BACKGROUND Digital mental health interventions (DMHIs) are effective in reducing symptoms of depression and anxiety. Low user engagement and uptake of DMHIs observed in previous research may be addressed by involving the intended target audience in the design of the DMHI from the outset. OBJECTIVE The present study is phase 1 of a multi-phase project to design, develop, and evaluate a blended DMHI for depression and anxiety in Australia. Our objective was to partner with adults with lived and living experiences of depression and anxiety on their needs and expectations of a new transdiagnostic DMHI for depression and anxiety. This included identifying strategies that would help increase their engagement with the DMHI and their preferences for integrating the DMHI with psychotherapy. METHODS A mixed-method co-design approach was used to collect quantitative and qualitative data via an online survey and semi-structured interviews. Feedback on participants’ needs and expectations for the DMHI, including accessibility, content, features, functionality, format, data sharing, preferred clinical support pathways, and barriers and facilitators of user engagement, was collected. Qualitative interview data were analyzed using reflexive thematic analysis. RESULTS Most participants preferred a DMHI that was a mobile app (190/257; 74%) that could be used at any time of the day. Ease of use and a well-designed interface was important, as was a positive, encouraging and uplifting DMHI look and feel. Other preferences included symptom tracking, diverse therapeutic content and features that facilitate social connection and peer support (e.g., online community, stories of lived and living experience). Participants also suggested several strategies to enhance engagement with the DMHI, including personalization, reminders, short and achievable activities and goal setting. Participants reported strong interest in sharing information from their DMHI with mental health professionals (to facilitate therapy), especially changes to their emotions. CONCLUSIONS Transdiagnostic DMHIs for depression and anxiety have great potential to improve access to affordable, evidence-based mental health support. Involving people with lived and living experiences of depression and anxiety in the design, development and conceptualization of DMHIs may improve uptake, acceptance, engagement, usability, and ultimately, treatment outcomes.
The present research tested the effects of being ostracized on risk-taking behavior and how emotional responses to ostracism mediate these effects. In two experiments, undergraduates were either ostracized or included during an Internet ball-toss game (Cyberball). In Experiment 1 (N = 52), ostracism increased self-reported risk-taking inclinations, and the relation between ostracism and risk-taking was mediated by feelings of anger, but not control. In Experiment 2 (N = 72), ostracism increased risky driving during a driving video game. The effect of ostracism on risk-taking was again mediated by post-ostracism anger (but not control or ostracism-induced sadness). This research suggests that anger elicited by ostracism may increase risk-taking.
Cognitive bias modification (CBM) interventions have demonstrated efficacy in augmenting core biases implicated in psychopathology. The current randomized controlled trial (RCT) will evaluate the efficacy of an internet-delivered positive imagery cognitive bias modification intervention for obsessive compulsive disorder (OCD) when compared to a control condition. Patients meeting diagnostic criteria for a current or lifetime diagnosis of OCD will be recruited via the research arm of a not-for-profit clinical and research unit in Australia. The minimum sample size for each group (alpha set at 0.05, power at .80) was identified as 29, but increased to 35 to allow for 20% attrition. We will measure the impact of CBM on interpretations bias using the OC Bias Measure (The Ambiguous Scenarios Test for OCD ;AST-OCD) and OC-beliefs (The Obsessive Beliefs Questionnaire-TRIP; OBQ-TRIP). Secondary outcome measures include the Dimensional Obsessive-Compulsive Scale (DOCS), the Patient Health Questionnaire (PHQ-9), The Kessler Psychological Distress Scale (K10), and the Word Sentence Association Test for OCD (WSAO). Change in diagnostic status will be indexed using the OCD Mini International Neuropsychiatric Interview (M.I.N.I) Module at baseline and follow-up. Intent-to-treat (ITT) marginal and mixed-effect models using restricted maximum likelihood (REML) estimation will be used to evaluate the primary hypotheses. Stability of bias change will be assessed at 1-month follow-up. A limitation of the online nature of the study is the inability to include a behavioral outcome measure. The trial was registered on 10 October 2013 with the Australian New Zealand Clinical Trials Registry ( ACTRN12613001130752 )
Objective: StepCare is an online, stepped mental healthcare service in general practice which identifies adults with common mental disorders, recommends evidence-based treatments and monitors symptoms and risk, with feedback to the patient and GP. Previous data suggested that StepCare was acceptable and feasible, assisting GPs to identify and manage patients’ depression and anxiety. Areas for improvement were recommended by GPs, practice staff and patients. StepCare was accordingly upgraded and a new implementation strategy was introduced, consistent with the Australian Government's reform agenda. This study aimed to evaluate the augmented StepCare and new implementation model.Methods: Two Primary Health Networks (PHNs) and 22 general practices took part. The StepCare team trained and supported PHN staff to implement the Service in their general practices. PHN staff, GPs, practice staff and patients rated the acceptability, feasibility and effectiveness of StepCare. New cases at screening and patients’ symptom change over 12 weeks were measured. Implementation facilitators and barriers were also investigated.Results: The majority of PHN staff, GPs, practice staff and patients rated StepCare as acceptable and feasible, GPs reported it assisted their identification and management of common mental health conditions and most patients indicated they would recommend it to a friend. 37% of patients reporting symptoms at screening were new cases. Patients’ depression symptoms reduced significantly by 12 weeks.Discussion: Augmented StepCare is able to identify new cases and produce clinical change within routine general practice. It also has the potential to be implemented by PHNs with assistance from the StepCare team.
Suicide amongst Australian Aboriginal and Torres Strait Islander communities occurs at twice the rate of the general population and, with significant barriers to treatment, help-seeking prior to a suicide attempt is low. This trial aims to test the effectiveness of an app (iBobbly) designed with Aboriginal and Torres Strait Islander people for reducing suicidal ideation.
Social anxiety disorder (SAD) is a common, chronic and disabling mental disorder. Cognitive Behaviour Therapy (CBT) is a highly effective treatment of SAD and internet CBT (iCBT) offers a cost-effective and convenient alternative to face to face approaches, with high fidelity and demonstrated efficacy. The aim of the current paper was to evaluate the effectiveness of an iCBT programme for SAD (The This Way Up Clinic Shyness Programme) when delivered in routine practice through two different pathways. Patients in the prescription pathway (Study 1, N = 368, 50% female, mean age = 34) were 'prescribed' the Shyness Programme by a registered practitioner of the This Way Up Clinic who supervised their progress throughout the programme. Patients in the referral pathway (Study 2, N = 192, 50% female, mean age = 36) were referred to the This Way Up Clinic and supervised by a specialist CBT clinician at the clinic. Intention-to-treat marginal model analyses demonstrated significant reductions in primary outcomes of social anxiety symptoms (Mini-SPIN) and psychological distress (K10), corresponding to large effect sizes (Cohen's d = .82–1.09, 95% CIs .59–1.31) and secondary outcomes of impairment (WHODAS-II) and depressive symptoms (PHQ9), corresponding to small effect sizes (Cohen's d = .36–.46, 95% CIs .19–.68) for patients in both pathways. Results provide evidence of the effectiveness of iCBT for social anxiety disorder when delivered in routine practice.
Anxiety disorders and depression are prevalent among youth. General practitioners (GPs) are often the first point of professional contact for treating health problems in young people. A Web-based mental health service delivered in partnership with schools may facilitate increased access to psychological care among adolescents. However, for such a model to be implemented successfully, GPs' views need to be measured.This study aimed to examine the needs and attitudes of GPs toward a Web-based mental health service for adolescents, and to identify the factors that may affect the provision of this type of service and likelihood of integration. Findings will inform the content and overall service design.GPs were interviewed individually about the proposed Web-based service. Qualitative analysis of transcripts was performed using thematic coding. A short follow-up questionnaire was delivered to assess background characteristics, level of acceptability, and likelihood of integration of the Web-based mental health service.A total of 13 GPs participated in the interview and 11 completed a follow-up online questionnaire. Findings suggest strong support for the proposed Web-based mental health service. A wide range of factors were found to influence the likelihood of GPs integrating a Web-based service into their clinical practice. Coordinated collaboration with parents, students, school counselors, and other mental health care professionals were considered important by nearly all GPs. Confidence in Web-based care, noncompliance of adolescents and GPs, accessibility, privacy, and confidentiality were identified as potential barriers to adopting the proposed Web-based service.GPs were open to a proposed Web-based service for the monitoring and management of anxiety and depression in adolescents, provided that a collaborative approach to care is used, the feedback regarding the client is clear, and privacy and security provisions are assured.
Copy number variation (CNV) is a common source of genetic variation that has been implicated in many genomic disorders. This has resulted in the widespread application of genomic microarrays as a first-tier diagnostic tool for CNV detection. More recently, whole-exome sequencing (WES) has been proven successful for the detection of clinically relevant point mutations and small insertion-deletions exome wide. We evaluate the utility of short-read WES (SOLiD 5500xl) to detect clinically relevant CNVs in DNA from 10 patients with intellectual disability and compare these results to data from two independent high-resolution microarrays. Eleven of the 12 clinically relevant CNVs were detected via read-depth analysis of WES data; a heterozygous single-exon deletion remained undetected by all algorithms evaluated. Although the detection power of WES for small CNVs currently does not match that of high-resolution microarray platforms, we show that the majority (88%) of rare coding CNVs containing three or more exons are successfully identified by WES. These results show that the CNV detection resolution of WES is comparable to that of medium-resolution genomic microarrays commonly used as clinical assays. The combined detection of point mutations, indels, and CNVs makes WES a very attractive first-tier diagnostic test for genetically heterogeneous disorders.
BACKGROUND Digital mental health interventions stand to play a critical role in managing the mental health impact of the COVID-19 pandemic. Thus, enhancing their uptake is a key priority. General practitioners (GPs) are well positioned to facilitate access to digital interventions, but tools that assist GPs in identifying suitable patients are lacking. OBJECTIVE This study aims to evaluate the suitability of a web-based mental health screening and treatment recommendation tool (<i>StepCare</i>) for improving the identification of anxiety and depression in general practice and, subsequently, uptake of digital mental health interventions. METHODS StepCare screens patients for symptoms of depression (9-item Patient Health Questionnaire) and anxiety (7-item Generalized Anxiety Disorder scale) in the GP waiting room. It provides GPs with stepped treatment recommendations that include digital mental health interventions for patients with mild to moderate symptoms. Patients (N=5138) from 85 general practices across Australia were invited to participate in screening. RESULTS Screening identified depressive or anxious symptoms in 43.09% (1428/3314) of patients (one-quarter were previously unidentified or untreated). The majority (300/335, 89.6%) of previously unidentified or untreated patients had mild to moderate symptoms and were candidates for digital mental health interventions. Although less than half were prescribed a digital intervention by their GP, when a digital intervention was prescribed, more than two-thirds of patients reported using it. CONCLUSIONS Implementing web-based mental health screening in general practices can provide important opportunities for GPs to improve the identification of symptoms of mental illness and increase patient access to digital mental health interventions. Although GPs prescribed digital interventions less frequently than in-person psychotherapy or medication, the promising rates of uptake by GP-referred patients suggest that GPs can play a critical role in championing digital interventions and maximizing the associated benefits. CLINICALTRIAL
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