Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester

There is increasing evidence to support the effectiveness of eTherapies for mental health, although limited data have been reported from community-based services | BMJ Open

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Results: Data indicated baseline differences, with the Breaking Free Online group having higher scores for depression and anxiety than the Living Life to the Full Interactive and Sleepio  groups. Promising improvements in mental health scores were found within all three groups, as were significant reductions in numbers of service users reaching clinical threshold scores for mental health difficulties. Number of days of engagement was not related to change from baseline for the Living Life to the Full or Sleepio programmes but was associated with degree of change for Breaking Free Online.

Conclusion: Data presented provide evidence for feasibility of this eTherapy delivery model in supporting service users with a range of mental health difficulties and suggest that eTherapies may be a useful addition to treatment offering in community-based services.

Full reference: Elison, S. et al. (2017) Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester: repeated-measures and between-groups study of ‘Living Life to the Full Interactive’, ‘Sleepio’ and ‘Breaking Free Online’ at ‘Self Help Services’. BMJ Open. 7:e016392

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Facilitating mental health help-seeking by young adults with a dedicated online program

Link is a dedicated online mental health help-seeking navigation tool that matches user’s mental health issues, severity and service-type preferences (online, phone and face-to-face) with appropriate youth-friendly services | BMJ Open

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Objective: To explore the feasibility of a dedicated online youth mental health help-seeking intervention and to evaluate using a randomised controlled trial (RCT) study design in order to identify any modifications needed before commencement of the full-scale RCT.

Results: Fifty-one participants were randomised (intervention: n=24; comparison: n=27). Three out of four of the intervention and two out of five of the study design criteria were met. Unmet criteria could be addressed by modifications to the study design. Qualitative analysis demonstrated that Link was useful to participants and may have increased their positive experiences towards help-seeking. There were no observable differences between arms in any outcome measures and no harms were detected.

Conclusion: Generally, the Link intervention and study design were acceptable and feasible with modifications suggested for the four out of nine unmet criteria. The main trial will hence have shorter surveys and a simpler recruitment process, use positive affect as the primary outcome and will not link to Google.com for the comparison arm.

Full reference: Kauer, S.D. et al. (2017) Facilitating mental health help-seeking by young adults with a dedicated online program: a feasibility study of Link. BMJ Open. 7:e015303

New programme will assess how digital therapies can help treat anxiety and depression

NICE is to start assessing new digital therapies that will help treat more people with anxiety and depression.

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Guided self-help, which can track people’s mood or advise on breathing exercises for example, is recommended by NICE guidance to help treat mild to moderate anxiety and depression.

As part of NHS England’s Improving Access to Psychological Therapies (IAPT) programme, NICE has been asked to assess digital applications or computer programmes, which will sit alongside face-to-face, phone and online therapy.

Developers of therapy applications are being invited to submit their product to NICE to see if it meets the criteria to be entered into the new programme. An eligible product will be assessed by NICE for its content, how effective it is at treating anxiety and depression, how cost effective it is and whether it complies with technical NHS standards. NICE will then produce an IAPT assessment briefing (IAB) on the product which will be looked at by an expert panel, made up of mental health clinicians, statisticians, an economist and a patient representative. They will look at NICE’s briefing and make a decision on whether the product can be recommended for real-life testing in selected IAPT services, where further evidence can be collected on its effectiveness.

Over the next two years, NICE’s expert panel will review data from this evaluation in practice and decide if the digital therapy should be adopted for use across the whole of NHS England’s IAPT service. Funding will also be made available from NHS England for digital therapies that are identified by the expert panel as promising, but need further development.

 

Ethics of digital technology for mental health

The potential of digital technology to make the lives of people with mental health difficulties better has never been greater | The Mental Elf

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The advent of the smartphone and mobile internet access has created the conditions for an ever-expanding range of opportunities for the use of technology to influence outcomes in health. However, ethical considerations remain for professionals in suggesting the use of such technologies.

Bauer et al.’s (2017) open access paper Ethical perspectives on recommending digital technology for patients with mental illness reviews some of the major ethical concerns presented to medical professionals by this explosion of technological possibilities and explores some of the ways in which new technologies challenge the boundaries between health, commerce and the private and public uses of data.

Read the full blog post here

Tele-Mental Health for Children: Using Videoconferencing for Cognitive Behavioral Therapy (CBT)

Goldschmidt, K. Journal of Pediatric Nursing. Published online: October 7, 2016

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Mental health disorders occur in 4% of children and 10 to 20% of adolescents and are linked with “depression, anxiety, risky behaviors, poor physical health, obesity, substance abuse and suicide” (Garber, Frankel, & Herrington, 2016, p. 181). Adolescents diagnosed with a depressive disorder have high rates of recurrence: 25% within one year, 40% within two years, and 70% within five years (Mash & Wolfe, 2012). It is imperative for mental health specialist to reach children with mental health disorders early in their development in an effort to decrease morbidity and mortality; however, access to mental health care, especially for children, is limited (Lauckner & Whitten, 2015).

Read the abstract here

Interventions for Adolescent Mental Health: An Overview of Systematic Reviews

Das, J.K. et al. (2016) The Journal of Adolescent Health. 59(4) pp. S49–S60

mental-health-1420801_960_720Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders among young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population.

A total of 38 systematic reviews were included. We classified the included reviews into the following categories for reporting the findings: school-based interventions (n = 12); community-based interventions (n = 6); digital platforms (n = 8); and individual-/family-based interventions (n = 12).

Evidence from school-based interventions suggests that targeted group-based interventions and cognitive behavioral therapy are effective in reducing depressive symptoms (standard mean difference [SMD]: −.16; 95% confidence interval [CI]: −.26 to −.05) and anxiety (SMD: −.33; 95% CI: −.59 to −.06). School-based suicide prevention programs suggest that classroom-based didactic and experiential programs increase short-term knowledge of suicide (SMD: 1.51; 95% CI: .57–2.45) and knowledge of suicide prevention (SMD: .72; 95% CI: .36–1.07) with no evidence of an effect on suicide-related attitudes or behaviors. Community-based creative activities have some positive effect on behavioral changes, self-confidence, self-esteem, levels of knowledge, and physical activity. Evidence from digital platforms supports Internet-based prevention and treatment programs for anxiety and depression; however, more extensive and rigorous research is warranted to further establish the conditions. Among individual- and family-based interventions, interventions focusing on eating attitudes and behaviors show no impact on body mass index (SMD: −.10; 95% CI: −.45 to .25); Eating Attitude Test (SMD: .01; 95% CI: −.13 to .15); and bulimia (SMD: −.03; 95% CI: −.16 to .10). Exercise is found to be effective in improving self-esteem (SMD: .49; 95% CI: .16–.81) and reducing depression score (SMD: −.66; 95% CI: −1.25 to −.08) with no impact on anxiety scores. Cognitive behavioral therapy compared to waitlist is effective in reducing remission (odds ratio: 7.85; 95% CI: 5.31–11.6). Psychological therapy when compared to antidepressants have comparable effect on remission, dropouts, and depression symptoms.

The studies evaluating mental health interventions among adolescents were reported to be very heterogeneous, statistically, in their populations, interventions, and outcomes; hence, meta-analysis could not be conducted in most of the included reviews. Future trials should also focus on standardized interventions and outcomes for synthesizing the exiting body of knowledge. There is a need to report differential effects for gender, age groups, socioeconomic status, and geographic settings since the impact of mental health interventions might vary according to various contextual factors.

Read the abstract here