Online Problem-Solving Training with and without Peer Support in Veterans with Unmet Mental Health Needs: A Pilot Study of Feasibility, User Acceptability and Patient Engagement (Preprint)

BACKGROUND Electronic health (eHealth) tools have the potential to meet the mental health needs of individuals who have barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase engagement with eHealth. OBJECTIVE This pilot study aimed to 1) test the feasibility and acceptability of a novel, completely automated online system to recruit, screen, enroll, assess, randomize and then deliver an intervention to a national sample of military veterans with unmet mental health needs, 2) investigate whether phone-based peer support increased usage of an online problem-solving training compared to self-directed use and 3) generate hypotheses about potential mechanisms of action for problem-solving and peer support for future full-scale research. METHODS Veterans (n=81) with unmet mental health needs were recruited via social media advertising and enrolled and randomized to self-directed use of an online problem-solving training called Moving Forward (n=28), peer supported Moving Forward (n=27), or a waitlist control (n=26) (ClinicalTrials.gov NCT03555435). Participants completed pre and post study measures (8 weeks later) of problem-solving skills and confidence as well as mental health symptoms. Satisfaction was assessed at post-treatment and objective use of Moving Forward was measured with number of log-ins. RESULTS Automated recruitment, enrollment and initial assessment methods were feasible and resulted in a diverse sample of veterans with unmet mental health needs from 38 states. Automated follow-up methods resulted in 46% retention. Peer support was delivered with high fidelity and was associated with favorable patient satisfaction. Participants randomized to receive peer support had significantly more Moving Forward logins than self-directed Moving Forward participants, and those who received peer support had greater decreases in depression. Problem-solving confidence was associated with greater Moving Forward use and improvements in mental health symptoms among participants both with and without peer support. CONCLUSIONS Enrolling and assessing individuals in eHealth studies without human contact is feasible, but different methods or designs are necessary to achieve acceptable participant engagement and follow-up rates. Peer support shows potential for increasing engagement in online interventions and in reducing symptoms. Future research should investigate when and for whom peer support of eHealth is helpful. Problem-solving confidence should be further investigated as a mechanism of action for online problem-solving training. CLINICALTRIAL ClinicalTrials.gov NCT03555435

Download Full-text

Online Problem-Solving Training with and without Peer Support in Veterans with Unmet Mental Health Needs: A Pilot Study of Feasibility, User Acceptability and Participant Engagement (Preprint)

Journal of Medical Internet Research ◽

10.2196/29559 ◽

2021 ◽

Author(s):

Kyle Possemato ◽

Justina Wu ◽

Carolyn Greene ◽

Rex MacQueen ◽

Daniel Blonigen ◽

...

Keyword(s):

Mental Health ◽

Pilot Study ◽

Problem Solving ◽

Peer Support ◽

Health Needs ◽

Mental Health Needs ◽

Participant Engagement ◽

User Acceptability ◽

Unmet Mental Health

Download Full-text

Exploring Cancer Screening in the Context of Unmet Mental Health Needs: A Participatory Pilot Study

Progress in Community Health Partnerships Research Education and Action ◽

10.1353/cpr.2013.0023 ◽

2013 ◽

Vol 7 (2) ◽

pp. 111-113 ◽

Cited By ~ 2

Author(s):

Abigail Williams ◽

Jennifer Erb-Downward ◽

Emilie Bruzelius ◽

Ellen O'Hara-Cicero ◽

Alison Maling ◽

...

Keyword(s):

Mental Health ◽

Cancer Screening ◽

Pilot Study ◽

Health Needs ◽

Mental Health Needs ◽

Unmet Mental Health

Download Full-text

Exploring Cancer Screening in the Context of Unmet Mental Health Needs: A Participatory Pilot Study

Progress in Community Health Partnerships Research Education and Action ◽

10.1353/cpr.2013.0027 ◽

2013 ◽

Vol 7 (2) ◽

pp. 123-134 ◽

Cited By ~ 6

Author(s):

Abigail Williams ◽

Jennifer Erb-Downward ◽

Emilie Bruzelius ◽

Ellen O'Hara-Cicero ◽

Alison Maling ◽

...

Keyword(s):

Mental Health ◽

Cancer Screening ◽

Pilot Study ◽

Health Needs ◽

Mental Health Needs ◽

Unmet Mental Health

Download Full-text

Mental Health of Refugees and Torture Survivors: A Critical Review of Prevalence, Predictors, and Integrated Care

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16132309 ◽

2019 ◽

Vol 16 (13) ◽

pp. 2309 ◽

Cited By ~ 6

Author(s):

Abu Suhaiban ◽

Grasser ◽

Javanbakht

Keyword(s):

Mental Health ◽

Integrated Care ◽

Primary Care Physicians ◽

War Trauma ◽

Health Needs ◽

Original Research ◽

Torture Survivors ◽

Mental Health Needs ◽

Mental Health Symptoms ◽

Health Symptoms

Civilian war trauma and torture rank among the most traumatic life experiences; exposure to such experiences is pervasive in nations experiencing both internal and external conflict. This has led to a high volume of refugees resettling throughout the world with mental health needs that primary care physicians may not be screening for and prepared to effectively address. In this article, we review the literature on demographics, predictors, mental health outcomes of torture, and integrated care for the mental health needs of refugees. We searched PubMed and PSYCINFO databases for original research articles on refugees and mental health published in the English language between 2010 and present. Nine percent of 720 adults in conflict areas in Nepal, with predominance of literate married males, met the threshold for Post-Traumatic Stress Disorder (PTSD), 27.5% for depression, and 22.9% for anxiety. While, PTSD rate has been documented as high as 88.3% among torture survivors from Middle East (ME), Central Africa (CA), South Asia (SA), Southeast Europe (SE). Depression was recorded as high as 94.7% among 131 African torture survivors and anxiety as high as 91% among 55 South African torture survivors. Torture severity, post-migration difficulties, and wait time to receive clinical services were significantly associated with higher rate of mental health symptoms. Mental health screening is not a standard component of initial physical exams for refugees, yet these individuals have had high trauma exposure that should inform clinical care. Integrated care models are lacking but would greatly benefit this community to prevent progression to greater severity of mental health symptoms.

Download Full-text

Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs

Sports Medicine - Open ◽

10.1186/s40798-019-0220-1 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 10

Author(s):

Rosemary Purcell ◽

Kate Gwyther ◽

Simon M. Rice

Keyword(s):

Mental Health ◽

Mental Health Professionals ◽

Sports Medicine ◽

Elite Athletes ◽

Health Needs ◽

Mental Health Needs ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Health And Wellbeing ◽

The Right

Abstract The current ‘state of play’ in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a comprehensive mental health framework to promote athlete mental health and wellbeing, and respond to the needs of athletes who are at-risk of developing, or already experiencing mental health symptoms or disorders. Early detection of, and intervention for, mental health symptoms is essential in the elite sporting context. Such approaches help build cultures that acknowledge that an athlete’s mental health needs are as important as their physical health needs, and that both are likely to contribute to optimising the athlete’s overall wellbeing in conjunction with performance excellence. The proposed framework aims at (i) helping athletes develop a range of self-management skills that they can utilise to manage psychological distress, (ii) equipping key stakeholders in the elite sporting environment (such as coaches, sports medicine and high-performance support staff) to better recognise and respond to concerns regarding an athlete’s mental health and (iii) highlighting the need for specialist multi-disciplinary teams or skilled mental health professionals to manage athletes with severe or complex mental disorders. Combined, these components ensure that elite athletes receive the intervention and support that they need at the right time, in the right place, with the right person.

Download Full-text

Effectiveness and costs associated with a lay counselor–delivered, brief problem-solving mental health intervention for adolescents in urban, low-income schools in India: 12-month outcomes of a randomized controlled trial

PLoS Medicine ◽

10.1371/journal.pmed.1003778 ◽

2021 ◽

Vol 18 (9) ◽

pp. e1003778

Author(s):

Kanika Malik ◽

Daniel Michelson ◽

Aoife M. Doyle ◽

Helen A. Weiss ◽

Giulia Greco ◽

...

Keyword(s):

Mental Health ◽

Problem Solving ◽

Low Income ◽

Mental Health Problems ◽

Well Being ◽

Scaling Up ◽

Sensitivity Analyses ◽

Mental Health Symptoms ◽

Health Symptoms

Background Psychosocial interventions for adolescent mental health problems are effective, but evidence on their longer-term outcomes is scarce, especially in low-resource settings. We report on the 12-month sustained effectiveness and costs of scaling up a lay counselor–delivered, transdiagnostic problem-solving intervention for common adolescent mental health problems in low-income schools in New Delhi, India. Methods and findings Participants in the original trial were 250 school-going adolescents (mean [M] age = 15.61 years, standard deviation [SD] = 1.68), including 174 (69.6%) who identified as male. Participants were recruited from 6 government schools over a period of 4 months (August 20 to December 14, 2018) and were selected on the basis of elevated mental health symptoms and distress/functional impairment. A 2-arm, randomized controlled trial design was used to examine the effectiveness of a lay counselor–delivered, problem-solving intervention (4 to 5 sessions over 3 weeks) with supporting printed booklets (intervention arm) in comparison with problem solving delivered via printed booklets alone (control arm), at the original endpoints of 6 and 12 weeks. The protocol was modified, as per the recommendation of the Trial Steering Committee, to include a post hoc extension of the follow-up period to 12 months. Primary outcomes were adolescent-reported psychosocial problems (Youth Top Problems [YTP]) and mental health symptoms (Strengths and Difficulties Questionnaire [SDQ] Total Difficulties scale). Other self-reported outcomes included SDQ subscales, perceived stress, well-being, and remission. The sustained effects of the intervention were estimated at the 12-month endpoint and over 12 months (the latter assumed a constant effect across 3 follow-up points) using a linear mixed model for repeated measures and involving complete case analysis. Sensitivity analyses examined the effect of missing data using multiple imputations. Costs were estimated for delivering the intervention during the trial and from modeling a scale-up scenario, using a retrospective ingredients approach. Out of the 250 original trial participants, 176 (70.4%) adolescents participated in the 12-month follow-up assessment. One adverse event was identified during follow-up and deemed unrelated to the intervention. Evidence was found for intervention effects on both SDQ Total Difficulties and YTP at 12 months (YTP: adjusted mean difference [AMD] = −0.75, 95% confidence interval [CI] = −1.47, −0.03, p = 0.04; SDQ Total Difficulties: AMD = −1.73, 95% CI = −3.47, 0.02, p = 0.05), with stronger effects over 12 months (YTP: AMD = −0.98, 95% CI = −1.51, −0.45, p < 0.001; SDQ Total Difficulties: AMD = −1.23, 95% CI = −2.37, −0.09; p = 0.03). There was also evidence for intervention effects on internalizing symptoms, impairment, perceived stress, and well-being over 12 months. The intervention effect was stable for most outcomes on sensitivity analyses adjusting for missing data; however, for SDQ Total Difficulties and impairment, the effect was slightly attenuated. The per-student cost of delivering the intervention during the trial was $3 United States dollars (USD; or $158 USD per case) and for scaling up the intervention in the modeled scenario was $4 USD (or $23 USD per case). The scaling up cost accounted for 0.4% of the per-student school budget in New Delhi. The main limitations of the study’s methodology were the lack of sample size calculations powered for 12-month follow-up and the absence of cost-effectiveness analyses using the primary outcomes. Conclusions In this study, we observed that a lay counselor–delivered, brief transdiagnostic problem-solving intervention had sustained effects on psychosocial problems and mental health symptoms over the 12-month follow-up period. Scaling up this resource-efficient intervention is an affordable policy goal for improving adolescents’ access to mental health care in low-resource settings. The findings need to be interpreted with caution, as this study was a post hoc extension, and thus, the sample size calculations did not take into account the relatively high attrition rate observed during the long-term follow-up. Trial registration ClinicalTrials.gov NCT03630471.

Download Full-text

Bridging Hospital and Community Care for Homeless Adults with Mental Health Needs: Outcomes of a Brief Interdisciplinary Intervention

The Canadian Journal of Psychiatry ◽

10.1177/0706743718772539 ◽

2018 ◽

Vol 63 (11) ◽

pp. 774-784 ◽

Cited By ~ 3

Author(s):

Vicky Stergiopoulos ◽

Agnes Gozdzik ◽

Rosane Nisenbaum ◽

Janet Durbin ◽

Stephen W. Hwang ◽

...

Keyword(s):

Mental Health ◽

Service Use ◽

Health Needs ◽

Mental Health Needs ◽

Mental Health Symptoms ◽

Homeless Adults ◽

Health Symptoms ◽

Discharge From Hospital ◽

Post Hoc ◽

Interdisciplinary Intervention

Objective: This study examines health and service use outcomes and associated factors among homeless adults participating in a brief interdisciplinary intervention following discharge from hospital. Method: Using a pre-post cohort design, 223 homeless adults with mental health needs were enrolled in the Coordinated Access to Care for the Homeless (CATCH) program, a 4- to 6-month interdisciplinary intervention offering case management, peer support, access to primary psychiatric care, and supplementary community services. Study participants were interviewed at program entry and at 3- and 6-month follow-up visits and assessed for health status, acute care service use, housing outcomes, mental health, substance use, quality of life, and their working alliance with service providers. Linear mixed models and generalized estimating equations were performed to examine outcomes longitudinally. Additional post hoc analyses evaluated differences between CATCH participants and a comparison group of homeless adults experiencing mental illness who received usual services over the same period. Results: In the pre-post analyses, CATCH participants had statistically significant improvements in mental and physical health status and reductions in mental health symptoms, substance misuse, and the number of hospital admissions. The strength of the working alliance between participants and their case manager was associated with reduced health care use and mental health symptoms. Post hoc analyses suggest that CATCH may be associated with statistically significant improvements in mental health symptoms in the study population. Conclusions: A brief interdisciplinary intervention may be a promising approach to improving health outcomes among homeless adults with unmet health needs. Further rigorous research is needed into the effectiveness of brief interventions following discharge from hospital.

Download Full-text