, no previous study has asked young people (1) how much of a priority cognitive functioning is within mental health treatment, and (2) what types of cognition-focused treatments are most appealing. The current study aimed to address these questions. METHODS Your Mind, Your Choice was a survey-based study involving an Australian sample of young people who were receiving mental health treatment. The survey asked participants to (1) provide demographic and mental health history, (2) rate the importance of 20 recovery domains, including cognition, when receiving mental health treatment, (3) share their experiences of cognitive functioning, and (4) rate their likelihood of trying 14 different behavioural, biochemical, and physical treatments that may address cognitive functioning. RESULTS Two-hundred and forty-three participants (Mage = 20.07, SD = 3.25, range = 15-25, 74% female) completed the survey. Participants reported that addressing cognitive functioning in mental health care was very important (M = 76.33, SD = 20.7, rated on a scale from 0 = not important to 100 = extremely important), ranking cognition among their top six treatment needs. Seventy percent of participants reported experiencing cognitive difficulties, but less than one-third had received treatment for these difficulties. Compensatory training, sleep interventions and psychoeducation were ranked as treatments that participants were most likely to try to support their cognitive functioning. CONCLUSIONS Young people with mental ill-health commonly experience cognitive difficulties and would like this to be a focus of treatment; however, this need is often unmet and should be a focus of research and implementation.
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Affiliation(s)
- Shayden Bryce
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
- Alfred Mental and Addiction Health, Melbourne, Australia
| | - Nicholas Cheng
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | | | - Alexandra Stainton
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Isabel Zbukvic
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | - Jacquie Uren
- Alfred Mental and Addiction Health, Melbourne, Australia
- Headspace Early Psychosis, Alfred Health, Melbourne, Australia
| | | | - Rothanthi Daglas-Georgiou
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Kelly Allott
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
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Stainton A, Cheng N, Bryce S, Dalton A, Ojinnaka A, Zbukvic I, Ratheesh A, O'Halloran C, Uren J, Gates J, Daglas-Georgiou R, Wood SJ, Allott K. Cognition is a treatment priority for young people with psychosis: Findings from the Your Mind, Your Choice survey. Schizophr Res 2023; 262:30-31. [PMID: 37922840 DOI: 10.1016/j.schres.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/13/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Alexandra Stainton
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.
| | - Nicholas Cheng
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Shayden Bryce
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Alfred Mental and Addiction Health, Melbourne, Australia
| | | | | | - Isabel Zbukvic
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | - Jacquie Uren
- Alfred Mental and Addiction Health, Melbourne, Australia; Headspace Early Psychosis, Alfred Health, Melbourne, Australia
| | | | - Rothanthi Daglas-Georgiou
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; School of Psychology, University of Birmingham, UK
| | - Kelly Allott
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
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Rheinberger D, Baffsky R, McGillivray L, Zbukvic I, Dadich A, Larsen ME, Lin PI, Gan DZQ, Kaplun C, Wilcox HC, Eapen V, Middleton PM, Torok M. Examining the Feasibility of Implementing Digital Mental Health Innovations Into Hospitals to Support Youth in Suicide Crisis: Interview Study With Young People and Health Professionals. JMIR Form Res 2023; 7:e51398. [PMID: 37971790 PMCID: PMC10690533 DOI: 10.2196/51398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Hospitals are insufficiently resourced to appropriately support young people who present with suicidal crises. Digital mental health innovations have the potential to provide cost-effective models of care to address this service gap and improve care experiences for young people. However, little is currently known about whether digital innovations are feasible to integrate into complex hospital settings or how they should be introduced for sustainability. OBJECTIVE This qualitative study explored the potential benefits, barriers, and collective action required for integrating digital therapeutics for the management of suicidal distress in youth into routine hospital practice. Addressing these knowledge gaps is a critical first step in designing digital innovations and implementation strategies that enable uptake and integration. METHODS We conducted a series of semistructured interviews with young people who had presented to an Australian hospital for a suicide crisis in the previous 12 months and hospital staff who interacted with these young people. Participants were recruited from the community nationally via social media advertisements on the web. Interviews were conducted individually, and participants were reimbursed for their time. Using the Normalization Process Theory framework, we developed an interview guide to clarify the processes and conditions that influence whether and how an innovation becomes part of routine practice in complex health systems. RESULTS Analysis of 29 interviews (n=17, 59% young people and n=12, 41% hospital staff) yielded 4 themes that were mapped onto 3 Normalization Process Theory constructs related to coherence building, cognitive participation, and collective action. Overall, digital innovations were seen as a beneficial complement to but not a substitute for in-person clinical services. The timing of delivery was important, with the agreement that digital therapeutics could be provided to patients while they were waiting to be assessed or shortly before discharge. Staff training to increase digital literacy was considered key to implementation, but there were mixed views on the level of staff assistance needed to support young people in engaging with digital innovations. Improving access to technological devices and internet connectivity, increasing staff motivation to facilitate the use of the digital therapeutic, and allowing patients autonomy over the use of the digital therapeutic were identified as other factors critical to integration. CONCLUSIONS Integrating digital innovations into current models of patient care for young people presenting to hospital in acute suicide crises is challenging because of several existing resource, logistical, and technical barriers. Scoping the appropriateness of new innovations with relevant key stakeholders as early as possible in the development process should be prioritized as the best opportunity to preemptively identify and address barriers to implementation.
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Affiliation(s)
- Demee Rheinberger
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rachel Baffsky
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Isabel Zbukvic
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Parramatta, NSW, Australia
| | - Mark Erik Larsen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Ping-I Lin
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- Mental Health Research Unit, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Academic Unit of Infant Child and Adolescent Services (AUCS), South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Daniel Z Q Gan
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Catherine Kaplun
- Transforming Early Education and Child Health (TeEACH) Research Centre, Western Sydney University, Sydney, NSW, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Holly C Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Valsamma Eapen
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Infant Child and Adolescent Services (AUCS), South Western Sydney Local Health District, Liverpool, NSW, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Paul M Middleton
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Emergency Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Emergency Research Institute (SWERI), Ingham Institute, Liverpool, NSW, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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Zbukvic I, Bryce S, Moullin J, Allott K. The use of implementation science to close the research-to-treatment gap for cognitive impairment in psychosis. Aust N Z J Psychiatry 2023; 57:1308-1315. [PMID: 36964703 PMCID: PMC10517591 DOI: 10.1177/00048674231160987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
For people living with psychosis, cognitive impairment is common and can have significant impacts for functional recovery, impacting engagement with treatment and quality of life more broadly. There is now strong evidence for the effectiveness of cognition-focused treatments, such as cognitive remediation to improve clinical and functional outcomes for people with psychosis. However, engagement with treatment has been a long-standing issue in mental health care, including for people with psychosis, who often experience difficulties with motivation. While research on clinical effectiveness of cognition-focused treatment is growing, to date there has been little research focused on the implementation of such treatments and it is not clear how best to support uptake and engagement across diverse mental health settings. Implementation science is the study of methods and strategies to promote the adoption, application, and maintenance of evidence-based practices in routine care. To integrate cognition-focused treatments into routine practice, and improve engagement with treatment and the quality and effectiveness of care for people with psychosis, researchers need to embrace implementation science and research. This paper provides a succinct overview of the field of implementation science, current evidence for implementation of cognition-focused treatments for psychosis and practical guidance for using implementation science in clinical research. The future of psychosis research includes multidisciplinary teams of clinical researchers and implementation scientists, working together with providers and consumers to build the evidence that can improve the implementation of cognition-focused treatments.
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Affiliation(s)
- Isabel Zbukvic
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shayden Bryce
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Joanna Moullin
- enAble Institute, Curtin University, Perth, WA, Australia
| | - Kelly Allott
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
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Beames JR, Werner-Seidler A, Hodgins M, Brown L, Fujimoto H, Bartholomew A, Maston K, Huckvale K, Zbukvic I, Torok M, Christensen H, Batterham PJ, Calear AL, Lingam R, Boydell KM. Implementing a Digital Depression Prevention Program in Australian Secondary Schools: Cross-Sectional Qualitative Study. JMIR Pediatr Parent 2023; 6:e42349. [PMID: 37307051 DOI: 10.2196/42349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/23/2023] [Accepted: 04/18/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Depression is common during adolescence and is associated with adverse educational, employment, and health outcomes in later life. Digital programs are increasingly being implemented in schools to improve and protect adolescent mental health. Although digital depression prevention programs can be effective, there is limited knowledge about how contextual factors influence real-world delivery at scale in schools. OBJECTIVE The purpose of this study was to examine the contextual factors that influence the implementation of the Future Proofing Program (FPP) from the perspectives of school staff. The FPP is a 2-arm hybrid type 1 effectiveness-implementation trial evaluating whether depression can be prevented at scale in schools, using an evidence-based smartphone app delivered universally to year 8 students (13-14 years of age). METHODS Qualitative interviews were conducted with 23 staff from 20 schools in New South Wales, Australia, who assisted with the implementation of the FPP. The interviews were guided by our theory-driven logic model. Reflexive thematic analysis, using both deductive and inductive coding, was used to analyze responses. RESULTS Staff perceived the FPP as a novel ("innovative approach") and appropriate way to address an unmet need within schools ("right place at the right time"). Active leadership and counselor involvement were critical for planning and engaging; teamwork, communication, and staff capacity were critical for execution ("ways of working within schools"). Low student engagement and staffing availability were identified as barriers for future adoption and implementation by schools ("reflecting on past experiences"). CONCLUSIONS Four superordinate themes pertaining to the program, implementation processes, and implementation barriers were identified from qualitative responses by school staff. On the basis of our findings, we proposed a select set of recommendations for future implementation of digital prevention programs delivered at scale in schools. These recommendations were designed to facilitate an organizational change and help staff to implement digital mental health programs within their schools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-042133.
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Affiliation(s)
- Joanne R Beames
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Michael Hodgins
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Lyndsay Brown
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Hiroko Fujimoto
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Kate Maston
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Kit Huckvale
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
| | - Isabel Zbukvic
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
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Ramadan R, Randell A, Lavoie S, Gao CX, Manrique PC, Anderson R, McDowell C, Zbukvic I. Empirical evidence for climate concerns, negative emotions and climate-related mental ill-health in young people: A scoping review. Early Interv Psychiatry 2023. [PMID: 36641809 DOI: 10.1111/eip.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 10/18/2022] [Accepted: 01/01/2023] [Indexed: 01/16/2023]
Abstract
BACKGROUND Climate change represents a serious threat to human health, including mental health, due to both the traumatizing effects of extreme climate events and the psychological effect of worry about climate change. OBJECTIVES This scoping review aims to search the literature for original research investigating mental health and climate-related negative emotions in young people. Findings will help to understand the current landscape, gaps in the literature, and provide recommendations for future youth mental health research and practice. METHODS A scoping review of the literature examining negative emotions associated with climate change in young people was undertaken. Studies published prior to March 2022 were included if they examined mental ill-health (e.g., symptoms of depression or anxiety) or negative emotions (e.g., distress, worry, concern) associated with the threat of climate change. RESULTS Of 3939 articles screened, 26 met the inclusion criteria. Together, studies show that young people are worried about climate change. Negative emotions about climate change were correlated with symptoms of mental ill-health. Studies also explored coping strategies young people use to manage their distress caused by climate change. DISCUSSION The limited literature in this area indicates a key gap in youth mental health research. While available evidence suggests that young people are concerned about climate change, more research is needed on the relationship between climate-related negative emotions and mental ill-health. Clinicians should assess for and address climate-related negative emotions in young people. Mental health leaders are urged to advocate for actions to mitigate the mental health impact of climate change.
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Affiliation(s)
- Reem Ramadan
- Orygen, Parkville, Victoria, Australia.,Orygen, North Western Mental Health, Melbourne Health, Parkville, Victoria, Australia
| | - Alicia Randell
- Orygen, Parkville, Victoria, Australia.,Headspace National Youth Mental Health Foundation, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzie Lavoie
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Caroline X Gao
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paula Cruz Manrique
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Rebekah Anderson
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Caitlin McDowell
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Isabel Zbukvic
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Zbukvic I, Nicholas J, Hamilton C, Cruz-Manrique P, Crlenjak C, Purcell R. Using Implementation Science to Inform Workforce and Service Development in Youth Mental Health: An Australian Case Study. Glob Implement Res Appl 2022; 2:321-331. [PMID: 36196065 PMCID: PMC9521882 DOI: 10.1007/s43477-022-00058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/08/2022] [Indexed: 10/28/2022]
Abstract
AbstractGlobally, mental illness and substance use disorders are the leading cause of disability and disease burden for young people. Orygen is an Australian youth mental health organisation with a mission to reduce the impact of mental ill health on young people, families and society, through research, clinical services, advocacy, and the design and delivery of youth mental health workforce and service development initiatives. Orygen is one of only a few known research and clinical centres with a dedicated knowledge translation division, which concentrates on growing the capacity of the systems, services, and professionals who support young people experiencing mental ill health. This paper provides a case study of the workforce development team within the Orygen knowledge translation, outlining how implementation science informs their work and how the division has adapted its model in the face of COVID-19. Since 2017, the team has delivered training to more than 4000 youth mental health workers across Australia, on the topics of trauma, psychosis, mood and anxiety disorders, brief interventions, cognition and other areas of youth mental health. The COVID-19 pandemic generated abrupt and dramatic changes to the delivery of workforce and service development initiatives in Australia due to significant restrictions to travel and in-person events. It also placed major delivery demands on youth mental health services. This paper outlines how the team at Orygen adapted their approach to youth mental health workforce development in response to COVID-19, offering reflections and future directions for implementation science that can support flexible models of support in a changing system.
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Bell I, Pot-Kolder RM, Wood SJ, Nelson B, Acevedo N, Stainton A, Nicol K, Kean J, Bryce S, Bartholomeusz CF, Watson A, Schwartz O, Daglas-Georgiou R, Walton CC, Martin D, Simmons M, Zbukvic I, Thompson A, Nicholas J, Alvarez-Jimenez M, Allott K. Digital technology for addressing cognitive impairment in recent-onset psychosis: A perspective. Schizophr Res Cogn 2022; 28:100247. [PMID: 35281550 PMCID: PMC8914197 DOI: 10.1016/j.scog.2022.100247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 02/06/2023]
Abstract
Cognitive impairments in psychosis negatively impact functional recovery and quality of life. Existing interventions for improving cognitive impairment in recent-onset psychosis show inconsistent treatment efficacy, small effects, suboptimal engagement and limited generalizability to daily life functioning. In this perspective we explore how digital technology has the potential to address these limitations in order to improve cognitive and functional outcomes in recent-onset psychosis. Computer programs can be used for standardized, automated delivery of cognitive remediation training. Virtual reality provides the opportunity for learning and practicing cognitive skills in real-world scenarios within a virtual environment. Smartphone apps could be used for notification reminders for everyday tasks to compensate for cognitive difficulties. Internet-based technologies can offer psychoeducation and training materials for enhancing cognitive skills. Early findings indicate some forms of digital interventions for cognitive enhancement can be effective, with well-established evidence for human-supported computer-based cognitive remediation in recent-onset psychosis. Emerging evidence regarding virtual reality is favorable for improving social cognition. Overall, blending digital interventions with human support improves engagement and effectiveness. Despite the potential of digital interventions for enhancing cognition in recent-onset psychosis, few studies have been conducted to date. Implementation challenges affecting application of digital technologies for cognitive impairment in recent-onset psychosis are sustained engagement, clinical integration, and lack of quality in the commercial marketplace. Future opportunities lie in including motivational frameworks and behavioral change interventions, increasing service engagement in young people and lived experience involvement in digital intervention development.
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Affiliation(s)
- Imogen Bell
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Roos M.C.A. Pot-Kolder
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Stephen J. Wood
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- School of Psychology, University of Birmingham, UK
| | - Barnaby Nelson
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Nicola Acevedo
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Alexandra Stainton
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Katie Nicol
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - James Kean
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Shayden Bryce
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Cali F. Bartholomeusz
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Amity Watson
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Orli Schwartz
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Rothanthi Daglas-Georgiou
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Courtney C. Walton
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Donel Martin
- School of Psychiatry, University of New South Wales and Black Dog Institute, NSW, Australia
| | - Magenta Simmons
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Isabel Zbukvic
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Thompson
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Jennifer Nicholas
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Kelly Allott
- Orygen, 35 Poplar Rd, Parkville 3052, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Zbukvic I, Rheinberger D, Rosebrock H, Lim J, McGillivray L, Mok K, Stamate E, McGill K, Shand F, Moullin JC. Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework. Implementation Research and Practice 2022; 3:26334895211065786. [PMID: 37091106 PMCID: PMC9924249 DOI: 10.1177/26334895211065786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.
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Affiliation(s)
- Isabel Zbukvic
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Demee Rheinberger
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Hannah Rosebrock
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jaclyn Lim
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren McGillivray
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Katherine Mok
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Eve Stamate
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
| | - Katie McGill
- MH-READ, Hunter New England Mental Health Services, Newcastle, New South Wales, Australia
- Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Fiona Shand
- Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Joanna C Moullin
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Bryce S, Zbukvic I, Wood SJ, Allott K. Cognitive remediation to address impairment in schizophrenia: Moving beyond effectiveness and toward implementation. Psychiatry Res 2021; 305:114232. [PMID: 34649185 DOI: 10.1016/j.psychres.2021.114232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Shayden Bryce
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Isabel Zbukvic
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen J Wood
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; School of Psychology, University of Birmingham, UK
| | - Kelly Allott
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
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Beames JR, Lingam R, Boydell K, Calear AL, Torok M, Maston K, Zbukvic I, Huckvale K, Batterham PJ, Christensen H, Werner-Seidler A. Protocol for the process evaluation of a complex intervention delivered in schools to prevent adolescent depression: the Future Proofing Study. BMJ Open 2021; 11:e042133. [PMID: 33436468 PMCID: PMC7805380 DOI: 10.1136/bmjopen-2020-042133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Process evaluations provide insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a cluster randomised trial of a digital depression prevention intervention delivered to secondary school students (the Future Proofing Study). The purpose is to describe the methods that will be used to capture process evaluation data within this trial. METHODS AND ANALYSIS Using a hybrid type 1 design, a mixed-methods approach will be used with data collected in the intervention arm of the Future Proofing Study. Data collection methods will include semistructured interviews with school staff and study facilitators, automatically collected intervention usage data and participant questionnaires (completed by school staff, school counsellors, study facilitators and students). Information will be collected about: (1) how the intervention was implemented in schools, including fidelity; (2) school contextual factors and their association with intervention reach, uptake and acceptability; (3) how school staff, study facilitators and students responded to delivering or completing the intervention. How these factors relate to trial effectiveness outcomes will also be assessed. Overall synthesis of the data will provide school cluster-level and individual-level process outcomes. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of New South Wales (NSW) Human Research Ethics Committee (HC180836; 21st January 2019) and the NSW Government State Education Research Applications Process (SERAP 2019201; 19th August 2019). Results will be submitted for publication in peer-reviewed journals and discussed at conferences. Our process evaluation will contextualise the trial findings with respect to how the intervention may have worked in some schools but not in others. This evaluation will inform the development of a model for rolling out digital interventions for the prevention of mental illness in schools. TRIAL REGISTRATION NUMBER ANZCTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true.
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Affiliation(s)
- Joanne R Beames
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Katherine Boydell
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Maston
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Isabel Zbukvic
- Orygen The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Kit Huckvale
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
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Bührmann L, Schuurmans J, Ruwaard J, Fleuren M, Etzelmüller A, Piera-Jiménez J, Finch T, Rapley T, Potthoff S, Aouizerate B, Batterham PJ, Calear A, Christensen H, Pedersen CD, Ebert DD, Van der Eycken E, Fanaj N, van Genugten C, Hanssen D, Hegerl U, Hug J, Kleiboer A, Mathiasen K, May C, Mustafa S, Oehler C, Cerga-Pashoja A, Pope C, Qirjako G, Rosmalen J, Sacco Y, Samalin L, Skjøth MM, Tarp K, Titzler I, Zanalda E, Zbukvic I, Smit JH, Riper H, Vis C. Tailored implementation of internet-based cognitive behavioural therapy in the multinational context of the ImpleMentAll project: a study protocol for a stepped wedge cluster randomized trial. Trials 2020; 21:893. [PMID: 33115545 PMCID: PMC7592568 DOI: 10.1186/s13063-020-04686-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/14/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Internet-based Cognitive Behavioural Therapy (iCBT) is found effective in treating common mental disorders. However, the use of these interventions in routine care is limited. The international ImpleMentAll study is funded by the European Union's Horizon 2020 programme. It is concerned with studying and improving methods for implementing evidence-based iCBT services for common mental disorders in routine mental health care. A digitally accessible implementation toolkit (ItFits-toolkit) will be introduced to mental health care organizations with the aim to facilitate the ongoing implementation of iCBT services within local contexts. This study investigates the effectiveness of the ItFits-toolkit by comparing it to implementation-as-usual activities. METHODS A stepped wedge cluster randomized controlled trial (SWT) design will be applied. Over a trial period of 30 months, the ItFits-toolkit will be introduced sequentially in twelve routine mental health care organizations in primary and specialist care across nine countries in Europe and Australia. Repeated measures are applied to assess change over time in the outcome variables. The effectiveness of the ItFits-toolkit will be assessed in terms of the degree of normalization of the use of the iCBT services. Several exploratory outcomes including uptake of the iCBT services will be measured to feed the interpretation of the primary outcome. Data will be collected via a centralized data collection system and analysed using generalized linear mixed modelling. A qualitative process evaluation of routine implementation activities and the use of the ItFits-toolkit will be conducted within this study. DISCUSSION The ImpleMentAll study is a large-scale international research project designed to study the effectiveness of tailored implementation. Using a SWT design that allows to examine change over time, this study will investigate the effect of tailored implementation on the normalization of the use of iCBT services and their uptake. It will provide a better understanding of the process and methods of tailoring implementation strategies. If found effective, the ItFits-toolkit will be made accessible for mental health care service providers, to help them overcome their context-specific implementation challenges. TRIAL REGISTRATION ClinicalTrials.gov NCT03652883 . Retrospectively registered on 29 August 2018.
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Affiliation(s)
- Leah Bührmann
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands.
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Josien Schuurmans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jeroen Ruwaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Margot Fleuren
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Dutch Nurses Association, Utrecht, The Netherlands
| | - Anne Etzelmüller
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- GET.ON Institute, Hamburg, Germany
| | - Jordi Piera-Jiménez
- Department of Research and Innovation, Badalona Serveis Assistencials, Badalona, Spain
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sebastian Potthoff
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Bruno Aouizerate
- Fondation FondaMental, Creteil, France
- Regional Reference Center for the Management and Treatment of Anxiety and Depressive Disorders, Expert Center for Treatment-Resistant Depression, CH Charles Perrens, University of Bordeaux, Bordeaux, France
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alison Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Randwick, Australia
| | - Claus Duedal Pedersen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - David Daniel Ebert
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- GET.ON Institute, Hamburg, Germany
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Naim Fanaj
- Mental Health Center Prizren, Prizren, Kosovo
- College of Medical Sciences Rezonanca, Prishtina, Kosovo
| | - Claire van Genugten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Denise Hanssen
- University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Juliane Hug
- European Alliance Against Depression e.V., Leipzig, Germany
| | - Annet Kleiboer
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kim Mathiasen
- Research Unit for Depression and Anxiety, Aarhus University Hospital, Aarhus N, Denmark
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sevim Mustafa
- Mental Health Center Prizren, Prizren, Kosovo
- Faculty of Education, University St. Kliment Ohridski, Bitola, North Macedonia
| | | | - Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gentiana Qirjako
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Judith Rosmalen
- University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Ylenia Sacco
- Dipartimento di Salute Mentale, Azienda Sanitaria Locale Torino 3, Turin, Italy
| | - Ludovic Samalin
- Fondation FondaMental, Creteil, France
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Mette Maria Skjøth
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kristine Tarp
- Centre for Telepsychiatry, Region of Southern Denmark, Denmark
| | - Ingrid Titzler
- GET.ON Institute, Hamburg, Germany
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Enrico Zanalda
- Dipartimento di Salute Mentale, Azienda Sanitaria Locale Torino 3, Turin, Italy
| | - Isabel Zbukvic
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Johannes H Smit
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Shand F, Torok M, Cockayne N, Batterham PJ, Calear AL, Mackinnon A, Martin D, Zbukvic I, Mok K, Chen N, McGillivray L, Phillips M, Cutler H, Draper B, Sara G, Christensen H. Protocol for a stepped-wedge, cluster randomized controlled trial of the LifeSpan suicide prevention trial in four communities in New South Wales, Australia. Trials 2020; 21:332. [PMID: 32293516 PMCID: PMC7161184 DOI: 10.1186/s13063-020-04262-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite increasing investment in suicide prevention, Australian suicide rates have increased steadily in the past decade. In response to growing evidence for multicomponent intervention models for reducing suicide, the LifeSpan model has been developed as the first multicomponent, evidence-based, system-wide approach to suicide prevention in Australia. The LifeSpan model consists of nine evidence-based strategies. These include indicated, selective and universal interventions which are delivered simultaneously to community and healthcare systems over a 2-year implementation period. This study will evaluate the effectiveness of the LifeSpan model in reducing suicide attempts and suicide deaths in four geographically defined regions in New South Wales, Australia. METHODS We outline the protocol for a stepped-wedge, cluster randomized controlled trial. Following a 6-month transition phase, the trial sites will move to the 2-year active implementation phase in 4-monthly intervals with evaluation extending a minimum of 24 months after establishment of the full active period. Analysis will be undertaken of the change attributable to the invention across the four sites. The primary outcome for the study is the rate of attempted suicide in the regions involved. Rate of suicide deaths within each site is a secondary outcome. DISCUSSION If proven effective, the LifeSpan model for suicide prevention could be more widely delivered in Australian communities, providing a valuable new approach to tackle rising suicide rates. LifeSpan has the potential to significantly contribute to the mental health of Australians by improving help-seeking for suicide, facilitating early detection, and improving aftercare to reduce re-attempts. The findings from this research should also contribute to the evidence base for multilevel suicide prevention programs internationally. TRIAL REGISTRATION Australia New Zealand Clinical Trials Register, ID: ACTRN12617000457347. Prospectively registered on 28 March 2017. https://www.anzctr.org.au/TrialSearch.aspx#&&conditionCode=&dateOfRegistrationFrom=&interventionDescription=&interventionCodeOperator=OR&primarySponsorType=&gender=&distance=&postcode=&pageSize=20&ageGroup=&recruitmentCountryOperator=OR Protocol Version: 1.0, 31 May 2019.
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Affiliation(s)
- Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Nicole Cockayne
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, NSW, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, NSW, Australia
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Dean Martin
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Isabel Zbukvic
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Katherine Mok
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Nicola Chen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lauren McGillivray
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Phillips
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Henry Cutler
- Macquarie University Centre for Health Economics, Macquarie University, Sydney, NSW, Australia
| | - Brian Draper
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Grant Sara
- System Information and Analytics Branch, NSW Ministry of Health, Sydney, NSW, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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McGillivray L, Torok M, Calear A, Shand F, Mackinnon A, Kuhnert RL, Batterham P, Rosebrock H, Mok K, Zbukvic I, Christensen H. Suicide prevention among young people: A study protocol for evaluating Youth Aware of Mental Health in Australian secondary schools. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.mhp.2019.200178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Kim JH, Perry C, Luikinga S, Zbukvic I, Brown RM, Lawrence AJ. Extinction of a cocaine-taking context that protects against drug-primed reinstatement is dependent on the metabotropic glutamate 5 receptor. Addict Biol 2015; 20:482-9. [PMID: 24712397 DOI: 10.1111/adb.12142] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We investigated the effects of extinguishing action-reward versus context-reward associations on drug-primed reinstatement, and the potential role of the metabotropic glutamate 5 receptor (mGlu5) in these different types of extinction in rats that self-administer cocaine. We observed that daily context extinction (non-reinforced exposures to the cocaine-taking context with retracted levers) was just as effective as daily lever extinction in reducing cocaine-primed reinstatement compared with passive abstinence. Additionally, systemic injections of the mGlu5 negative allosteric modulator MTEP (3-[(2-methyl-1,3-thiazol-4-yl)ethynyl]-pyridine) following each extinction session significantly impaired the ability of context extinction to reduce cocaine-primed reinstatement, without affecting reinstatement after lever extinction or passive abstinence.
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Affiliation(s)
- Jee Hyun Kim
- Behavioural Neuroscience Division; The Florey Institute of Neuroscience and Mental Health; Australia
- Florey Department of Neuroscience and Mental Health; University of Melbourne; Australia
| | - Christina Perry
- Behavioural Neuroscience Division; The Florey Institute of Neuroscience and Mental Health; Australia
- Florey Department of Neuroscience and Mental Health; University of Melbourne; Australia
| | - Sophia Luikinga
- Behavioural Neuroscience Division; The Florey Institute of Neuroscience and Mental Health; Australia
| | - Isabel Zbukvic
- Behavioural Neuroscience Division; The Florey Institute of Neuroscience and Mental Health; Australia
- Florey Department of Neuroscience and Mental Health; University of Melbourne; Australia
| | - Robyn M. Brown
- Behavioural Neuroscience Division; The Florey Institute of Neuroscience and Mental Health; Australia
- Florey Department of Neuroscience and Mental Health; University of Melbourne; Australia
| | - Andrew J. Lawrence
- Behavioural Neuroscience Division; The Florey Institute of Neuroscience and Mental Health; Australia
- Florey Department of Neuroscience and Mental Health; University of Melbourne; Australia
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Perry CJ, Zbukvic I, Kim JH, Lawrence AJ. Role of cues and contexts on drug-seeking behaviour. Br J Pharmacol 2014; 171:4636-72. [PMID: 24749941 PMCID: PMC4209936 DOI: 10.1111/bph.12735] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/04/2014] [Accepted: 04/10/2014] [Indexed: 01/15/2023] Open
Abstract
Environmental stimuli are powerful mediators of craving and relapse in substance-abuse disorders. This review examined how animal models have been used to investigate the cognitive mechanisms through which cues are able to affect drug-seeking behaviour. We address how animal models can describe the way drug-associated cues come to facilitate the development and persistence of drug taking, as well as how these cues are critical to the tendency to relapse that characterizes substance-abuse disorders. Drug-associated cues acquire properties of conditioned reinforcement, incentive motivation and discriminative control, which allow them to influence drug-seeking behaviour. Using these models, researchers have been able to investigate the pharmacology subserving the behavioural impact of environmental stimuli, some of which we highlight. Subsequently, we examine whether the impact of drug-associated stimuli can be attenuated via a process of extinction, and how this question is addressed in the laboratory. We discuss how preclinical research has been translated into behavioural therapies targeting substance abuse, as well as highlight potential developments to therapies that might produce more enduring changes in behaviour.
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Affiliation(s)
- Christina J Perry
- Behavioural Neuroscience Division, The Florey Institute of Neuroscience and Mental HealthParkville, Vic., Australia
- Florey Department of Neuroscience and Mental Health, University of MelbourneParkville, Vic., Australia
| | - Isabel Zbukvic
- Behavioural Neuroscience Division, The Florey Institute of Neuroscience and Mental HealthParkville, Vic., Australia
- Florey Department of Neuroscience and Mental Health, University of MelbourneParkville, Vic., Australia
| | - Jee Hyun Kim
- Behavioural Neuroscience Division, The Florey Institute of Neuroscience and Mental HealthParkville, Vic., Australia
- Florey Department of Neuroscience and Mental Health, University of MelbourneParkville, Vic., Australia
| | - Andrew J Lawrence
- Behavioural Neuroscience Division, The Florey Institute of Neuroscience and Mental HealthParkville, Vic., Australia
- Florey Department of Neuroscience and Mental Health, University of MelbourneParkville, Vic., Australia
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