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

Anxiety Symptoms as Precursors of Major Depression and Suicidal Ideation

Background Relative to depression symptoms, the role of anxiety symptoms in the development of depression and suicidal ideation has not been well established. This study aimed to identify the anxiety and depression symptoms that confer the greatest amount of risk for depression and suicidal ideation at the population level. Method The PATH through Life study is an Australian community-based longitudinal cohort study of 7,485 younger, middle-aged, and older adults. Adjusted population attributable risk (PAR) for incident depression and suicidal ideation after 4 years was assessed for 18 symptoms of anxiety and depression. Results Anxiety symptoms contributed greater risk overall to both depression (45%) and suicidal ideation (23%) incidence than depression symptoms (35% and 16%, respectively). Anxiety symptoms had largest PARs among younger age groups. Conclusions Prevention programs for depression and suicide should aim to reduce anxiety symptoms in addition to depression symptoms, and target individuals reporting symptoms such as worrying or irritability. (C) 2013 Wiley Periodicals, Inc

Detecting suicidality on Twitter

Twitter is increasingly investigated as a means of detecting mental health status, including depression and suicidality, in the population. However, validated and reliable methods are not yet fully established. This study aimed to examine whether the level of concern for a suicide-related post on Twitter could be determined based solely on the content of the post, as judged by human coders and then replicated by machine learning. From 18th February 2014 to 23rd April 2014, Twitter was monitored for a series of suicide-related phrases and terms using the public Application Program Interface (API). Matching tweets were stored in a data annotation tool developed by the Commonwealth Scientific and Industrial Research Organisation (CSIRO). During this time, 14,701 suicide-related tweets were collected: 14% were randomly (n = 2000) selected and divided into two equal sets (Set A and B) for coding by human researchers. Overall, 14% of suicide-related tweets were classified as ‘strongly concerning’, with the majority coded as ‘possibly concerning’ (56%) and the remainder (29%) considered ‘safe to ignore’. The overall agreement rate among the human coders was 76% (average κ = 0.55). Machine learning processes were subsequently applied to assess whether a ‘strongly concerning’ tweet could be identified automatically. The computer classifier correctly identified 80% of ‘strongly concerning’ tweets and showed increasing gains in accuracy; however, future improvements are necessary as a plateau was not reached as the amount of data increased. The current study demonstrated that it is possible to distinguish the level of concern among suicide-related tweets, using both human coders and an automatic machine classifier. Importantly, the machine classifier replicated the accuracy of the human coders. The findings confirmed that Twitter is used by individuals to express suicidality and that such posts evoked a level of concern that warranted further investigation. However, the predictive power for actual suicidal behaviour is not yet known and the findings do not directly identify targets for intervention.This project was supported in part by funding from the NSW Mental Health Commission and the NHMRC John Cade Fellowship 1056964. PJB and ALC are supported by the NHMRC Early Career Fellowships 1035262 and 1013199

A systematic review of the predictions of the Interpersonal-Psychological Theory of Suicidal Behavior

CONTEXT Since the development of the Interpersonal Psychological Theory (IPTS; Joiner, 2005), a growing body of literature has emerged testing different aspects of the theory across a range of populations. OBJECTIVE The aim of this review was to identify support for the IPTS, and critical gaps in the evidence base, by systematically reviewing current evidence testing the effects of thwarted belongingness, perceived burdensomeness, and acquired capability on suicide ideation and attempt. METHODS PsycInfo and PubMed databases were electronically searched for articles published between January 2005 and July 2015. Articles were included if they directly assessed the IPTS constructs as predictors of suicidal ideation or suicide attempt. RESULTS Fifty-eight articles reporting on 66 studies were identified. Contrary to expectations, the studies provided mixed evidence across the theory's main predictions. The effect of perceived burdensomeness on suicide ideation was the most tested and supported relationship. The theory's other predictions, particularly in terms of critical interaction effects, were less strongly supported. CONCLUSIONS Future research focused on expanding the availability of valid measurement approaches for the interpersonal risk factors, and further elaborating upon their mixed relationships with suicide ideation and attempt across multiple populations is important to advance theoretical and clinical progress in the field

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 association between suicidal ideation and increased mortality from natural causes

Background: Despite strong evidence for increased suicide mortality among individuals experiencing thoughts of suicide, the effect of suicidal ideation on increased natural mortality has not been evaluated. The present study aimed to assess whether there is excess mortality from all natural causes or from specific natural causes that is attributable to suicidal ideation. Adjustments were made for a range of demographic, mental health and physical health measures to examine evidence for specific mechanisms of the relationship. Method: A community-based Australian cohort of 861 older adults was followed for up to 17 years. Vital status and cause of death were ascertained from a national death registry. Results: After adjusting for demographics, physical health and mental health, presence of suicidal ideation was associated with a 23% increase in the risk of mortality from natural causes (p=0.034). The increased mortality was largely attributable to heart disease deaths (hazard ratio=1A3, p=0.041). Limitations: There was a limited number of deaths from respiratory disease or stroke, and modest rates of suicidal ideation in the cohort. Assessment of suicidal ideation was brief, while adjustment for mental health symptoms relied on non-diagnostic measures. Conclusions: Although the relationship between suicidal ideation and mortality from natural causes was partly explained by physical and mental health status, thoughts of suicide independently accounted for an increased risk of mortality. Further research should examine whether this relationship is mediated by poorer health behaviours among individuals experiencing thoughts of suicide. (C) 2013 Elsevier B.V. All rights reserved

Hierarchical screening for multiple mental disorders

Background: There is a need for brief, accurate screening when assessing multiple mental disorders. Two-stage hierarchical screening, consisting of brief pre-screening followed by a battery of disorder-specific scales for those who meet diagnostic criteria, may increase the efficiency of screening without sacrificing precision. This study tested whether more efficient screening could be gained using two-stage hierarchical screening than by administering multiple separate tests. Method: Two Australian adult samples (N=1990) with high rates of psychopathology were recruited using Facebook advertising to examine four methods of hierarchical screening for four mental disorders: major depressive disorder, generalised anxiety disorder, panic disorder and social phobia. Results: Using K6 scores to determine whether full screening was required did not increase screening efficiency. However, pre-screening based on two decision tree approaches or item gating led to considerable reductions in the mean number of items presented per disorder screened, with estimated item reductions of up to 54%. The sensitivity of these hierarchical methods approached 100% relative to the full screening battery. Limitations: Further testing of the hierarchical screening approach based on clinical criteria and in other samples is warranted. Conclusions: The results demonstrate that a two-phase hierarchical approach to screening multiple mental disorders leads to considerable increases efficiency gains without reducing accuracy. Screening programs should take advantage of prescreeners based on gating items or decision trees to reduce the burden on respondents. (C) 2013 Elsevier B.V. All rights reserved

Development and pilot evaluation of an online psychoeducational program for suicide prevention among university students: A randomised controlled trial

Introduction Suicide is the second leading cause of death for the university aged population globally. A significant proportion of students with suicidal ideation or behaviours do not seek professional help. Few primary suicide prevention programs have specifically targeted help seeking for suicidal ideation or behaviours among university students. Methods This study reported the development and pilot test of a brief, two-module online psychoeducational program (ProHelp) that aimed to encourage help seeking for suicidal ideation and behaviours among university students. The program consists of two five-minute modules that address the risk factors and warning signs of suicide, stigmatising attitudes, and perceived barriers to help seeking. 156 Chinese university students and 101 Australian university students were recruited to evaluate the effectiveness of this program at post-test and one-month follow-up. Participants were randomly assigned to the psychoeducational program or an attention control program. Results Of the Chinese and Australian students who were randomised into the study, around 50% completed the two­day post­test survey, and 30% completed the one-month follow­up survey. Although no significant difference was found between the control and experimental group on professional help-seeking beliefs and intentions, both groups' help-seeking attitudes increased during the study (p = 0.003 for the post­test survey, and p = 0.008 for the follow­up survey). The experimental group in both countries demonstrated a significant improvement in suicide literacy at the post-test survey (p = 0.015) compared to control. Qualitative feedback indicated that the ProHelp program was user-friendly, clear, and helpful. Conclusions This study provides initial evidence that a brief online psychoeducational program could enhance university students' suicide literacy in both China and Australia. It also suggests that increasing suicide literacy might not be sufficient to improve students' help seeking, although effect sizes indicated that this low­intensity online approach shows promise in encouraging more positive beliefs towards help seeking and preparedness to help individuals with suicidal ideation among young people

Recruiting for health, medical or psychosocial research using Facebook: systematic review

Recruiting participants is a challenge for many health, medical and psychosocial research projects. One tool more frequently being used to improve recruitment is the social networking website Facebook. A systematic review was conducted to identify studies that have used Facebook to recruit participants of all ages, to any psychosocial, health or medical research. 110 unique studies that used Facebook as a recruitment source were included in the review. The majority of studies used a cross-sectional design (80%) and addressed a physical health or disease issue (57%). Half (49%) of the included studies reported specific details of the Facebook recruitment process. Researchers paid between $1.36 and$110 per completing participants (Mean = $17.48, SD =$23.06). Among studies that examined the representativeness of their sample, the majority concluded (86%) their Facebook-recruited samples were similarly representative of samples recruited via traditional methods. These results indicate that Facebook is an effective and cost-efficient recruitment method. Researchers should consider their target group, advertisement wording, offering incentives and no-cost methods of recruitment when considering Facebook as a recruitment source. It is hoped this review will assist researchers to make decisions regarding the use of Facebook as a recruitment tool in future research.PJB, FKL and ALC are supported by NHMRC fellowships. LKT is supported by a University of New South Wales Vice-Chancellor Postdoctoral Fellowship