Emma Gliddon

A randomized head to head trial of MoodSwings.net.au: An internet based self-help program for bipolar disorder

BACKGROUND Adjunctive psychosocial interventions are efficacious in bipolar disorder, but their incorporation into routine management plans are often confounded by cost and access constraints. We report here a comparative evaluation of two online programs hosted on a single website (www.moodswings.net.au). A basic version, called MoodSwings (MS), contains psychoeducation material and asynchronous discussion boards; and a more interactive program, MoodSwings Plus (MS-Plus), combined the basic psychoeducation material and discussion boards with elements of Cognitive Behavioral Therapy. These programs were evaluated in a head-to-head study design. METHOD Participants with Bipolar I or II disorder (n=156) were randomized to receive either MoodSwings or MoodSwings-Plus. Outcomes included mood symptoms, the occurrence of relapse, functionality, Locus of Control, social support, quality of life and medication adherence. RESULTS Participants in both groups showed baseline to endpoint reductions in mood symptoms and improvements in functionality, quality of life and medication adherence. The MoodSwings-Plus group showed a greater number of within-group changes on symptoms and functioning in depression and mania, quality of life and social support, across both poles of the illness. MoodSwings-Plus was superior to MoodSwings in improvement on symptoms of mania scores at 12 months (p=0.02) but not on the incidence of recurrence. LIMITATIONS The study did not have an attention control group and therefore could not demonstrate efficacy of the two active arms. There was notable (81%) attrition by 12 months from baseline. CONCLUSION This study suggests that both CBT and psychoeducation delivered online may have utility in the management of bipolar disorder. They are feasible, readily accepted, and associated with improvement.

Staging in bipolar disorder: from theoretical framework to clinical utility

Illness staging is widely utilized in several medical disciplines to help predict course or prognosis, and optimize treatment. Staging models in psychiatry in general, and bipolar disorder in particular, depend on the premise that psychopathology moves along a predictable path: an at‐risk or latency stage, a prodrome progressing to a first clinical threshold episode, and one or more recurrences with the potential to revert or progress to late or end‐stage manifestations. The utility and validity of a staging model for bipolar disorder depend on its linking to clinical outcome, treatment response and neurobiological measures. These include progressive biochemical, neuroimaging and cognitive changes, and potentially stage‐specific differences in response to pharmacological and psychosocial treatments. Mechanistically, staging models imply the presence of an active disease process that, if not remediated, can lead to neuroprogression, a more malignant disease course and functional deterioration. Biological elements thought to be operative in bipolar disorder include a genetic diathesis, physical and psychic trauma, epigenetic changes, altered neurogenesis and apoptosis, mitochondrial dysfunction, inflammation, and oxidative stress. Many available agents, such as lithium, have effects on these targets. Staging models also suggest the utility of stage‐specific treatment approaches that may not only target symptom reduction, but also impede illness neuroprogression. These treatment approaches range from prevention for at‐risk individuals, to early intervention strategies for prodromal and newly diagnosed individuals, complex combination therapy for rapidly recurrent illness, and palliative‐type approaches for those at chronic, late stages of illness. There is hope that prompt initiation of potentially disease modifying therapies may preclude or attenuate the cognitive and structural changes seen in the later stages of bipolar disorder. The aims of this paper are to: a) explore the current level of evidence supporting the descriptive staging of the syndromal pattern of bipolar disorder; b) describe preliminary attempts at validation; c) make recommendations for the direction of further studies; and d) provide a distillation of the potential clinical implications of staging in bipolar disorder within a broader transdiagnostic framework.

Online and mobile technologies for self-management in bipolar disorder: A systematic review.

Objective: Internet (eHealth) and smartphone-based (mHealth) approaches to self-management for bipolar disorder are increasingly common. Evidence-based self-management strategies are available for bipolar disorder and provide a useful framework for reviewing existing eHealth/mHealth programs to determine whether these strategies are supported by current technologies. This review assesses which self-management strategies are most supported by technology. Method: Based on 3 previous studies, 7 categories of self-management strategies related to bipolar disorder were identified, followed by a systematic literature review to identify existing eHealth and mHealth programs for this disorder. Searches were conducted by using PubMed, CINAHL, PsycINFO, EMBASE, and the Cochrane Database of Systematic Reviews for relevant peer-reviewed articles published January 2005 to May 2015. eHealth and mHealth programs were summarized and reviewed to identify which of the 7 self-management strategy categories were supported by eHealth or mHealth programs. Results: From 1,654 publications, 15 papers were identified for inclusion. From these, 9 eHealth programs and 2 mHealth programs were identified. The most commonly supported self-management strategy categories were “ongoing monitoring,” “maintaining hope,” “education,” and “planning for and taking action”; the least commonly supported categories were “relaxation” and “maintaining a healthy lifestyle.” eHealth programs appear to provide more comprehensive coverage of self-management strategies compared with mHealth programs. Conclusions and Implications for Practice: Both eHealth and mHealth programs present a wide range of self-management strategies for bipolar disorder, although individuals seeking comprehensive interventions might be best served by eHealth programs, while those seeking more condensed and direct interventions might prefer mHealth programs.

Online ethics: where will the interface of mental health and the internet lead us?

While e-health initiatives are poised to revolutionize delivery and access to mental health care, conducting clinical research online involves specific contextual and ethical considerations. Face-to-face psychosocial interventions can at times entail risk and have adverse psychoactive effects, something true for online mental health programs too. Risks associated with and specific to internet psychosocial interventions include potential breaches of confidentiality related to online communications (such as unencrypted email), data privacy and security, risks of self-selection and self-diagnosis as well as the shortcomings of receiving psychoeducation and treatment at distance from an impersonal website. Such ethical issues need to be recognized and proactively managed in website and study design as well as treatment implementation. In order for online interventions to succeed, risks and expectations of all involved need to be carefully considered with a focus on ethical integrity.

Progressing MoodSwings. The upgrade and evaluation of MoodSwings 2.0: An online intervention for bipolar disorder

MoodSwings 2.0 is a self-guided online intervention for bipolar disorder. The intervention incorporates technological improvements on an earlier validated version of the intervention (MoodSwings 1.0). The previous MoodSwings trial provides this study with a unique opportunity to progress previous work, whilst being able to take into consideration lesson learnt, and technological enhancements. The structure and technology of MoodSwings 2.0 are described and the relevance to other online health interventions is highlighted. An international team from Australia and the US updated and improved the programs content pursuant to changes in DSM-5, added multimedia components and included larger numbers of participants in the group discussion boards. Greater methodological rigour in this trial includes an attention control condition, quarterly telephone assessments, and red flag alerts for significant clinical change. This paper outlines these improvements, including additional security and safety measures. A 3 arm RCT is currently evaluating the enhanced program to assess the efficacy of MS 2.0; the primary outcome is change in depressive and manic symptoms. To our knowledge this is the first randomized controlled online bipolar study with a discussion board attention control and meets the key methodological criteria for online interventions.

Mental health information online: what we have learned from social media metrics in BuzzFeed’s Mental Health Week

INTRODUCTION The Internet has seen rapid growth in the number of websites focusing on mental health content. Considering the increased need for access to accurate information about mental health treatment, it is important to understand the promotion of this information online. OBJECTIVE To analyze BuzzFeeds Mental Health Week (BFMHW) interactions on its own website and in related social media platforms (Facebook, Twitter and YouTube) using metrics of information delivery in mental health topics. METHODS We extracted social media metrics from the 20 posts with the highest number of BuzzFeed interactions on the BFMHW website and from 41 videos available on the BFMHW playlist created by the BuzzFeed Video profile on YouTube. We analyzed the format and content used in BuzzFeeds publishing methods as well as the following social media metrics: exposure (presence online, views and time online), influence (likes) and engagement (comments, shares, replies and BuzzFeed interactions). RESULTS Analysis of the variables revealed that audience engagement is associated with the number of medias in which the content is published: views on YouTube and shares on Facebook (0.71, p<0.001), total interactions on Facebook (0.66, p<0.001) and BuzzFeed number of total interactions (0.56, p<0.001). CONCLUSIONS Our results suggest that videos on YouTube may be an important information channel, including activity and engagement on other medias such as Facebook. Information may be more effective in reaching the audience if it is delivered in more than one media and includes personal experiences, some humor in content and detailed information about treatment.

A randomized controlled trial of MoodSwings 2.0: An internet-based self-management program for bipolar disorder

MoodSwings 2.0 is an online self‐guided intervention for bipolar disorder that includes educational modules, interactive tools, and discussion forums. The primary aim of the study was to determine if participation in MoodSwings 2.0 would result in decreased symptoms of depression and mania compared to the control condition. Secondary aims were to identify improvements in core depression symptoms, quality of life, medication adherence, functioning, and time to relapse.

An update on adjunctive treatment options for bipolar disorder

Bipolar disorder is a complex illness often requiring combinations of therapies to successfully treat symptoms. In recent years, there have been significant advancements in a number of therapies for bipolar disorder. It is therefore timely to provide an overview of current adjunctive therapeutic options to help treating clinicians to inform their patients and work towards optimal outcomes.

Fostering early and mid-career research in affective disorders.

In the area of affective disorders, the life of an early/mid-career researcher (EMCR; i.e. the first 5–10 years postPhD) has become increasingly difficult. Statistics on the 2014 grant outcomes from Australia’s peak medical funding body, the National Health and Medical Research Council (NHMRC), indicate that in comparison to the 30.1% success rate for senior fellowships, just 22.4% of early career and 13.5% of mid-career fellowship applications were successful. Statistics regarding NHMRC Project Grant outcomes are similarly disheartening, with less than 30% of all successful project grants going to Chief Investigators (CIAs) without a full or Associate Professorship and only 6.5% of successful applications awarded to new investigators (National Health and Medical Research Council, 2014). Moreover, despite wide recognition that depressive disorders are among the leading causes of disease burden worldwide (Ferrari et al., 2013; World Health Organization, 2004), less than five of the 183 early/mid-career fellowships offered went to individuals with projects specifically targeting bipolar or depressive disorders (based on project titles and keywords listed in the summary details of the 17 Oct 2014 Announcement (National Health and Medical Research Council, 2014)). When seated in the context of mental health research in general, compared to other National Health Priority Areas, mental health received only a very small proportion of available grant funding (7.1% compared to 18.3% and 15.3% for cancer and cardiovascular disease, respectively), which suggests that research targeting mental health is underfunded in Australia at this time. This is particularly clear in relation to the support of early/mid scholars working in these areas (National Health and Medical Research Council, 2014). Successful funding for EMCRs is largely determined by academic track record and translation of outcomes. To develop a competitive track record, EMCRs are acutely aware that they need to ‘publish or perish’, ‘make broad collaborations’, ‘cement relationships with industry partners’ – and the list goes on. However, without the proper supportive infrastructure, at best this kind of progression is significantly hampered and, at worst, the impending exodus of imminent research leaders leaves the future of mental health in a state of uncertainty. This is a sentiment echoed elsewhere in the world (Clark, 2014; National Institute of Health, 2014). High-impact research requires good mentorship and funding. Successful funding requires a good track record and collaborations; but, as young researchers, particularly those of us in the first 2–3 years postPhD, we ask ‘Is this really obtainable? Where do we begin? Where do we find genuine support to help us to become legitimately competitive?’. These questions led us to form the Early/Mid-Career Researcher SubCommittee of the Australasian Society for Bipolar and Depressive Disorders (ASBDD). This committee is dedicated to activities aimed at retaining and promoting early-career scholars working in affective disorder research. In a voluntary capacity, the committee, with the support of the ASBDD, will provide a much needed support network for such researchers through ASBDD membership. We believe that for research output in mood disorders to match the needs in the community, a significant increase in career opportunities for EMCRs will be required. Therefore, we aim to foster improved EMCR outcomes by lobbying for affective disorder-specific EMCR fellowship and project grant funding. We also aim to initiate activities that will facilitate EMCR careers, including collaborative Commentaries