Internet-based CBT for depression with and without telephone tracking in a national helpline: randomised controlled trial

BACKGROUND Telephone helplines are frequently and repeatedly used by individuals with chronic mental health problems and web interventions may be an effective tool for reducing depression in this population. AIM To evaluate the effectiveness of a 6 week, web-based cognitive behaviour therapy (CBT) intervention with and without proactive weekly telephone tracking in the reduction of depression in callers to a helpline service. METHOD 155 callers to a national helpline service with moderate to high psychological distress were recruited and randomised to receive either Internet CBT plus weekly telephone follow-up; Internet CBT only; weekly telephone follow-up only; or treatment as usual. RESULTS Depression was lower in participants in the web intervention conditions both with and without telephone tracking compared to the treatment as usual condition both at post intervention and at 6 month follow-up. Telephone tracking provided by a lay telephone counsellor did not confer any additional advantage in terms of symptom reduction or adherence. CONCLUSIONS A web-based CBT program is effective both with and without telephone tracking for reducing depression in callers to a national helpline. TRIAL REGISTRATION Controlled-Trials.comISRCTN93903959.Funding for the trial was provided by an Australian Research Council Linkage Project Grant (LP0667970) (http://www.arc.gov.au/). LF is supported by an Australian Postgraduate Award Industry scholarship. KG is supported by a National Health and Medical Research Council Fellowship (No. 525413) and HC is supported by a National Health and Medical Research Council Fellowship (No. 525411)

Protocol for a randomised controlled trial investigating the effectiveness of an online e health application for the prevention of Generalised Anxiety Disorder

BACKGROUND Generalised Anxiety Disorder (GAD) is a highly prevalent psychiatric disorder. Effective prevention in young adulthood has the potential to reduce the prevalence of the disorder, to reduce disability and lower the costs of the disorder to the community. The present trial (the WebGAD trial) aims to evaluate the effectiveness of an evidence-based online prevention website for GAD. METHODS/DESIGN The principal clinical question under investigation is the effectiveness of an online GAD intervention (E-couch) using a community-based sample. We examine whether the effect of the intervention can be maximised by either human support, in the form of telephone calls, or by automated support through emails. The primary outcome will be a reduction in symptoms on the GAD-7 in the active arms relative to the non active intervention arms. DISCUSSION The WebGAD trial will be the first to evaluate the use of an internet-based cognitive behavioural therapy (CBT) program contrasted with a credible control condition for the prevention of GAD and the first formal RCT evaluation of a web-based program for GAD using community recruitment. In general, internet-based CBT programs have been shown to be effective for the treatment of other anxiety disorders such as Post Traumatic Stress Disorder, Social Phobia, Panic Disorder and stress in clinical trials; however there is no evidence for the use of internet CBT in the prevention of GAD. Given the severe shortage of therapists identified in Australia and overseas, and the low rates of treatment seeking in those with a mental illness, the successful implementation of this protocol has important practical outcomes. If found to be effective, WebGAD will provide those experiencing GAD with an easily accessible, free, evidence-based prevention tool which can be promoted and disseminated immediately

The Y-Worri Project: study protocol for a randomized controlled trial

Background: Anxiety disorders are one of the most common psychological problems in adolescents. The school system has been identified as an ideal setting for the implementation of prevention and early intervention programs for anxiety; however, few programs are routinely delivered in schools and little is known about the best delivery methods. The aim of the current project is two-fold: to test the effectiveness of an intervention program for anxiety relative to a control condition, and to compare two methods of implementing the program. Methods/design: This study is a three-arm cluster randomised controlled trial consisting of a wait-list control condition and two intervention conditions evaluating the effectiveness of an Internet-based program for preventing generalised anxiety. The first intervention condition will involve classroom teachers supervising student completion of the intervention program, while the second intervention condition will involve the classroom teacher and an education officer from the local youth mental health centre supervising the program’s completion. At least 30 schools from across Australia will be recruited to the trial, with adolescents aged between 14 and 18 years invited to participate. Participants in the intervention conditions will complete the e-couch Anxiety and Worry program during class periods over six weeks. The primary outcome measure will be a scale reflecting the number and severity of generalised anxiety symptoms, while secondary outcomes will be symptoms of depression, social anxiety and anxiety sensitivity. Data will be collected at pre-intervention, post-intervention, 6- and 12-month follow-up. Intention-to-treat analyses will be conducted. Discussion: If demonstrated effective, a new service delivery model for the implementation of mental health programs in schools could be indicated. Such a model would significantly contribute to the mental health of young people in Australia by providing preventive interventions for mental health problems and consequently reducing the need for clinical services.This study is funded by the Vincent Fairfax Family Foundation, headspace: Australia’s National Youth Mental Health Foundation and the Brain and Mind Research Institute. ALC is supported by National Health and Medical Research Council (NHMRC) Fellowship 1013199, HC is supported by NHMRC Fellowship 525411, and KMG is supported by NHMRC Fellowship 425413. We would like to acknowledge Alison Parsons as the trial manager for the YWorri Project, and the ANU e-hub IT team for their assistance in setting up the trial infrastructure

The effect of a web based depression intervention on suicide ideation: secondary outcome from a randomised controlled trial in a helpline

Objectives: The effect of web-based interventions for depression on suicide ideation in callers to helplines is not known. The aim of this study was to determine if web-based Cognitive Behaviour Therapy (CBT) with and without telephone support is effective in reducing suicide ideation in callers to a helpline compared with treatment as usual (TAU). A secondary aim was to examine the factors that predict change in suicide ideation. Putative predictors included level of baseline depression, suicide behaviour, baseline anxiety and type of intervention. Design: Randomised controlled trial. Setting: Lifeline, Australia’s 24 h telephone counselling service participants: 155 callers to a national helpline service with moderate-to-high psychological distress. Interventions: Participants were recruited and randomised to receive either 6 weeks of internet CBT plus weekly telephone follow-up; internet CBT only; weekly telephone follow-up only or a wait-list TAU control group. Primary and secondary outcome measures: Suicidal ideation was measured using four items from the 28-item General Health Questionnaire. Predictors of change in ideation were tested using logistic regression analysis. Results: Regardless of the intervention condition, participants showed significant reductions in suicidal ideation over 12 months (p<0.001). Higher baseline suicidal behaviour decreased the odds of remission of suicidal ideation at postintervention (OR 0.409, p<0.001). However, change in depression over the course of the interventions was associated with improvement in suicide ideation (OR 1.165, p<0.001). Conclusions: Suicide ideation declines with and without proactive intervention. Improvements in depression are associated with the resolution of suicide ideation. Specific interventions focusing on suicide ideation should be further investigated.Australian Research Council Linkage Grant (LP0667970), 2006, 3 years, $279 325 (Christensen, Griffiths, Mackinnon, Smith), Internet technologies, health informatics, and statistical models, and new delivery platforms in call centres (CIA). HC and PB were supported by NHMRC 525411 and NHMRC Early Career Fellowship 1035262. KMG is supported by NHMRC Fellowship No. 525413

The mental health of Australian elite athletes

OBJECTIVES: Currently, little is known about the prevalence of mental disorders in athletes. This study aims to investigate Australian elite athletes' symptoms of general psychological distress and common mental disorders. DESIGN: A cross-sectional survey design was employed to assess self-reported symptom prevalence. METHODS: A total of 224 elite athletes (118 female, 106 male) from national sporting organisations in Australia were administered a self-report internet-based survey comprising measures of demographic status and mental health symptoms. RESULTS Overall, 46.4% of athletes were experiencing symptoms of at least one of the mental health problems assessed. Percentages meeting criteria for mental disorders were similar to previous epidemiological studies of both international athlete and community samples: depression (27.2%), eating disorder (22.8%), general psychological distress (16.5%), social anxiety (14.7%), generalised anxiety disorder (7.1%), and panic disorder (4.5%). Injured athletes had higher levels of both symptoms of depression (t=3.23, p=.001) and generalised anxiety disorder (t=2.26, p=.025). CONCLUSIONS: The level of symptoms of mental health problems reported by elite athletes appears similar to that observed in the community. However, caution must be exercised in interpreting the findings, as possible demographic differences between athletes and comparison population datasets may exist. Furthermore, self-selection of respondents in the present study may have reduced the representativeness of the sample and the validity of the comparisons. Athletes, particularly those currently injured, should be well-supported to seek help for mental disorders through access to mental health professionals.The study was supported by funding from the Australian Institute of Sport (AIS). AG was supported by a joint scholarship from the AIS, the Brain and Mind Research Institute, Orygen, and The Australian National University without which this research could not be possible. KG is supported by National Health and Medical Research Council (NHMRC) Senior Research Fellowship No. 525413. PB is supported by NHMRC Early Career Fellowship 1035262. The AIS provided the funding for the present study and assisted with recruitment but was not involved in the analysis, interpretation or the right to approve or disapprove publication of the research

Allometry of sodium requirements and mineral lick use among herbivorous mammals

Sodium (Na) plays a critical role in the functioning of terrestrial ecosystems. In Na-poor regions, plant consumers may experience Na deficiency and adapt by seeking supplementary Na resources. This can markedly impact animal behavior, space-use, and co-existence, with concomitant impacts on ecosystems. Many studies have noted that Na-seeking behaviors, such as soil consumption from mineral licks, are predominately observed for larger-bodied herbivores. However, the mechanisms that drive interspecific variation in Na deficiency and mineral lick use remain poorly understood. Here, we examine whether allometric scaling of Na requirements can explain variation in mineral lick use by herbivorous and omnivorous mammals. We 1) collated data from published literature to derive an allometric scaling of Na requirements in mammals, 2) compared predicted Na requirements to estimated Na intake of mammal communities in three globally distant sites: the Peruvian Amazon, Kalahari Desert, and Malaysian Borneo and 3) examined the relationship between predicted Na deficiency and mineral lick use utilizing camera-trap and mammal abundance data at each site. We found that minimum daily Na maintenance requirements in mammals scaled allometrically at a higher factor (BM0.91 (CI: 0.80–1.0)) than that of food and water Na intake (BM0.71–0.79), indicating that larger species may be more susceptible to Na limitation. This aligned with a positive association between mineral lick use and body mass (BM), as well as Na deficiency, by species at all sites, and increased artificial salt and mineral lick consumption by larger-bodied mammals in the Kalahari. Our results suggest that larger herbivores may be more sensitive to anthropogenic impacts to Na availability, which may alter their functional roles in ecosystems, particularly in Na-poor regions. Further research is needed to explore the consequences of changing Na availability on animals and ecosystems, as well as advance our understanding of Na physiology in mammals

Population genomics and phylogeography of a benthic coastal shark (Scyliorhinus canicula) using 2b-RAD single nucleotide polymorphisms

The existence of strong genetic structure is expected in species with limited ability to disperse and philopatric behaviour. These life-history traits are found in many small benthic elasmobranchs, such as in the small-spotted catshark (Scyliorhinus canicula). However, no evidence of genetic structure was found across its northeastern Atlantic (NEA) range using traditional molecular markers. Here, fine-scale genetic differentiation was detected between the British Isles and southern Iberia using 2674 single nucleotide polymorphism loci generated using 2b-restriction site-associated DNA (2b-RAD). Geographical distance and historical demography were two major drivers shaping the distribution of genetic diversity of S. canicula along the NEA. Significant positive spatial autocorrelation of allelic frequencies was detected, with genetic differentiation generally increasing with geographical distance. However, marked genetic divergence of the Celtic Sea and South Portugal collections from their closest neighbours resulted in geographically constrained genetic breaks south of the British Isles and off southwestern Iberia. Historical demographic reconstruction of population pairs across these genetic breaks suggested a scenario of historical isolation before secondary contact, probably related to distinct northern and southern glacial refugia. These results provide new insights into the population structure of S. canicula along the NEA and serve as a reference for benthic elasmobranchs with similar distribution ranges

The ANU WellBeing study: a protocol for a quasi-factorial randomised controlled trial of the effectiveness of an Internet support group and an automated Internet intervention for depression

BACKGROUND Recent projections suggest that by the year 2030 depression will be the primary cause of disease burden among developed countries. Delivery of accessible consumer-focused evidenced-based services may be an important element in reducing this burden. Many consumers report a preference for self-help modes of delivery. The Internet offers a promising modality for delivering such services and there is now evidence that automated professionally developed self-help psychological interventions can be effective. By contrast, despite their popularity, there is little evidence as to the effectiveness of Internet support groups which provide peer-to-peer mutual support. METHODS/DESIGN Members of the community with elevated psychological distress were randomised to receive one of the following: (1) Internet Support Group (ISG) intervention, (2) a multi-module automated psychoeducational and skills Internet Training Program (ITP), (3) a combination of the ISG and ITP, or (4) an Internet Attention Control website (IAC) comprising health and wellbeing information and question and answer modules. Each intervention was 12 weeks long. Assessments were conducted at baseline, post-intervention, 6 and 12 months to examine depressive symptoms, social support, self-esteem, quality of life, depression literacy, stigma and help-seeking for depression. Participants were recruited through a screening postal survey sent to 70,000 Australians aged 18 to 65 years randomly selected from four rural and four metropolitan regions in Australia. DISCUSSION To our knowledge this study is the first randomised controlled trial of the effectiveness of a depression ISG. TRIAL REGISTRATION Current Controlled Trials ISRCTN65657330.This study was funded by a National Health and Medical Research Council Project Grant 471435 to KG, HC and AM. KG is supported by NHMRC Fellowship No. 525413 and HC is supported by Fellowship No. 525411

A dual lane piezoelectric ring bender actuated nozzle-flapper servo valve for aero engine fuel metering

Amongst many other high performance flow control applications, servo valves are used to control aero engines by metering the fuel delivered from the fuel pump. Conventionally, a fuel metering servo valve has a pilot stage with an electromagnetic torque motor moving a flapper which differentially restricts a pair of nozzles to create a hydraulic signal (i.e. a pressure difference). These valve pilot stages use mature, optimised technology such that to achieve improvements requires a novel approach. Torque motors in particular present reliability and manufacturing difficulties, and news solutions should ultimately allow a reduction in manual assembly and set-up, improve repeatability, and eliminate failures associated with fine wire devices. In this paper, a pilot stage actuated by piezoelectric ring benders is proposed, designed, built and tested, and test results are compared with a model used to predict pressure-flow characteristics. A particular challenge is the need to include redundancy, and thus a pair of ring benders is used, allowing isolation between duplicated electrical control channels. Another challenge is the mounting of the ring bender, which has to flex to allow the outer edge of the ring bender to deform, yet be stiff enough to adequately react against generated forces. O-ring mounts made from three different elastomer materials are compared in this study. In aerospace, an added complication is the large range of fuel temperature; F70 fluorosilicone O-rings have been chosen with this in mind, and successfully demonstrated in the range -50 C to +180 C. With one active and one inactive ring bender to simulate a failure condition, the new dual lane pilot stage achieves +/-50 μm displacement under test, giving control port flows up to +/-0.6 l min -1, and a control port pressure variation of 40 bar using a 100 bar supply pressure difference (supply minus return pressure). This research establishes that a piezoelectric aero engine fuel valve is feasible, and in particular, that piezoelectric ring bender actuators with elastomeric mountings are highly suited to this application. </p