Feasibility, acceptability and costs of nurse-led Alpha-Stim cranial electrostimulation to treat anxiety and depression in university students

Abstract

Background Only a relatively low proportion of university students seek help for anxiety and depression disorders, partly because they dislike current drug and psychological treatment options and would prefer home-based care. The aim of this study is to determine the feasibility, acceptability and cost utility of Alpha-Stim cranial electrostimulation (CES) delivered through a nurse led primary care clinic as a daily treatment for anxiety and depression symptoms by the student at home in contrast to usual primary care. Method Feasibility and acceptability of a nurse led clinic offering Alpha-Stim CES in terms of the take up and completion of the six-week course of Alpha-Stim CES. Change in score on the GAD-7 and PHQ-9 as measures of anxiety and depression symptoms at baseline and at 8 weeks following a course of Alpha-Stim CES. Similar evaluation in a non-randomised control group attending a family doctor over the same period. Cost-utility analysis of the nurse led Alpha-Stim CES and family doctor pathways with participants failing to improve following further NICE Guideline clinical care (facilitated self-help and cognitive behaviour therapy). Results Of 47 students (mean age 22.1, years, 79% female opting for Alpha-Stim CES at the nurse-led clinic 46 (97.9%) completed a 6-week daily course. Forty-seven (47) students comprised a comparison group receiving usual family doctor care. Both Alpha-Stim CES and usual family doctor care were associated with large effect size reductions in GAD-7 and PHQ-9 scores from baseline to 8 weeks. There were no adverse effects and only one participant showed a clinically important deterioration in the Alpha-Stim group. In the cost utility analysis, Alpha-Stim CES was a cheaper option than usual family doctor care under all deterministic or probabilistic assumptions. Conclusion Nurse delivered Alpha-Stim CES may be a feasible, acceptable and cheaper way of providing greater choice and home-based care for some university students seeking help from primary care with new presentations of anxiety and depression.

Alpha-Stim AID Cranial Electrotherapy Stimulation (CES) for Anxiety Treatment: Outcomes in a Community Healthcare Service

“…The significant improvements in anxiety align with published RCT findings and service based study results (Barclay & Barclay, 2014;Shekelle et al, 2018;Morriss et al, 2019;Griffiths et al, 2021;Royal et al, 2022). This current study's positive remission and reliable improvement rates add to evidence from three other NHS service based Alpha-Stim studies (Morriss et al, 2019;Griffiths et al, 2021;Royal et al, 2022).…”

“…Alpha-Stim CES has been delivered through a UK based primary care social prescribing service and evaluation of outcomes found it to be effective in reducing anxiety and depression symptoms and improving health related quality of life; it was found that Alpha-Stim AID was acceptable to most patients, most used as instructed and returned it following use (Griffiths et al, 2021). Delivering Alpha-stim through a nurse led primary care clinic to univer-sity students with a clinical diagnosis of anxiety or depression was found to be acceptable and feasible; improvements in anxiety and depression symptoms were found, and it was calculated to be cheaper than treatment through a general practitioner (GP) (Royal et al, 2022).…”

The experience of using Alpha-Stim AID cranial electrotherapy stimulation (CES) for symptoms of anxiety

“…Participants found engagement with the Alpha-Stim AID was enabled through the useability of the device, in that it was accessible, easy to use, reliable, could be embedded into their daily routine, and did not have any adverse side effects preventing use; these factors promoted treatment compliance. The findings add to and align with evidence of useability, feasibility, ease of use, and lack of side effects found in other studies (Barclay & Barclay, 2014;Griffiths et al, 2021;Morriss et al, 2019;Royal et al, 2022;Shekelle et al, 2018). Medication side-effects can cause treatment failure (Sundbom & Bingefors, 2013); and the lack of Alpha-Stim AID side effects meant that some participants perceived the Alpha-Stim AID as a preferred alternative to medication.…”

“…The participants described reductions in their anxiety and panic attacks, and increases in feelings of calmness and relaxation. This supports evidence from quantitative research, which found Alpha-Stim AID significantly reduces anxiety symptoms (Barclay & Barclay, 2014;Griffiths et al, 2021;Morriss et al, 2019;Royal et al, 2022;Shekelle et al, 2018). Participants reported improvements in sleep quality and duration.…”

“…A study in primary care NHS patients experiencing anxiety symptoms reported significant improvements in anxiety, depression, and quality of life (Griffiths et al, 2021), as did a study set in an NHS Improving Access to Psychology Treatment (IAPT) service with patients diagnosed with GAD (Morriss et al, 2019). Providing Alpha-Stim AID through a nurse-led primary care clinic to university students with a diagnosis of anxiety or depression delivered improvements in anxiety and depression symptoms (Royal et al, 2022). These studies indicate that Alpha-Stim AID is safe, well-tolerated, and acceptable to the majority of patients, and the majority of patients will conform to the required treatment protocol.…”