Amy J. Morgan

Participant distress in psychiatric research : a systematic review

BACKGROUND There has been ethical concern that participants in psychiatric research will become distressed and their mental state might worsen. METHOD A systematic search was carried out for studies that examined distress following participation in research that involved the assessment of psychiatric state or associated risk factors. There were 46 relevant studies. RESULTS A minority of participants become distressed immediately after participation, with distress more likely in studies of traumatic experiences. There is limited evidence on longer-term effects, but what there is suggests no adverse impact. Positive reactions to participation show little association with distress and these are more common than negative reactions. Very few studies of distress in research have used control groups to establish causal associations. However, what evidence there is suggests no causal role, including for research on suicidality. Researchers in this area have made a range of suggestions about ethical practice. CONCLUSIONS A minority of participants in psychiatric research become distressed, but there is no evidence of longer-term harm. Nevertheless, researchers need to take account of ethical concerns in designing studies. Future research in the area needs to be carried out with stronger designs involving control groups.

Beliefs about appropriate first aid for young people with mental disorders: findings from an Australian national survey of youth and parents

Objective:  To determine the mental health first‐aid knowledge and beliefs of young people and their parents.

Self-help interventions for depressive disorders and depressive symptoms: a systematic review

BackgroundResearch suggests that depressive disorders exist on a continuum, with subthreshold symptoms causing considerable population burden and increasing individual risk of developing major depressive disorder. An alternative strategy to professional treatment of subthreshold depression is population promotion of effective self-help interventions that can be easily applied by an individual without professional guidance. The evidence for self-help interventions for depressive symptoms is reviewed in the present work, with the aim of identifying promising interventions that could inform future health promotion campaigns or stimulate further research.MethodsA literature search for randomised controlled trials investigating self-help interventions for depressive disorders or depressive symptoms was performed using PubMed, PsycINFO and the Cochrane Database of Systematic Reviews. Reference lists and citations of included studies were also checked. Studies were grouped into those involving participants with depressive disorders or a high level of depressive symptoms, or non-clinically depressed participants not selected for depression. A number of exclusion criteria were applied, including trials with small sample sizes and where the intervention was adjunctive to antidepressants or psychotherapy.ResultsThe majority of interventions searched had no relevant evidence to review. Of the 38 interventions reviewed, the ones with the best evidence of efficacy in depressive disorders were S-adenosylmethionine, St Johns wort, bibliotherapy, computerised interventions, distraction, relaxation training, exercise, pleasant activities, sleep deprivation, and light therapy. A number of other interventions showed promise but had received less research attention. Research in non-clinical samples indicated immediate beneficial effects on depressed mood for distraction, exercise, humour, music, negative air ionisation, and singing; while potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalise to self-help without professional guidance.ConclusionA number of self-help interventions have promising evidence for reducing subthreshold depressive symptoms. Other forms of evidence such as expert consensus may be more appropriate for interventions that are not feasible to evaluate in randomised controlled trials. There needs to be evaluation of whether promotion to the public of effective self-help strategies for subthreshold depressive symptoms could delay or prevent onset of depressive illness, reduce functional impairment, and prevent progression to other undesirable outcomes such as harmful use of substances.

Internet-based recruitment to a depression prevention intervention: lessons from the Mood Memos study.

Background Recruiting participants to randomized controlled trials of health interventions can be very difficult. Internet-based recruitment is becoming an increasingly important mode of recruitment, yet there are few detailed accounts of experiences recruiting participants to mental health interventions. Objective To report on our experience with Internet-based recruitment to an online depression prevention intervention and pass on lessons we learned. Methods Participants were recruited to the Mood Memos study, an online preventive depression intervention, purely through Internet-based sources. The study was targeted to adults with subthreshold depression symptoms from several English-speaking countries. A variety of online recruitment sources were trialed, including search engine advertising (Google, Yahoo!, Bing), Facebook advertising, posts in forums and online noticeboards, and promotion through relevant websites and email newsletters of mental health organizations. Results The study website received visits from 94,808 individuals over the 14-month recruitment period. The recruitment target was reached with 1699 individuals signing up to the randomized controlled trial and 1326 fully enrolling. Most visitors arrived via Google advertising, which promoted a depression-screening questionnaire. Google advertising accounted for nearly half of the total participants who signed up to the study, at an average cost of AUD

Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources

12 per participant. Promoting the study through trustworthy organizations and websites known to participants was also effective. Recruitment techniques that were less effective were contacting forums, email groups, and community noticeboards. Conclusions Several techniques, including Google advertising, were successful in recruiting participants to a trial evaluating an online depression intervention. Results suggest that Internet-based recruitment to mental health interventions is feasible and can be relatively affordable. Trial Registration ACTRN12609000925246

Stigmatising attitudes towards people with mental disorders: a comparison of Australian health professionals with the general community.

BACKGROUND Although mental health information on the internet is often of poor quality, relatively little is known about the quality of websites, such as Wikipedia, that involve participatory information sharing. The aim of this paper was to explore the quality of user-contributed mental health-related information on Wikipedia and compare this with centrally controlled information sources. METHOD Content on 10 mental health-related topics was extracted from 14 frequently accessed websites (including Wikipedia) providing information about depression and schizophrenia, Encyclopaedia Britannica, and a psychiatry textbook. The content was rated by experts according to the following criteria: accuracy, up-to-dateness, breadth of coverage, referencing and readability. RESULTS Ratings varied significantly between resources according to topic. Across all topics, Wikipedia was the most highly rated in all domains except readability. CONCLUSIONS The quality of information on depression and schizophrenia on Wikipedia is generally as good as, or better than, that provided by centrally controlled websites, Encyclopaedia Britannica and a psychiatry textbook.

Email-based promotion of self-help for subthreshold depression: Mood Memos randomised controlled trial

Objective: The aim of this paper was to explore attitudes towards people with mental disorders among Australian health professionals (psychiatrists, psychologists and general practitioners (GPs)) and to compare their attitudes with members of the general community. Methods: The study involved a postal survey of 518 GPs, 506 psychiatrists and 498 clinical psychologists and a telephone survey of 6019 members of the general community. Participants were given a case vignette describing a person with either depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, post-traumatic stress disorder (PTSD) or social phobia and two questionnaires to assess stigmatising attitudes (the Depression Stigma Scale and the Social Distance Scale). Exploratory structural equation modelling was used to elucidate the structure of stigma as measured by the two scales, to establish dimensions of stigma and to compare patterns of association according to gender, age, vignette and professional grouping. Results: The measurement characteristics of stigmatising attitudes in health professionals were found to be comparable to those in members of the general community in social distance and also in personal and perceived attitude stigma, with each forming distinct dimensions and each comprising ‘Weak-not-sick’ and ‘Dangerous/unpredictable’ components. Among health professionals, female gender, age and being a GP were associated with higher scores on the personal stigma scales. Mental health professionals had lower scores on the personal ‘Weak-not-sick’ and ‘Dangerous/unpredictable’ scales than members of the general community, while there were no significant differences in the desire for social distance between health professionals and the general community. Conclusions: While mental health professionals have less stigmatising attitudes than the general public, the greater beliefs in dangerousness and personal weakness by GPs should be addressed.

Self-help strategies that are helpful for sub-threshold depression: A Delphi consensus study

BACKGROUND Subthreshold depression is common, impairs functioning and increases the risk of major depression. Improving self-help coping strategies could help subthreshold depression and prevent major depression. AIMS To test the effectiveness of an automated email-based campaign promoting self-help behaviours. METHOD A randomised controlled trial was conducted through the website: www.moodmemos.com. Participants received automated emails twice weekly for 6 weeks containing advice about self-help strategies. Emails containing general information about depression served as a control. The principal outcome was depression symptom level on the nine-item Patient Health Questionnaire (PHQ-9) (trial registration: ACTRN12609000925246). RESULTS The study recruited 1326 adults with subthreshold depression. There was a small significant difference in depression symptoms at post-intervention, favouring the active group (d = 0.17, 95% CI 0.01-0.34). There was a lower, although non-significant, risk of major depression in the active group (number needed to treat (NNT) 25, 95% CI 11 to ∞ to NNT(harm) 57). CONCLUSIONS Emails promoting self-help strategies were beneficial. Internet delivery of self-help messages affords a low-cost, easily disseminated and highly automated approach for indicated prevention of depression.

First aid strategies that are helpful to young people developing a mental disorder: beliefs of health professionals compared to young people and parents.

BACKGROUND Sub-threshold depressive symptoms cause substantial disability in the population and are often managed with self-help strategies. However, it is unclear which self-help strategies are likely to be helpful and should be encouraged. METHODS The Delphi method was used to assess expert consensus on helpful self-help strategies. An international sample of 63 depression consumers and 34 professionals participated. A literature search found 282 self-help strategies that have been proposed as helpful for depressive symptoms. A systematic review of the evidence was carried out and given to panellists to assist their judgments. Panellists rated the likely helpfulness of each strategy in reducing sub-threshold depressive symptoms. Helpful strategies were then assessed for feasibility of implementation. RESULTS Forty-eight strategies were endorsed by at least 80% of both consumers and professionals as likely to be helpful. Consumers and professionals rated a few strategies quite differently, but overall there was considerable agreement about the types of strategies most likely to be helpful, which were typically lifestyle or psychosocial in nature. Strategies rated helpful but difficult to implement were eliminated from the final list. LIMITATIONS Panellists found rating feasibility difficult and there was limited evidence from trials on which panellists could base their helpfulness ratings. CONCLUSIONS We identified a list of self-help strategies which are likely to be helpful and are feasible to implement by people with sub-threshold depression. The promotion of these strategies to the public needs to be evaluated to see if it could reduce the disability burden of sub-threshold depression.

Helping someone with problem drinking: mental health first aid guidelines - a Delphi expert consensus study

BackgroundLittle is known about the best ways for a member of the public to respond when someone in their social network develops a mental disorder. Controlled trials are not feasible in this area, so expert consensus may be the best guide.MethodsTo assess expert views, postal surveys were carried out with Australian GPs, psychiatrists and psychologists listed on professional registers and with mental health nurses who were members of a professional college. These professionals were asked to rate the helpfulness of 10 potential first aid strategies for young people with one of four disorders: depression, depression with alcohol misuse, social phobia and psychosis. Data were obtained from 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses, with respective response rates of 24%, 35%, 40% and 32%. Data on public views were available from an earlier telephone survey of 3746 Australian youth aged 12–25 years and 2005 of their parents, which included questions about the same strategies.ResultsA clear majority across the four professions believed in the helpfulness of listening to the person, suggesting professional help-seeking, making an appointment for the person to see a GP and asking about suicidal feelings. There was also a clear majority believing in the harmfulness of ignoring the person, suggesting use of alcohol to cope, and talking to them firmly. Compared to health professionals, young people and their parents were less likely to believe that asking about suicidal feelings would be helpful and more likely to believe it would be harmful. They were also less likely to believe that talking to the person firmly would be harmful.ConclusionSeveral first aid strategies can be recommended to the public based on agreement of clinicians about their likely helpfulness. In particular, there needs to be greater public awareness of the helpfulness of asking a young person with a mental health problem about suicidal feelings.