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03/13/2023

Supporting people affected by problematic alcohol, substance use and other behaviours under pandemic conditions: A pragmatic evaluation of how SMART recovery Australia responded to COVID-19

Beck AK, Larance B, Baker AL, Deane FP, Manning V, Hides L, & Kelly PJ. (2023). Supporting people affected by problematic alcohol, substance use and other behaviours under pandemic conditions: A pragmatic evaluation of how SMART recovery Australia responded to COVID-19. Addictive Behaviors, 139, 107577–107577. https://doi.org/10.1016/j.addbeh.2022.107577

Researchers conducted a pragmatic evaluation of the scaling up of online, group-based addiction services during the COVID-19 pandemic. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) was applied to analyze the SMART Recovery Australia (SRAU) online program for 12 months and at 2-month follow-up. SRAU is a mutual-help program based on a four-point curriculum (building motivation, coping with urges, problem solving, and lifestyle balance) and led by a trained facilitator via Zoom. Before the pandemic, there were only 6 online groups and SRAU aimed to expand this service during the pandemic by developing 100 groups. Data was collected by online self-report participant surveys, Zoom data analytics on meetings and attendees, and administrative logs of third-party providers. During the 12-month evaluation period, the number of online groups increased from 6 to 132. A total of 2786 meetings were delivered with 41,752 attendees. Participant survey results (N=1052) showed that 91% of participants were highly engaged and 92% had positive experiences with the online group meetings. Further, 91% of participants who had experienced the in-person format rated their online experience as equivalent or better. However, 21% reported technical difficulties. The average number of meetings delivered and number of attendees per month were sustained at the two-month follow-up. Overall, SRAU achieved the goal of establishing at least 100 online mutual-help groups in response to the COVID-19 pandemic. Results support the acceptability and sustainability of delivering groups online for substance use behaviors.

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01/10/2023

Challenges in Recruiting University Students for Web-Based Indicated Prevention of Depression and Anxiety: Results From a Randomized Controlled Trial (ICare Prevent)

Bolinski F, Kleiboer A, Neijenhuijs K, Karyotaki E, Wiers R, de Koning L, Jacobi C, Zarski A, Weisel K, Cuijpers P, Riper H. Challenges in Recruiting University Students for Web-Based Indicated Prevention of Depression and Anxiety: Results From a Randomized Controlled Trial (ICare Prevent). J Med Internet Res 2022;24(12):e40892. DOI: 10.2196/40892

This study described recruitment challenges for a transdiagnostic, web-based prevention program and presented initial analysis on the intervention’s effectiveness on depression and anxiety symptoms. The study was a 3-arm randomized controlled trial with students (at least 16 years old) with subclinical symptoms of depression and anxiety to compare individually guided and automatically guided versions of ICare Prevent versus care as usual. ICare Prevent is a web-based and mobile-supported intervention for prevention of depression and anxiety. ICare Prevent is a 7-session web-based program (45-60 minutes each) and participants were instructed to complete 1-2 sessions weekly. ICare Prevent also provides elective modules and diaries that target factors common to mood and anxiety problems (i.e., sleep, alcohol use, positive activities). The individually guided version provided structured and personalized feedback on exercises and the automatically guided version provided standard and computerized feedback after each session. The study’s original recruitment goal was 252 student participants. Various strategies of recruitment were used, including social media campaigns on Facebook and Instagram, printed advertising at universities, paid participant platform, and other collaborations. Direct recruitment using students’ email addresses via the student administration was the most effective strategy. Despite these strategies, data was available for only 35 participants (individually guided: n=14, automatically guided: n=8, care as usual: n=13). Participants provided self-reported depression and anxiety symptoms at baseline, 6-month, and 12-month follow-up. Log data from the intervention platform showed low usage, with an average of 3 out of 7 sessions completed. Results did not show sufficient evidence of intervention effects on depression and anxiety over time in any intervention arm. Overall, recruitment for this population was challenging and more research is needed to identify factors to better engage college students in research studies.

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11/29/2022

Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems

Kählke F, Buntrock C, Smit F, Ebert DD. Systematic review of economic evaluations for internet- and mobile-based interventions for mental health problems. npj Digit. Med. 5, 175 (2022). https://doi.org/10.1038/s41746-022-00702-w

A systematic review was conducted to summarize the cost-effectiveness of internet and mobile-based interventions (IMIs) for mental health disorders and symptoms. This review also assessed methodological quality of included studies. The literature search identified studies of psychological interventions provided in an online setting to treat mental health disorders or any type of psychological symptoms regardless of participant age. Studies had to be randomized controlled trials that included a full economic evaluation. A total of 4,044 articles were identified, of which 36 articles met eligibility criteria. Sixty-five economic evaluations were conducted. The most commonly targeted mental health problem was major depressive disorder or depressive symptoms, followed by anxiety. Cost-effectiveness was determined using the threshold of at or below £30,000 per quality-adjusted life year (QALY) gained. Overall, the majority of economic evaluations of IMIs (n=56) presented evidence of cost-effectiveness. Guided IMIs (i.e., interventions that include support by a provider via email, chat, or automated feedback delivery) were likely to be cost-effective in depression and anxiety studies. Methodological quality of the cost-effectiveness analyses was mostly evaluated as good, however a few studies showed high risk of bias. Researchers found high heterogeneity across studies due to factors such as costing methods, design, comparators, and outcomes used. Overall, these findings suggest the cost-effectiveness of IMIs and include new evidence in under-researched disorders such as obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), stress, and sleep. Future research is needed to continue to target underrepresented disorders (e.g., panic disorder and specific phobias), as well as research in low- and middle-income countries.

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10/31/2022

Parent-Based Prevention of Bullying and Cyberbullying During COVID-19 Social Distancing: A Pilot Intervention using the MOST Framework

Doty J, Gabrielli J, Abraczinskas M, Giron K, Yourell J, Stormshak E. Parent-Based Prevention of Bullying and Cyberbullying During COVID-19 Social Distancing: A Pilot Intervention using the MOST Framework. J of Prevention 43, 719–734 (2022). https://doi.org/10.1007/s10935-022-00696-x

This pilot study investigated satisfaction and acceptability of an evidence-based parenting intervention enhanced to address bullying and cyberbullying. The Everyday Parenting intervention focuses on content on positive reinforcement, monitoring daily activities, setting limits, negotiation, and positive parenting. This program was enhanced with intensive role playing, social emotional coaching, and media parenting components. The pilot was delivered via video teleconferencing during the COVID-19 pandemic. Thirty-two parents (88% female) with children ages 9-12 years old participated in weekly online 60-minute sessions for 8 weeks. Eligibility for free- or reduced-price lunch was met by 56% of participants. Thirty of the parents completed all the sessions. Researchers examined participant satisfaction and qualitative analyses to explain outcomes and explore participant acceptability. Average satisfaction with individual sessions was high (3.93 on 4-point scale). Qualitative findings reinforced and explained quantitative findings. Participants found the intervention and virtual delivery acceptable and gave feedback to strengthen the focus on bullying and cyberbullying topics. There were non-significant differences in satisfaction and delivery in families eligible for free- or reduced-priced lunch. Overall, parents found the enhancements to Everyday Parenting program acceptable. It was also feasible to deliver the program through video conferencing with parents. The increase in technology engagement due to the COVID-19 pandemic will potentially increase the importance of online safety for children.

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10/10/2022

Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden: a randomised, clinical, non-inferiority trial

Mechler J, Lindqvist K, Carlbring P, Topooco N, Falkenström F, Lilliengren P, Andersson G, Johansson R, Midgley N, Edbrooke-Childs J, Dahl H-S J, Sandell R, Thorén A, Ulberg R, Bergsten KL, & Philips B. (2022). Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden: a randomised, clinical, non-inferiority trial. The Lancet (British Edition), 4(8), e594–e603. https://doi.org/10.1016/S2589-7500(22)00095-4

This study compared internet-based psychodynamic therapy (IPDT) with an established evidence-based treatment (internet-based cognitive behavioral therapy (ICBT)) for adolescents with depression. Participants aged 15-19 years with a diagnosis of major depressive disorder (N=272) were recruited in Sweden and randomly assigned to receive IPDT or ICBT. Both online interventions consisted of 8 self-help modules delivered over 10 weeks. Modules contained text, videos, and interactive exercises. All participants were also offered 30 minutes of weekly therapist support via live chat. The primary outcome was change in depression severity measured weekly by a brief self-report measure (Quick Inventory of Depressive Symptomatology ()). Participants in both groups showed similar engagement levels and high completion rates (defined as completing at least five modules and chat sessions and post-treatment assessment). Depressive symptoms in both groups significantly improved during treatment. At the end of treatment, demonstrated that IPDT was non-inferior to ICBT in the treatment of depression for adolescents. Results contribute to the evidence base for feasibility of online delivery of both IPDT and ICBT for the treatment of depression among a late-adolescent population.

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09/26/2022

Predictors of adolescent engagement and outcomes – A cross-sectional study using the Togetherall (formerly Big White Wall) digital mental health platform

Marinova N, Rogers T, and MacBeth A. “Predictors of Adolescent Engagement and Outcomes – A Cross-Sectional Study Using the Togetherall (formerly Big White Wall) Digital Mental Health Platform.” Journal of affective disorders 311 (2022): 284–293. https://doi.org/10.1016/j.jad.2022.05.058

This study modelled predictors of engagement and symptom change in adolescent users of Togetherall anonymous digital mental health peer-support platform. Researchers conducted a retrospective analysis of longitudinal user data from 606 Togetherall users (16-18 years old) referred from mental health services in the United Kingdom. Togetherall is a membership-based digital platform that supports delivery of peer support moderated by professionals, self-help materials, guided courses, digital art, and self-monitoring of mental well-being. Usage metrics, including number of logins, session duration, usage time, and number of guided courses and self-help materials accessed were collected. Participant characteristics and anxiety and depression symptoms were used to predict engagement and participants chose when and whether to complete a symptom measure. Average number of logins was 5.11 and mean usage time 64.22 minutes. 34% of participants discontinued use after one log-in. Total usage time predicted more access of self-help materials. Females made greater use of materials and courses than males. Higher baseline depression and anxiety, longer usage time, and session duration predicted lower post intervention depression scores. Higher baseline depression and anxiety and more self-help materials accessed predicted lower post intervention anxiety scores. Findings demonstrate that adolescents with significant levels of morbidity readily engaged with an anonymous online platform for support with mental health. Togetherall may offer a supportive community for adolescents using mental health services. Future studies are needed to establish effectiveness, adherence and acceptability using robust RCTs with active comparison groups.

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08/23/2022

Implementation and impact of a technology-based HIV risk-reduction intervention among Thai men who have sex with men using “Vialogues”: a randomized controlled trial

Anand T, Nitpolprasert C, Jantarapakde J, Meksena R, Phomthong S, Phoseeta P, Phanuphak P & Phanuphak N (2020) Implementation and impact of a technology-based HIV risk-reduction intervention among Thai men who have sex with men using “Vialogues”: a randomized controlled trial, AIDS Care, 32:3, 394-405, DOI: 10.1080/09540121.2019.1622638

A randomized controlled trial was conducted to evaluate the impact of a technology-based intervention on HIV risks and condom use behaviors among men who have sex with men (MSM) in Thailand. Seventy-six participants who were at least 18 years of age and reported unprotected sex in the last 6 months were recruited from the Thai Red Cross Anonymous Clinic. Participants were randomly assigned to control (N=39) and intervention arms (N=37). The intervention group received HIV/STI prevention education videos delivered online via Vialogues.com and video sessions with a counselor monthly for 12 months. The control group received HIV counseling and testing alone for 12 months. Researchers compared attendance rates of recommended clinic visits and HIV testing, changes in HIV/AIDS knowledge, behavioral intentions, attitudes for engaging in safer sex, condom use self-efficacy, and risky behaviors at baseline, 6-month and 12-month follow-ups for both groups. Eighty-nine percent of participants in the intervention arm completed all monthly Vialogues sessions. At 12 months, participants in the intervention arm had significantly more clinic visits than those in the control arm (p=0.03). At 12 months, the intervention group also reported a significantly higher percentage of condom use for anal intercourse than the control group (p=0.003). Participants receiving the intervention also reported significantly reduced self-perceived HIV risk (p=0.001), popper use (p=0.002), and number of sexual partners (p=0.003), and increased condom use (p=0.006) from baseline to 6 months and 12 months. Results demonstrated that the Vialogues program was effective for improving safer sex behaviors and attitudes to lower HIV risk among Thai MSM.

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06/13/2022

Effect of digital psychoeducation and peer support on the mental health of family carers supporting individuals with psychosis in England (COPe-support): a randomised clinical trial

Sin J, Henderson C, Elkes J, Cornelius V, Woodham LA, Batchelor R, Chen T, Corredor AM, Coughlan D, Dhital R, Evans S, Haider B, Heathcote J, Mansfield S, O’Brien A, Qassim M, Sserunkuma J, Travis CH, Williams E & Gillard S. (2022). Effect of digital psychoeducation and peer support on the mental health of family carers supporting individuals with psychosis in England (COPe-support): a randomised clinical trial. The Lancet (British Edition), 4(5), e320–e329. https://doi.org/10.1016/S2589-7500(22)00031-0

Researchers evaluated the effectiveness of a web-based multicomponent intervention (COPe-support) for improving the mental health and caregiving outcomes of caregivers of individuals with serious mental illness. A randomized two-arm trial was conducted to compare the COPe-support intervention to a passive control condition (an online information resource). Participants were adult relatives and close friends who provided at least weekly support in any format for persons with psychosis. Four hundred and seven participants were recruited from 30 mental health provider organizations across England. The COPe-support intervention included features addressing psychoeducation about psychosis and treatment, caregiving issues, wellbeing promotion, expert and peer support forums, and relevant external resources. Participants in the treatment group downloaded the free app and had access for 40 weeks. Participants were recommended to use the app for at least 30 minutes weekly. Participants completed self-reported assessments of psychological wellbeing, quality of life, caregiving experience and support at baseline, 10 weeks, 20 weeks, and 40 weeks. The results found no difference in mental wellbeing between the COPe-support group and the control group at 20 weeks follow-up. Participants who reported higher use of COPe-support reported a greater effect in improved mental well-being, but this difference was not statistically significant. The results were similar at the 40 weeks follow-up as well. Overall, the COPe-support for caregivers supporting an individual with psychosis was not superior to an information resource at 20 weeks. Considering the projected increase in the caregiver population and demand for support, a digital intervention targeting psychological support for caregivers such as COPe-support is valuable. Research to demonstrate the efficacy of digital interventions to support caregivers of individuals with serious mental illness is needed.

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05/30/2022

Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial

Hammersley M, Wyse R, Jones R, Okely A, Wolfenden L, Eckermann S, Xu J, Green A, Stacey F, Yoong S, Jackson J, Innes-Hughes C, Li V, Rissel C. Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial. J Med Internet Res 2022;24(5):e35771 DOI: 10.2196/35771

Researchers conducted a mixed methods process evaluation of a translational trial targeting the dietary habits and movement behaviors of children with 3 partially randomized arms. The Time for Healthy Habits study recruited 458 total parents of children aged 2 to 6 years. The three arms were a telephone intervention, a web-based app intervention, and an active control (written education materials). At baseline, participants were asked to indicate their preferred intervention delivery method (telephone, web, written) or if they preferred to be randomized to condition. Participants received the assigned intervention for 12 weeks. Intervention acceptability and process evaluation were assessed at 3 months post baseline using a questionnaire developed by the researchers and qualitative interviews. Data on intervention fidelity and study attrition were also collected. Thirty participants completed the qualitative interviews, and 144 (31.4%) participants completed the postintervention follow-up. Most participants preferred the web-based delivery method at baseline. Results demonstrated high acceptability of the web-based and telephone interventions. Participants reported the healthy eating content to be the most useful component of the web-based modules and telephone calls. A significantly higher proportion of participants completed the telephone intervention compared to the web-based intervention. However, study attrition was higher in the telephone intervention arm. Overall, the process evaluation showed high acceptability of all interventions, but significantly more participants preferred the web-based intervention and were retained in the study relative to the other arms. This study highlighted the strengths and weaknesses of remotely delivered interventions and can inform directions for policy makers and practitioners.

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