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)

Adherence to the MoodGYM program: Outcomes and predictors for an adolescent school-based population

Background Program adherence has been associated with improved intervention outcomes for mental and physical conditions. The aim of the current study is to investigate adolescent adherence to an Internet-based depression prevention program in schools to identify the effect of adherence on outcomes and to ascertain the predictors of program adherence. Methods Data for the current study (N=1477) was drawn from the YouthMood Project, which was conducted to test the effectiveness of the MoodGYM program in reducing and preventing symptoms of anxiety and depression in an adolescent school-based population. The current study compares intervention effects across three sub-groups: high adherers, low adherers and the wait-list control condition. Results When compared to the control condition, participants in the high adherence intervention group reported stronger intervention effects at post-intervention and 6-month follow-up than participants in the low adherence group for anxiety (d=0.34–0.39 vs. 0.11–0.22), and male (d=0.43–0.59 vs. 0.26–0.35) and female depression (d=0.13–0.20 vs. 0.02–0.04). No significant intervention effects were identified between the high and low adherence groups. Being in Year 9, living in a rural location and having higher pre-intervention levels of depressive symptoms or self-esteem were predictive of greater adherence to the MoodGYM program. Limitations The program trialled is Internet-based and therefore the predictors of adherence identified may not generalise to face-to-face interventions. Conclusions The current study provides preliminary support for the positive relationship between program adherence and outcomes in a school environment. The identification of significant predictors of adherence will assist in identifying the type of user who will engage most with an online depression prevention program.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 42541

An enterprise search paradigm based on extended query auto-completion: do we still need search and navigation?

Enterprise query auto-completion (QAC) can allow website or intranet visitors to satisfy a need more efficiently than traditional searching and browsing. The limited scope of an enterprise makes it possible to satisfy a high proportion of information needs through completion. Further, the availability of structured sources of completions such as product catalogues compensates for sparsity of log data. Extended forms (X-QAC) can give access to information that is inaccessible via a conventional crawled index. We show that it can be guaranteed that for every suggestion there is a prefix which causes it to appear in the top k suggestions. Using university query logs and structured lists, we quantify the significant keystroke savings attributable to this guarantee (worst case). Such savings may be of particular value for mobile devices. A user experiment showed that a staff lookup task took an average of 61% longer with a conventional search interface than with an X-QAC system. Using wine catalogue data we demonstrate a further extension which allows a user to home in on desired items in faceted-navigation style. We also note that advertisements can be triggered from QAC. Given the advantages and power of X-QAC systems, we envisage that websites and intranets of the [near] future will provide less navigation and rely less on conventional search

The DiSCmap project : digitisation of special collections: mapping, assessment, prioritisation

The paper presents the outcomes of DiSCmap, a JISC and RIN-funded project which aimed to study users' priorities for digitisation of special collections within the context of the higher education institutions in the UK. The project produced a 'long list' of 945 collections nominated for digitisation by intermediaries and end users and a user-driven prioritisation framework. Web surveys were used as a tool to gather data in combination with focus groups and telephone interviews with end users helped to get additional insights on their views in particular domains. The project developed an online forum and a group in Facebook in order to find to what extent the social networking technologies can be used to sustain a professional informal community but this did not prove to be successful. Over 1000 specialists took part in the different forms used to gather intermediaries and end users' nominations of collections for the "long list" and opinions about digitisation priorities. The long list of 945 special collections nominated for digitisation can be useful as an evidence of identified user interest; this list is not seen as a "snapshot" but as an outcome which needs to be sustained and further developed in the future. A user-driven framework for prioritizing digitisation was produced; it fits well with the current JISC digitisation strategy, providing a further level of detail on user priorities. The project also suggests a flexible approach for prioritizing collections for digitisation based on the use of the framework in combination with the long list of collections. The project did not make a representative study; the participation of intermediaries and end users was a matter of good will. Yet, special collections from 44% of the higher education institutions in the UK were nominated to the long list. The work on the project provided new insights and evidence on the user priorities in digitisation of special collections. It also suggests a user-driven digitisation prioritization framework which would be of benefit in future decision making

DiSCmap : digitisation of special collections mapping, assessment, prioritisation. Final project report

Traditionally, digitisation has been led by supply rather than demand. While end users are seen as a priority they are not directly consulted about which collections they would like to have made available digitally or why. This can be seen in a wide range of policy documents throughout the cultural heritage sector, where users are positioned as central but where their preferences are assumed rather than solicited. Post-digitisation consultation with end users isequally rare. How are we to know that digitisation is serving the needs of the Higher Education community and is sustainable in the long-term? The 'Digitisation in Special Collections: mapping, assessment and prioritisation' (DiSCmap) project, funded by the Joint Information Systems Committee (JISC) and the Research Information Network (RIN), aimed to:- Identify priority collections for potential digitisation housed within UK Higher Education's libraries, archives and museums as well as faculties and departments.- Assess users' needs and demand for Special Collections to be digitised across all disciplines.- Produce a synthesis of available knowledge about users' needs with regard to usability and format of digitised resources.- Provide recommendations for a strategic approach to digitisation within the wider context and activity of leading players both in the public and commercial sector.The project was carried out jointly by the Centre for Digital Library Research (CDLR) and the Centre for Research in Library and Information Management (CERLIM) and has taken a collaborative approach to the creation of a user-driven digitisation prioritisation framework, encouraging participation and collective engagement between communities.Between September 2008 and March 2009 the DiSCmap project team asked over 1,000 users, including intermediaries (vocational users who take care of collections) and end users (university teachers, researchers and students) a variety of questions about which physical and digital Special Collections they make use of and what criteria they feel must be considered when selecting materials for digitisation. This was achieved through workshops, interviews and two online questionnaires. Although the data gathered from these activities has the limitation of reflecting only a partial view on priorities for digitisation - the view expressed by those institutions who volunteered to take part in the study - DiSCmap was able to develop:- a 'long list' of 945 collections nominated for digitisation both by intermediaries andend-users from 70 HE institutions (see p. 21);- a framework of user-driven prioritisation criteria which could be used to inform current and future digitisation priorities; (see p. 45)- a set of 'short lists' of collections which exemplify the application of user-driven criteria from the prioritisation framework to the long list (see Appendix X):o Collections nominated more than once by various groups of users.o Collections related to a specific policy framework, eg HEFCE's strategically important and vulnerable subjects for Mathematics, Chemistry and Physics.o Collections on specific thematic clusters.o Collections with highest number of reasons for digitisation

The DiSCmap project : overview and first results

Traditionally, digitisation of cultural and scientific heritage material for use by the scholarly community has been led by supply rather than demand. The DiSCmap project commissioned by JISC in 2008, aimed to study what refocussing of digitisation efforts will suit best the users of digitised materials, especially in the context of the research and teaching in the higher education institutions in the UK. The paper presents some of its initial outcomes based on quantitative and qualitative analysis of 945 special collections nominated for digitisation by intermediary users (librarians, archivist and museum curators), as well as end users' study involving a combination of online survey, focus groups and in-depth interviews. The criteria for prioritising digitisation advanced by intermediaries and end users were analysed and cross-mapped to a range of existing digitisation frameworks. A user-driven prioritisation framework which synthesises the findings of the project is presented

Models in the delivery of depression care: a systematic review of randomised and controlled intervention trials

BACKGROUND: There is still debate as to which features, types or components of primary care interventions are associated with improved depression outcomes. Previous reviews have focused on components of collaborative care models in general practice settings. This paper aims to determine the effective components of depression care in primary care through a systematic examination of both general practice and community based intervention trials. METHODS: Fifty five randomised and controlled research trials which focused on adults and contained depression outcome measures were identified through PubMed, PsycInfo and the Cochrane Central Register of Controlled Trials databases. Trials were classified according to the components involved in the delivery of treatment, the type of treatment, the primary focus or setting of the study, detailed features of delivery, and the discipline of the professional providing the treatment. The primary outcome measure was significant improvement on the key depression measure. RESULTS: Components which were found to significantly predict improvement were the revision of professional roles, the provision of a case manager who provided direct feedback and delivered a psychological therapy, and an intervention that incorporated patient preferences into care. Nurse, psychologist and psychiatrist delivered care were effective, but pharmacist delivery was not. Training directed to general practitioners was significantly less successful than interventions that did not have training as the most important intervention. Community interventions were effective. CONCLUSION: Case management is important in the provision of care in general practice. Certain community models of care (education programs) have potential while others are not successful in their current form (pharmacist monitoring)

Age differences in mental health literacy

BACKGROUND: The community's knowledge and beliefs about mental health problems, their risk factors, treatments and sources of help may vary as a function of age. METHODS: Data were taken from an epidemiological survey conducted during 2003–2004 with a national clustered sample of Australian adults aged 18 years and over. Following the presentation of a vignette describing depression (n = 1001) or schizophrenia (n = 997), respondents were asked a series of questions relating to their knowledge and recognition of the disorder, beliefs about the helpfulness of treating professionals and medical, psychological and lifestyle treatments, and likely causes. RESULTS: Participant age was coded into five categories and cross-tabulated with mental health literacy variables. Comparisons between age groups revealed that although older adults (70+ years) were poorer than younger age groups at correctly recognising depression and schizophrenia, young adults (18–24 years) were more likely to misidentify schizophrenia as depression. Differences were also observed between younger and older age groups in terms of beliefs about the helpfulness of certain treating professionals and medical and lifestyle treatments for depression and schizophrenia, and older respondents were more likely to believe that schizophrenia could be caused by character weakness. CONCLUSION: Differences in mental health literacy across the adult lifespan suggest that more specific, age appropriate messages about mental health are required for younger and older age groups. The tendency for young adults to 'over-identify' depression signals the need for awareness campaigns to focus on differentiation between mental disorders

Unmet depression information needs in the community

Background Despite the well acknowledged importance of consumer health information, little is known about the public’s depression information needs. This study aimed to develop a formal measure of unmet need for depression information in the community, to investigate the level of this unmet need and to identify its predictors. Methods Data were collected as part of a survey of 12,319 Australian adults aged 18–65 years. This survey incorporated 21 questions targeting depression information need, together with measures of demographic status, self-reported current depression and personal stigma. The information needs data were subjected to principal components analysis followed by linear regression analyses to determine the demographic and other predictors of each of the resulting components. Results Between 50 and 75% of participants endorsed the need for more information on each of the 21 information need topics. The PCA yielded a 20-item Depression Information Needs Scale (DINS) of high reliability and factor validity comprising four subscales: General (facts about depression), Specific Treatments, Research and Policies, and Lived Experience. Controlling for other factors, those with self-reported current depression and those without tertiary education had greater information needs across all four factors. Limitations The survey response rate was low and further research is required to establish the adequacy of the psychometric properties of the DINS. Conclusions Given the high unmet need for depression information there is a need to develop and implement evidence-based strategies for ensuring the accessibility and uptake of depression information relevant to the needs of members of the community.This study was funded by a National Health and Medical Research Council (NHMRC) Project Grant 471435. K.G. is supported by NHMRC Fellowship no. 525413. The funding body played no further role in any aspect of this study

Self help e-health applications as primart health care tools

With the ageing of the Australian population, the cost of the health care system is projected to grow substantially over the next 30 years [1]. According to the 2008 national e-health strategy maintaining Australia's current good health outcomes in the face of these pressure will require a fundamental change in the way health care is delivered.[2]. E-health technologies offer a promising means for addressing this problem, particularly with respect to delivering high quality evidence-based treatments direct to the consumer. The current report summarises the activities and outcomes of an APHCRI-funded visit to Australia by Dr Lee Ritterband, an international expert in the field of e-health self help technologies for improving health outcomes. In this report, primary health care is interpreted broadly to refer to the provision of first level care in any setting including the delivery of self-help e-health services direct to the public.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy