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)

Clickety-Click: e-mental health train on track

Objective: Experts forecast that the Internet will bring about radical change in healthcare. This paper aims to summarise evidence concerning the efficacy of Internet-based programs in the delivery of mental health care and its implications for mental health professionals. It also describes those Internet programs which are both of demonstrated effectiveness in the treatment of anxiety or depression and available without restriction or cost to the public. Conclusions: There is evidence that Internet-based programs can improve a range of mental health conditions. Some of these programs could be used by psychiatrists and other mental health professionals as an adjunct to clinician-based treatment. However, clinicians need to know which programs work and how they can be accessed

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

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

Management or missed opportunity? Mental health care planning in Australian general practice

General practice care plans are designed to improve the management of chronic illness, facilitating multidisciplinary care and enabling GPs and consumers to work collaboratively. Evidence suggests that they work well for chronic physicalillnesses, butitis unclear ifthey operate asintended for people with mental disorders. The aims ofthis study were to: (1) compare rates of creation and review of GP care plans for mental disorders and type II diabetes; and (2) examine consumer experiences. Secondary analysis of 109 589 recorded encounters from a national cross-sectional study in Australian general practice (2006-16) demonstrated that encounters involving creation of a care plan for depression or anxiety were significantly higher than those for diabetes, bipolar disorder and schizophrenia. Rates of review were commensurate with creation of plans for diabetes, but not for mental disorders. Eighteen people with a GP care plan completed an online survey abouttheir experiences, reporting that care plans facilitated accessto allied health professionals, but did not improve the quality of care they received. Findings suggest that care plans are underutilised for people with low prevalence mental disorders, and while they offer financial benefits to consumers, they may not result in ongoing, collaborative care.At the time of the study, M. Banfield was the recipient of an Australian Research Council Discovery Early Career Researcher Award (DE150100637) funded by the Australian Government

Demographic and psychosocial predictors of major depression and generalised anxiety disorder in Australian university students

Abstract Background Few studies have examined modifiable psychosocial risk factors for mental disorders among university students, and of these, none have employed measures that correspond to clinical diagnostic criteria. The aim of this study was to examine psychosocial and demographic risk factors for major depression and generalised anxiety disorder (GAD) in a sample of Australian university students. Methods An anonymous web-based survey was distributed to undergraduate and postgraduate students at a mid-sized Australian university. A range of psychosocial and demographic risk factors were measured, and logistic regression models were used to examine significant predictors of major depression and GAD. Results A total of 611 students completed the survey. The prevalence of major depression and GAD in the sample was 7.9 and 17.5 %, respectively. In terms of demographic factors, the risk of depression was higher for students in their first year of undergraduate study, and the risk of GAD was higher for female students, those who moved to attend university, and students experiencing financial stress. In terms of psychosocial factors, students with experience of body image issues and lack of confidence were at significantly greater risk of major depression, and feeling too much pressure to succeed, lack of confidence, and difficulty coping with study was significantly associated with risk of GAD. Conclusions University students experience a range of unique psychosocial stressors that increase their risk of major depression and GAD, in addition to sociodemographic risk factors. It is important to examine psychosocial factors, as these are potentially modifiable and could be the focus of university-specific mental health interventions.This project was resourced by the Young and Well CRC (youngandwellcrc.org.au). The Young and Well CRC is established under the Australian Government’s Cooperative Research Centres Program. KMG is supported by a National Health and Medical Research Council Fellowship (No.1059620)

A brief intervention to increase uptake and adherence of an online program for depression and anxiety: Protocol for the Enhancing Engagement with Psychosocial Interventions (EEPI) Randomized Controlled Trial

BACKGROUND There is substantial evidence that psychosocial programs delivered online can be effective in treating and preventing mental health problems. However, use of evidence-based programs in the community is currently suboptimal, and there is a lack of evidence around how to increase engagement with existing evidence-based programs. Novel approaches to increasing the acceptability of online programs such as the use of brief engagement-facilitation interventions (EFI) require evaluation. AIMS The aims of this study are to 1) examine the effectiveness of a brief online engagement-facilitation intervention (EFI) presented prior to an online self-help mental health program (myCompass) in improving uptake of and adherence to that program, and 2) assess if greater uptake and/or adherence are associated with improved efficacy (greater reduction in symptoms of depression and anxiety) relative to a control condition). METHODS A three-arm randomized controlled trial will be conducted (target sample: N = 693 participants recruited via social media). An active online cognitive behavioural therapy (iCBT) intervention will be delivered either with (arm 1) or without (arm 2) the EFI. An attention control group (arm 3) will enable testing of the relative efficacy of the iCBT intervention. Primary outcomes are uptake of the intervention (initiation) and adherence (module completion). RESULTS Findings will inform the more efficient dissemination of a range of psychosocial programs into the community, with potential for significant efficiency gains in treating common mental health problems. CONCLUSIONS Greater engagement with online psychosocial programs may lead to significant reductions in the burden of common mental health problems in the community. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001565235.This project is supported by a National Health and Medical Research Fund (NHMRC) grant (#1138713). The lead author can disseminate the results of this trial without the express permission of the funder. PB is supported by NHMRC Fellowship 1083311; ALC is supported by NHMRC Fellowship (#1122544); FK-L is supported by NHMRC Fellowship (#1110371)

University staff mental health literacy, stigma and their experience of students with mental health problems

Despite high rates of mental disorders in university students, very few seek professional help. University teaching staff are well placed to connect students with mental health care. However, little is known about university staff attitudes to and knowledge about mental health problems, or whether these factors influence their experience with and assistance of students with these problems. A total of 224 teaching staff members at the Australian National University, Canberra completed an anonymous online survey via an email link (16.4% response rate from N ~ 1370). Measures included demographic and professional information, experiences with student mental health, knowledge of depression (literacy) and attitudes to depression (stigma). Strength of stigmatising attitude did not predict whether a teaching staff member would approach a student to assist with mental health problems. Teaching staff with higher levels of depression literacy (OR = 1.14, p = 0.007) were more likely to feel sufficiently informed to help students with mental health problems. Ensuring staff complete mental health literacy training and have adequate skills to respond appropriately to students with mental health problems may help in connecting young people to appropriate care in a university contextThis work was supported by the Young and Well CRC (youngandwellcrc.org.au), which was established under the Australian government’s Cooperative Research Centres Programme. Kathleen M. Griffiths was supported by a National Health and Medical Research Council Fellowship (No. 1059620)

A novel multi-component online intervention to improve the mental health of university students: Randomised controlled trial of the Uni Virtual Clinic

Background Of the millions of students enrolled in university, up to 50% will experience a mental disorder. Many of these students do not seek help, and for those who do, university-based services are often over-burdened. Anonymous, evidence-based, online interventions can improve students' access to mental health support. The Uni Virtual Clinic (UVC) is a transdiagnostic online mental health program designed specifically for university students. This paper reports on a randomised controlled trial examining the effectiveness of the UVC in a sample of Australian university students. Methods University students with elevated psychological distress (K10>15; n = 200) were randomised to the UVC intervention or a waitlist control condition for a period of 6 weeks. Baseline, post-intervention, and 3-month follow-up surveys assessed depression, anxiety, self-efficacy, quality of life, adherence, and satisfaction with the UVC intervention. Results Mixed models analysis demonstrated that use of the UVC was associated with small significant reductions in social anxiety and small improvements in academic self-efficacy. The program was not effective in reducing symptoms of depression, anxiety, or psychological distress compared to a control group. The majority of participants in the intervention condition who were retained at follow-up engaged with the program, and most of these participants reported satisfaction with the UVC. Discussion The results suggest that multi-component online interventions such as the UVC have utility in a university environment. Future trials of the UVC should examine the impact of guidance and/or tailoring on treatment efficacy, and the potential role of the UVC in a stepped care model incorporating on-campus services.Funding for this project was provided by an Early Career Researcher Award from the Society for Mental Health Research and the Australian Foundation for Mental Health Research (AFFIRM). LMF is supported by a fellowship from the Australian Research Council, DE190101382. PJB is supported by a fellowship from the National Health and Medical Research Council, 115870