Internet-delivered treatment for young adults with anxiety and depression: Evaluation in routine clinical care and comparison with research trial outcomes

Staples, Lauren G.; Dear, Blake F.; Johnson, Bareena; Fogliati, Vincent J.; Gandy, Milena; Fogliati, Rhiannon; Nielssen, Olav; Titov, Nickolai

doi:10.1016/j.jad.2019.05.058

Cited by 20 publications

(11 citation statements)

References 44 publications

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“…In addition, a significant increase in help-seeking behavior was measured in the intervention group compared to the control group at the 3-month follow-up. (3) Staples et al ( 76 ), also used CBT as the intervention type, and found significant reduction in symptoms of depression, anxiety and non-specific psychological distress with large within-group effect size ( d >1.0), high levels of treatment satisfaction and no significant differences between the online intervention group and the routine care group.…”

Section: Resultsmentioning

confidence: 99%

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Online Indicated Preventive Mental Health Interventions for Youth: A Scoping Review

et al. 2021

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Objective: Between the ages of 12 and 25 the onset of mental disorders typically occurs, and the burden of mental health problems is greatest for this group. Indicated preventive interventions to target individuals with subclinical symptoms to prevent the transition to clinical levels of disorders have gained considerable traction. However, the threshold to seek help appears to be high even when help is needed. Online interventions could offer a solution, especially during the COVID-19 pandemic. This scoping review will present an overview of the recent research of indicated online preventive interventions for youth (12–25 years) experiencing the early stages of mental health complaints with the aim of identifying the nature and extent of the research evidence.Methods: The 5-stage framework by Arksey and O'Malley was used. Academic literature published from 2013 onwards in printed or electronic format was included from Scopus, PsychINFO, and Ovid MEDLINE(R) ALL.Results: The search yielded 11,122 results, with the final selection resulting in inclusion of 30 articles for this review. In total, the articles included 4,950 participants. 26.7% of the selected articles focused on youth between 12 and 25 years. Of the articles 60% did not screen for, nor exclude participants with clinical levels of symptoms. Most studies used a common evidence-based therapy for the disorder-category targeted. More than half of the online interventions included some form of human support. Adherence levels ranged between 27.9 and 98%. The results indicate general effectiveness, usability and acceptability of online indicated preventive interventions. The most commonly used approach was CBT (n = 12 studies). Studies varied in their size, rigor of study, effectiveness and outcome measures. Online interventions with a combination of clinical and peer moderation (n = 3 studies) appear to result in the most stable and highest effect sizes.Conclusion: Online indicated preventive mental health interventions for youth with emerging mental health issues show promise in reducing various mental health complaints, and increasing positive mental health indicators such as well-being and resilience. Additionally, high levels of usability and acceptability were found. However, the included studies show important methodological shortcomings. Also, the research has mainly focused on specific diagnostic categories, meaning there is a lack of transdiagnostic approaches. Finally, clear definitions of- as well as instruments to measure- emerging or subclinical mental health symptoms in youth remain are missing.

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Section: Resultsmentioning

confidence: 99%

“…Overall, young people commonly reported high satisfaction and usability of online interventions. For example, high levels of treatment satisfaction were reported ( 76 ). Moreover, safety, reliability ( 53 ) and positive user experience ( 73 ) of online platforms were found.…”

Section: Resultsmentioning

confidence: 99%

Online Indicated Preventive Mental Health Interventions for Youth: A Scoping Review

et al. 2021

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“…The four transdiagnostic courses offered by the MindSpot Clinic are Mood Mechanic (for individuals aged 18–25 years), the Wellbeing Course (26–65 years), Wellbeing Plus (>65 years), and the Indigenous Wellbeing Course (for Aboriginal and Torres Strait Islander people). 14 , 19 , 20 , 21 , 22 These four interventions comprise evidence-based psychological treatment components, including psychoeducation about mediators and moderators of symptoms, cognitive therapy, behavioural activation, graded exposure, sleep training, communication and interpersonal skills, problem solving, and relapse prevention. 19 , 20 MindSpot also offers disorder-specific courses for obsessive compulsive disorder, post-traumatic stress disorder, and chronic pain.…”

Section: Methodsmentioning

confidence: 99%

User characteristics and outcomes from a national digital mental health service: an observational study of registrants of the Australian MindSpot Clinic

Titov

Dear

Nielssen

et al. 2020

The Lancet Digital Health

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Background Interest is growing in digital and telehealth delivery of mental health services, but data are scarce on outcomes in routine care. The federally funded Australian MindSpot Clinic provides online and telephone psychological assessment and treatment services to Australian adults. We aimed to summarise demographic characteristics and treatment outcomes of patients registered with MindSpot over the first 7 years of clinic operation. MethodsWe used an observational design to review all patients who registered for assessment with the MindSpot Clinic between Jan 1, 2013, and Dec 31, 2019. We descriptively analysed the demographics, service preferences, and baseline symptoms of patients. Among patients enrolled in a digital treatment course, we evaluated scales of depression (Patient Health Questionnaire-9 [PHQ-9]) and anxiety (Generalized Anxiety Disorder 7-Item Scale [GAD-7]), as primary measures of treatment outcome, from the screening assessment to post-treatment and a 3 month follow-up. The Kessler Psychological Distress 10-Item Plus Scale was also used to assess changes in general distress and disability, and course satisfaction was measured post-treatment. Outcomes A total of 121 652 screening assessments were started, of which 96 018 (78•9%) were completed. The mean age of patients was 35•7 years (SD 13•8) and 88 702 (72•9%) were women. Based on available assessment data, 36 866 (34•5%) of 106 811 participants had never previously spoken to a health professional about their symptoms, and most people self-reported symptoms of anxiety (88 879 [81•9%] of 108 494) or depression (78 803 [72•6%] of 108 494), either alone or in combination, at baseline. 21 745 patients started treatment in a therapist-guided online course, of whom 14 503 (66•7%) completed treatment (≥four of five lessons). Key trends in service use included an increase in the proportion of people using MindSpot primarily for assessment and information, from 52•6% in 2013 to 66•7% in 2019, while the prop ortion primarily seeking online treatment decreased, from 42•6% in 2013 to 26•7% in 2019. Effect sizes and percentage changes were large for estimated mean scores on the PHQ-9 and GAD-7 from assessment to post-treatment (PHQ-9, Cohen's d effect size 1•40 [95% CI 1•37-1•43]; and GAD-7, 1•45 [1•42-1•47]) and the 3 month follow-up (PHQ-9, 1•36 [1•34-1•38]; and GAD-7, 1•42 [1•40-1•44]); proportions of patients with reliable symptom deterioration (score increase of ≥6 points [PHQ-9] or ≥5 points [GAD-7]) were low post-treatment (of 13 058 respondents, 184 [1•4%] had symptom deterioration on the PHQ-9 and 282 [2•2%] on the GAD-7); and patient satisfaction rates were high (12 452 [96•6%] of 12 895 respondents would recommend the course and 12 433 [96•7%] of 12 860 reported the course worthwhile). We also observed small improvements in disability following treatment as measured by days out of role. Interpretation Our findings indicate improvement in psychological symptoms and positive reception among patients receiving online mental health treatment. ...

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“…The same conclusion has been drawn by separate systematic reviews (Ahern et al, 2018; Andrews et al, 2018; Josephine et al, 2017). The strength of support for iCBT is bolstered further by evidence that trials included in iCBT meta-analyses include severe and complex presentations of depression (see also Bower et al, 2013; Lorenzo-Luaces et al, 2018a) and that effect sizes from controlled trials generalise to everyday practice (Flygare et al, 2020; Staples et al, 2019).…”

Section: Treatmentsmentioning

confidence: 99%

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Malhi

Bell

Bassett³

et al. 2020

Aust N Z J Psychiatry

322

365

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Objectives: To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. Methods: Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. Results: The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. Conclusion: The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Mood disorders committee: Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.

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Internet-delivered treatment for young adults with anxiety and depression: Evaluation in routine clinical care and comparison with research trial outcomes

Cited by 20 publications

References 44 publications

Online Indicated Preventive Mental Health Interventions for Youth: A Scoping Review

Online Indicated Preventive Mental Health Interventions for Youth: A Scoping Review

User characteristics and outcomes from a national digital mental health service: an observational study of registrants of the Australian MindSpot Clinic

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

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