A cluster randomized controlled trial of an online psychoeducational intervention for people with a family history of depression

Llewellyn Mills, Bettina Meiser, Raghib Ahmad, Peter R. Schofield, Michelle Peate, Charlene Levitan, Lyndal Trevena, Kristine Barlow-Stewart, Timothy Dobbins, Helen Christensen, Kerry A. Sherman, Kate Dunlop, Philip B. Mitchell

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: People with a family history of major depressive disorder (MDD) or bipolar disorder (BD) report specific psychoeducational needs that are unmet by existing online interventions. This trial aimed to test whether an interactive website for people at familial risk for depression (intervention) would improve intention to adopt, or actual adoption of, depression prevention strategies (primary outcome) and a range of secondary outcome measures.

Methods: In this cluster randomised trial, primary care practises were randomised to either provide the link to the intervention or the control website. Primary health care attendees were invited by letter to opt into this study if they had at least one first-degree relative with MDD or BD and were asked to complete online questionnaires at baseline and 2-week follow-up.

Results: Twenty general practices were a randomized, and 202 eligible patients completed both questionnaires. Thirty-nine (19.3%) of participants were male and 163 (80.7%) female. At follow-up, compared to controls, the intervention group: (i) were more likely to intend to undergo, or to have actually undergone, psychological therapies (OR = 5.83, 95% CI: 1.58-21.47, p =.008); (ii) had better knowledge of depression risk factors and prevention strategies (mean difference = 0.47, 95% CI: 0.05-0.88, p =.029); and (iii) were more likely to accurately estimate their lifetime risk of developing BD (mean difference = 11.2, 95% CI: -16.52- -5.73, p <.001). There were no statistically significant between-group differences in change from baseline to follow up for any of the remaining outcome measures (Patient Health Questionnaire, Perceived Devaluation-Discrimination Questionnaire and Perceived Risk of Developing MDD).

Conclusion: The opt-in nature of the study may have led to participation bias, e.g. underrepresentation of males, and hence may limit generalisability to the broader population at familial risk for depression. This is the first website internationally focusing specifically on informational needs of those at familial risk of depression. Our interactive website can play an important role in improving the outcomes of individuals at familial risk for depression. Testing the intervention in other settings (e.g. psychology, psychiatry, genetic counselling) appears warranted.

LanguageEnglish
Article number29
Number of pages11
JournalBMC Psychiatry
Volume19
Issue number1
DOIs
Publication statusPublished - 17 Jan 2019

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Randomized Controlled Trials
Depression
Major Depressive Disorder
Bipolar Disorder
Primary Health Care
Outcome Assessment (Health Care)
Psychology
Genetic Counseling
Primary Prevention
General Practice
Psychiatry
Control Groups
Surveys and Questionnaires
Health
Therapeutics

Bibliographical note

Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • family history
  • major depressive disorder
  • bipolar disorder
  • online intervention
  • psycho-education

Cite this

Mills, Llewellyn ; Meiser, Bettina ; Ahmad, Raghib ; Schofield, Peter R. ; Peate, Michelle ; Levitan, Charlene ; Trevena, Lyndal ; Barlow-Stewart, Kristine ; Dobbins, Timothy ; Christensen, Helen ; Sherman, Kerry A. ; Dunlop, Kate ; Mitchell, Philip B. / A cluster randomized controlled trial of an online psychoeducational intervention for people with a family history of depression. In: BMC Psychiatry. 2019 ; Vol. 19, No. 1.
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abstract = "Background: People with a family history of major depressive disorder (MDD) or bipolar disorder (BD) report specific psychoeducational needs that are unmet by existing online interventions. This trial aimed to test whether an interactive website for people at familial risk for depression (intervention) would improve intention to adopt, or actual adoption of, depression prevention strategies (primary outcome) and a range of secondary outcome measures.Methods: In this cluster randomised trial, primary care practises were randomised to either provide the link to the intervention or the control website. Primary health care attendees were invited by letter to opt into this study if they had at least one first-degree relative with MDD or BD and were asked to complete online questionnaires at baseline and 2-week follow-up.Results: Twenty general practices were a randomized, and 202 eligible patients completed both questionnaires. Thirty-nine (19.3{\%}) of participants were male and 163 (80.7{\%}) female. At follow-up, compared to controls, the intervention group: (i) were more likely to intend to undergo, or to have actually undergone, psychological therapies (OR = 5.83, 95{\%} CI: 1.58-21.47, p =.008); (ii) had better knowledge of depression risk factors and prevention strategies (mean difference = 0.47, 95{\%} CI: 0.05-0.88, p =.029); and (iii) were more likely to accurately estimate their lifetime risk of developing BD (mean difference = 11.2, 95{\%} CI: -16.52- -5.73, p <.001). There were no statistically significant between-group differences in change from baseline to follow up for any of the remaining outcome measures (Patient Health Questionnaire, Perceived Devaluation-Discrimination Questionnaire and Perceived Risk of Developing MDD).Conclusion: The opt-in nature of the study may have led to participation bias, e.g. underrepresentation of males, and hence may limit generalisability to the broader population at familial risk for depression. This is the first website internationally focusing specifically on informational needs of those at familial risk of depression. Our interactive website can play an important role in improving the outcomes of individuals at familial risk for depression. Testing the intervention in other settings (e.g. psychology, psychiatry, genetic counselling) appears warranted.",
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note = "Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",
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Mills, L, Meiser, B, Ahmad, R, Schofield, PR, Peate, M, Levitan, C, Trevena, L, Barlow-Stewart, K, Dobbins, T, Christensen, H, Sherman, KA, Dunlop, K & Mitchell, PB 2019, 'A cluster randomized controlled trial of an online psychoeducational intervention for people with a family history of depression' BMC Psychiatry, vol. 19, no. 1, 29. https://doi.org/10.1186/s12888-018-1994-2

A cluster randomized controlled trial of an online psychoeducational intervention for people with a family history of depression. / Mills, Llewellyn; Meiser, Bettina; Ahmad, Raghib; Schofield, Peter R.; Peate, Michelle; Levitan, Charlene; Trevena, Lyndal; Barlow-Stewart, Kristine; Dobbins, Timothy; Christensen, Helen; Sherman, Kerry A.; Dunlop, Kate; Mitchell, Philip B.

In: BMC Psychiatry, Vol. 19, No. 1, 29, 17.01.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A cluster randomized controlled trial of an online psychoeducational intervention for people with a family history of depression

AU - Mills,Llewellyn

AU - Meiser,Bettina

AU - Ahmad,Raghib

AU - Schofield,Peter R.

AU - Peate,Michelle

AU - Levitan,Charlene

AU - Trevena,Lyndal

AU - Barlow-Stewart,Kristine

AU - Dobbins,Timothy

AU - Christensen,Helen

AU - Sherman,Kerry A.

AU - Dunlop,Kate

AU - Mitchell,Philip B.

N1 - Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2019/1/17

Y1 - 2019/1/17

N2 - Background: People with a family history of major depressive disorder (MDD) or bipolar disorder (BD) report specific psychoeducational needs that are unmet by existing online interventions. This trial aimed to test whether an interactive website for people at familial risk for depression (intervention) would improve intention to adopt, or actual adoption of, depression prevention strategies (primary outcome) and a range of secondary outcome measures.Methods: In this cluster randomised trial, primary care practises were randomised to either provide the link to the intervention or the control website. Primary health care attendees were invited by letter to opt into this study if they had at least one first-degree relative with MDD or BD and were asked to complete online questionnaires at baseline and 2-week follow-up.Results: Twenty general practices were a randomized, and 202 eligible patients completed both questionnaires. Thirty-nine (19.3%) of participants were male and 163 (80.7%) female. At follow-up, compared to controls, the intervention group: (i) were more likely to intend to undergo, or to have actually undergone, psychological therapies (OR = 5.83, 95% CI: 1.58-21.47, p =.008); (ii) had better knowledge of depression risk factors and prevention strategies (mean difference = 0.47, 95% CI: 0.05-0.88, p =.029); and (iii) were more likely to accurately estimate their lifetime risk of developing BD (mean difference = 11.2, 95% CI: -16.52- -5.73, p <.001). There were no statistically significant between-group differences in change from baseline to follow up for any of the remaining outcome measures (Patient Health Questionnaire, Perceived Devaluation-Discrimination Questionnaire and Perceived Risk of Developing MDD).Conclusion: The opt-in nature of the study may have led to participation bias, e.g. underrepresentation of males, and hence may limit generalisability to the broader population at familial risk for depression. This is the first website internationally focusing specifically on informational needs of those at familial risk of depression. Our interactive website can play an important role in improving the outcomes of individuals at familial risk for depression. Testing the intervention in other settings (e.g. psychology, psychiatry, genetic counselling) appears warranted.

AB - Background: People with a family history of major depressive disorder (MDD) or bipolar disorder (BD) report specific psychoeducational needs that are unmet by existing online interventions. This trial aimed to test whether an interactive website for people at familial risk for depression (intervention) would improve intention to adopt, or actual adoption of, depression prevention strategies (primary outcome) and a range of secondary outcome measures.Methods: In this cluster randomised trial, primary care practises were randomised to either provide the link to the intervention or the control website. Primary health care attendees were invited by letter to opt into this study if they had at least one first-degree relative with MDD or BD and were asked to complete online questionnaires at baseline and 2-week follow-up.Results: Twenty general practices were a randomized, and 202 eligible patients completed both questionnaires. Thirty-nine (19.3%) of participants were male and 163 (80.7%) female. At follow-up, compared to controls, the intervention group: (i) were more likely to intend to undergo, or to have actually undergone, psychological therapies (OR = 5.83, 95% CI: 1.58-21.47, p =.008); (ii) had better knowledge of depression risk factors and prevention strategies (mean difference = 0.47, 95% CI: 0.05-0.88, p =.029); and (iii) were more likely to accurately estimate their lifetime risk of developing BD (mean difference = 11.2, 95% CI: -16.52- -5.73, p <.001). There were no statistically significant between-group differences in change from baseline to follow up for any of the remaining outcome measures (Patient Health Questionnaire, Perceived Devaluation-Discrimination Questionnaire and Perceived Risk of Developing MDD).Conclusion: The opt-in nature of the study may have led to participation bias, e.g. underrepresentation of males, and hence may limit generalisability to the broader population at familial risk for depression. This is the first website internationally focusing specifically on informational needs of those at familial risk of depression. Our interactive website can play an important role in improving the outcomes of individuals at familial risk for depression. Testing the intervention in other settings (e.g. psychology, psychiatry, genetic counselling) appears warranted.

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