ORCID Profile
0000-0003-2532-0142
Current Organisation
The University of Auckland
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Publisher: Wiley
Date: 31-03-2014
DOI: 10.1111/EIP.12137
Abstract: Little evidence exists regarding the efficacy of suicide prevention programmes among the youth. This pilot study aimed to test the effects of a specifically designed, eight-module Internet-based programme on suicidal ideation among secondary school students. The study employed a pre-test ost-test design. Outcomes of interest were suicidal ideation, depression and hopelessness. Participants were recruited via the school well-being team, were assessed at baseline and immediately post-intervention. The intervention was delivered weekly at the young persons' school. Twenty-one students completed all eight modules and a post-intervention assessment, and constitute the observed case s le used for the analysis. Overall levels of suicidal ideation, depressive symptoms and hopelessness decreased significantly over the course of the study. This was a small pilot study with no control group. However, significant reductions were seen in suicidal ideation, depressive symptoms and hopelessness, indicating that Internet-based interventions may hold promise when it comes to reducing suicide risk among youth. Further investigation is warranted.
Publisher: Wiley
Date: 31-03-2014
DOI: 10.1111/EIP.12136
Abstract: Suicide-related behaviour is a major problem among adolescents. Yet relatively few studies have tested the efficacy, acceptability and safety of interventions for this population. We developed and pilot tested an online intervention for at-risk school students, which has led to reduced suicidal ideation, hopelessness and depressive symptoms. The aims of this study were to examine the safety and acceptability of the programme, and to determine which components were found to be most helpful and enjoyable. This pilot study employed a pre-test ost-test design, with an 8-week intervention phase. Participants were assessed immediately before, and immediately after the intervention. Participants were also asked to complete a weekly questionnaire immediately after the intervention, and again 2 days later assessing suicidal ideation and distress. Twenty-one young people completed the intervention. Overall, the intervention did not lead to increases in suicidal ideation or distress. Participants reported enjoying the programme, in particular watching the video diaries and completing the activities, and said they would recommend the programme to a friend. Overall, the cognitive components of the programme were found to be most helpful. Overall, the programme appeared to be a safe and acceptable intervention for at-risk adolescents. This was a small, pilot study so we need to interpret the results with caution. However, the findings are promising and suggest that young people at risk of suicide can safely be included in trials as long as adequate safety procedures are in place. The programme is now being tested in a randomized controlled trial.
Publisher: Hindawi Limited
Date: 2012
DOI: 10.1155/2012/820735
Abstract: Introduction. Depression in adolescents and young people is associated with reduced social, occupational, and interpersonal functioning, increases in suicide and self-harm behaviours, and problematic substance use. Age-appropriate, evidence-based treatments are required to provide optimal care. Methods. “Evidence mapping” methodology was used to quantify the nature and distribution of the extant high-quality research into the prevention and treatment of depression in young people across psychological, medical, and other treatment domains. Results. Prevention research is dominated by cognitive-behavioral- (CBT-) based interventions. Treatment studies predominantly consist of CBT and SSRI medication trials, with few trials of other psychological interventions or complementary/alternative treatments. Quality studies on relapse prevention and treatment for persistent depression are distinctly lacking. Conclusions. This map demonstrates opportunities for future research to address the numerous evidence gaps for interventions to prevent or treat depression in young people, which are of interest to clinical researchers, policy makers, and funding bodies.
Publisher: BMJ
Date: 03-2018
DOI: 10.1136/BMJOPEN-2017-020198
Abstract: Post-traumatic stress disorder (PTSD) is common among children and adolescents who are exposed to trauma, and it is often associated with significant negative impacts on their psychosocial functioning and quality of life. Many types of psychotherapies have been found to be effective for PTSD in children and adolescents. However, due to the lack of direct comparisons between different psychotherapies, the hierarchy of treatment efficacy is still unclear. Therefore, we plan to conduct a systematic review and network meta-analysis to evaluate the efficacy and acceptability of various types of psychotherapies for PTSD in children and adolescents. A systematic search will be conducted among eight electronic databases, including PubMed, Cochrane, Embase, Web of Science, PsycINFO, Cumulative Index of Nursing and Allied Health, Published International Literature on Traumatic Stress (PILOTS) and ProQuest Dissertations, from inception to October 2017. Randomised controlled trials, regardless of language, publication year and publication type, comparing any psychotherapies for PTSD to any control condition or alternative treatment in children and adolescents (18 years old or less) diagnosed with full or subclinical PTSD will be included. Study duration and the number of treatment sessions will not be limited. The primary outcome will be PTSD symptom severity at post-treatment as measured by a rating scale reported by the child, parent or a clinician. The secondary outcomes will include: (1) efficacy at follow-up (2) acceptability (all-cause discontinuation) (3) anxiety symptom severity (4) depressive symptom severity and (5) quality of life and functional improvement. Bayesian network meta-analyses for all relative outcome measures will be performed. We will conduct subgroup and sensitivity network meta-analyses to determine whether the findings are affected by study characteristics. The quality of the evidence contributing to network estimates of the primary outcome will be evaluated by the Grading of Recommendations, Assessment, Development and Evaluations framework. No ethical issues are foreseen. The results will be published in a peer-reviewed journal, which will be disseminated electronically and in print. This network meta-analysis may be updated to inform and guide the clinical management of PTSD in children and adolescents. CRD42016051786 .
Publisher: SAGE Publications
Date: 15-03-2021
Abstract: Effective treatment of depression is a key target for suicide prevention strategies. However, only around one-third of young people with suicide risk respond to evidence-based treatments. Understanding the trajectory of suicidal ideation, as a marker of suicide risk, over the course of evidence-based treatment for depression might provide insight into more targeted and effective treatments. This is a secondary analysis of data from the multicentre Youth Depression Alleviation–Combined Treatment trial. A total of 153 young people aged 15–25 years diagnosed with major depressive disorder were randomly assigned in this double-blind, placebo-controlled trial to either cognitive behavioural therapy plus fluoxetine or cognitive behavioural therapy plus placebo. Participants were assessed for depression and suicidal ideation at baseline and at weeks 4, 8 and 12. Using group-based trajectory modelling, we identified two distinct depression trajectories. The first (Improving 54.9% n = 83) comprised those who experienced a consistent decline in depression symptoms. The second (Persisting 45.1% n = 70) comprised those who, despite treatment, still had clinically significant levels of depression by the end of treatment. For suicidal ideation, we identified four distinct trajectories: Non-clinical (15.5% n = 20), Low Improving (47.1% n = 75), High Improving (24.8% n = 38) and High Persisting (12.7% n = 20). Treatment allocation was not significantly associated with trajectory membership for either depression or suicidal ideation. Understanding the course of depression and suicidal ideation during treatment has important implications for managing suicide risk. The findings suggest that there is an identifiable group of young people for whom enhanced psychological and/or pharmacological intervention might be required to ensure a better treatment response. Specific interventions for those with suicidal ideation may also be prudent from the outset. The Youth Depression Alleviation–Combined Treatment trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12612001281886).
Publisher: JMIR Publications Inc.
Date: 04-10-2017
DOI: 10.2196/MENTAL.7847
Abstract: Social media is increasingly being used by young people for health-related issues, including communicating about suicide. Due to the concerns about causing distress or inducing suicidal thoughts or behaviors, to date young people neither have been engaged in the development of social media–based suicide prevention interventions nor have interventions focused on educating young people about safe ways to communicate about suicide online. Given the potential that social media holds to deliver messages to vast numbers of people across space and time and the fact that young people often prefer to seek help from their friends and peers, safely educating and engaging young people to develop suicide prevention messages that can be delivered via social media is an obvious next step. The objectives of this study were to (1) provide education to a small number of secondary school students about safe ways to communicate about suicide via social media (2) engage the same young people in the development of a suite of social media–based suicide prevention multimedia messages (3) assess the impact of this on participants and (4) assess the acceptability and safety of the messages developed. This study involved two phases. In phase 1, 20 participants recruited from two schools took part in an 8- to 10-week program during which they were provided with psychoeducation about mental health and suicide, including how to talk safely about suicide online, and they were then supported to design and develop their own media messages. These participants completed an evaluation questionnaire at the conclusion of the program. In phase 2, a larger group of participants (n=69), recruited via an opt-in process, viewed the media messages and completed a short questionnaire about each one. Participants in phase 1 enjoyed the program and reported that they learned new skills, such as how to talk safely about suicide online, and felt more able to provide emotional support to others (16/20, 80%). No participants reported that the program made them feel suicidal. Participants in phase 2 generally rated the media messages as safe and acceptable, although some messages were rated more highly than others. This study suggests that young people can be safely engaged in developing suicide prevention messages, which can be disseminated via social media. Engaging young people in this process may improve the traction that such c aigns will have with other young people. The study also suggests that educating young people regarding how to talk safely about suicide online has multiple benefits and is not associated with distress. Overall, these findings pave the way for new approaches to prevent suicide among young people.
Publisher: JMIR Publications Inc.
Date: 02-05-2019
Abstract: here is an increasing interest in engaging people with lived experience in suicide prevention research. However, young people with suicidal thoughts have been described as a “hard-to-include” population due to time, distance, stigma, and social barriers. his study aims to investigate whether conducting synchronous Web conferencing technology–based online focus groups (W-OFGs) is a feasible method to engage young people with lived experience of suicidal thoughts in suicide prevention research. oung people aged between 16 and 25 years and living in Sydney, Australia, were recruited through flyers, emails, and social media advertisements. The W-OFGs were established using a Web conferencing technology called GoToMeeting. Participants’ response rate, attendance, and feedback of the W-OFGs were analyzed to determine whether the W-OFG system is feasible for suicide prevention research. Researchers’ reflections about how to effectively implement the W-OFGs were also reported as part of the results. n the pre–W-OFG survey, 39 (97.5%) young people (n=40) chose to attend the online focus group. Among the 22 participants who responded to the W-OFG invitations, 15 confirmed that they would attend the W-OFGs, of which 11 participants attended the W-OFGs. Feedback collected from the participants in the W-OFG and the post–W-OFG survey suggested that online focus groups are acceptable to young people in suicide prevention research. Considerations for selecting the Web conferencing platform, conducting the mock W-OFGs, implementing the risk management procedure, inviting participants to the W-OFGs, and hosting and moderating the W-OFGs as well as a few potential ethical and pragmatic challenges in using this method are discussed in this study. he Web conferencing technology provides a feasible replacement for conventional methods, particularly for qualitative research involving vulnerable populations and stigmatized topics including suicide prevention. Our results indicate that this modality is an optimal alternative to engage young people in the focus group discussion. Future studies should compare the data collected from the Web conferencing technology and conventional face-to-face methods in suicide prevention research to determine if these two methods are equivalent in data quality from a quantitative approach.
Publisher: Informa UK Limited
Date: 03-07-2019
DOI: 10.1080/13811118.2019.1619113
Abstract: To systematically review the quality of evidence regarding the effectiveness of supports for people affected by suicide. EMBASE, MEDLINE, and PsychINFO were searched for evaluations of community-based supports for people affected by suicide. Outcomes included suicide-related behavior, depression, grief, quality of life, caring ability, and qualitative experiences. Fifteen studies evaluated 15 supports of various modalities. Study quality was generally poor most studies examined bereaved in iduals with mixed findings. Few reduced suicide-related behavior, half improved depression, and grief, while studies of caring ability, quality of life, or qualitative experiences reported positive effects. Supports associated with better outcomes connected peers with similar experiences, were provided over a period of months, and involved veteran rather than novice facilitators. Supports for people affected by suicide may be effective for improving suicide-related behavior, psychological adjustment, quality of life and caregiving, but require further evaluation.
Publisher: Wiley
Date: 02-2022
DOI: 10.1111/EIP.13265
Abstract: Interpersonal trauma exposures are associated with anxiety, depression, and substance use in youth populations (aged 12–25 years). This meta‐analysis reports on the efficacy of psychological interventions on these symptom domains in addition to post‐traumatic stress. Following PRISMA guidelines, a search of electronic databases was performed for randomized controlled trials (RCTs) assessing interventions for young people following interpersonal trauma exposure. Risk of bias was assessed using the Cochrane Risk of Bias tool. Data were analysed using random‐effects meta‐analyses. Of the 4832 records screened, 78 studies were reviewed, and 10 RCTs, involving 679 participants (mean age 15.6 years), were analysed. There was a large pooled effect size for post‐traumatic stress (7 studies , g = 1.43, 95% CI [0.37, 2.15], p = .002) and substance use (2 studies , g = 0.70, 95% CI [−0.11, 1.22], p .001) and small effect sizes for anxiety (4 studies , g = 0.30, 95% CI [0.10, 0.49], p = .003), and trend‐level effect for depression (10 studies , g = 0.27, 95% CI [0.00, 0.54], p = .052). Heterogeneity was significant for post‐traumatic stress and moderate for depression. High‐quality RCTs of psychological interventions for anxiety, depression, substance use, and post‐traumatic stress symptoms in young people exposed to interpersonal trauma are scarce. While available studies show either statistically significant or trend‐level efficacy for psychological interventions in reducing these symptoms, wide confidence intervals, heterogeneity and small s le size mean that results need to be interpreted with caution.
Publisher: JMIR Publications Inc.
Date: 04-10-2019
DOI: 10.2196/14191
Abstract: There is an increasing interest in engaging people with lived experience in suicide prevention research. However, young people with suicidal thoughts have been described as a “hard-to-include” population due to time, distance, stigma, and social barriers. This study aims to investigate whether conducting synchronous Web conferencing technology–based online focus groups (W-OFGs) is a feasible method to engage young people with lived experience of suicidal thoughts in suicide prevention research. Young people aged between 16 and 25 years and living in Sydney, Australia, were recruited through flyers, emails, and social media advertisements. The W-OFGs were established using a Web conferencing technology called GoToMeeting. Participants’ response rate, attendance, and feedback of the W-OFGs were analyzed to determine whether the W-OFG system is feasible for suicide prevention research. Researchers’ reflections about how to effectively implement the W-OFGs were also reported as part of the results. In the pre–W-OFG survey, 39 (97.5%) young people (n=40) chose to attend the online focus group. Among the 22 participants who responded to the W-OFG invitations, 15 confirmed that they would attend the W-OFGs, of which 11 participants attended the W-OFGs. Feedback collected from the participants in the W-OFG and the post–W-OFG survey suggested that online focus groups are acceptable to young people in suicide prevention research. Considerations for selecting the Web conferencing platform, conducting the mock W-OFGs, implementing the risk management procedure, inviting participants to the W-OFGs, and hosting and moderating the W-OFGs as well as a few potential ethical and pragmatic challenges in using this method are discussed in this study. The Web conferencing technology provides a feasible replacement for conventional methods, particularly for qualitative research involving vulnerable populations and stigmatized topics including suicide prevention. Our results indicate that this modality is an optimal alternative to engage young people in the focus group discussion. Future studies should compare the data collected from the Web conferencing technology and conventional face-to-face methods in suicide prevention research to determine if these two methods are equivalent in data quality from a quantitative approach.
Publisher: MDPI AG
Date: 22-05-2020
Abstract: Background: Self-harm in young people can have a substantial negative impact on the well-being and functioning of parents and other carers. The “Coping with Self-Harm” booklet was originally developed in the UK as a resource for parents and carers of young people who self-harm, and an adaptation study of this resource was conducted in Australia. This paper presents qualitative analysis of interviews with parents about their experiences and psychoeducational needs when supporting a young person who engages in self harm. Methods: The qualitative study drew on semi-structured in idual and group interviews with parents (n = 19 participants) of young people who self-harm. Data were analysed using Thematic Analysis. Results: The analysis identified six themes: (1) the discovery of self-harm, (2) challenges in the parent-young person relationship, (3) parents’ need to understand self-harm, (4) parents’ emotional reactions to self-harm, (5) the importance of self-care and help-seeking among parents, and (6) the need for psychoeducational resources. Conclusion: The study highlights the need for support for parents and carers of young people who engage in self-harm, including development and adaptation of resources, such as the “Coping with Self-Harm” booklet, of which an Australian version has now been developed.
Publisher: Royal College of Psychiatrists
Date: 03-2017
DOI: 10.1192/APT.23.2.74
Publisher: Wiley
Date: 19-02-2015
DOI: 10.1111/EIP.12229
Abstract: Social media platforms are commonly used for the expression of suicidal thoughts and feelings, particularly by young people. Despite this, little is known about the ways in which social media can be used for suicide prevention. The aim of this study was to conduct a systematic review to identify current evidence pertaining to the ways in which social media are currently used as a tool for suicide prevention. Medline, PsycInfo, Embase, CINHAL and the Cochrane Library were searched for articles published between 1991 and April 2014. English language articles with a focus on suicide-related behaviour and social media were included. No exclusion was placed on study design. Thirty studies were included 4 described the development of social media sites designed for suicide prevention, 6 examined the potential of social media in terms of its ability to reach or identify people at risk of suicide, 15 examined the ways in which people used social media for suicide prevention-related purposes, and 5 examined the experiences of people who had used social media sites for suicide prevention purposes. No intervention studies were identified. Social media platforms can reach large numbers of otherwise hard-to-engage in iduals, may allow others to intervene following an expression of suicidal ideation online, and provide an anonymous, accessible and non-judgmental forum for sharing experiences. Challenges include difficulties controlling user behaviour and accurately assessing risk, issues relating to privacy and confidentiality and the possibility of contagion. Social media appears to hold significant potential for suicide prevention however, additional research into its safety and efficacy is required.
Publisher: JMIR Publications Inc.
Date: 23-01-2018
DOI: 10.2196/MENTAL.9041
Abstract: Effective treatment of depression in young people is critical, given its prevalence, impacts, and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice. The objective of this study was to address the gap between guidelines about monitoring and real-world practice by codesigning an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician. We engaged young people aged 18 to 25 years who had experienced depression, suicidal ideation including those who self-harm, as well as clinicians in a codesign process. We used a human-centered codesign design studio methodology where young people designed the features of the app first in idually and then as a group. This resulted in a minimal viable product design, represented through low-fidelity hand-drawn wireframes. Clinicians were engaged throughout the process via focus groups. The app incorporated a mood monitoring feature with innovative design aspects that allowed customization, and was named a “well-being tracker” in response to the need for a positive approach to this function. Brief personalized interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (ie, responding in a timely manner) and will need to be addressed during the full implementation of the app into clinical services. The potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress and increasing access to timely and evidence-based interventions are desirable outcomes. To achieve positive outcomes for young people using technology- (app) based interventions, it is critical to understand and incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians.
Publisher: SAGE Publications
Date: 11-01-2023
DOI: 10.1177/00048674221144262
Abstract: Depression and suicidal ideation are closely intertwined. Yet, among young people with depression, the specific factors that contribute to changes in suicidal ideation over time are uncertain. Factors other than depressive symptom severity, such as comorbid psychopathology and personality traits, might be important contributors. Our aim was to identify contributors to fluctuations in suicidal ideation severity over a 12-week period in young people with major depressive disorder receiving cognitive behavioural therapy. Data were drawn from two 12-week randomised, placebo-controlled treatment trials. Participants ( N = 283) were 15–25 years old, with moderate to severe major depressive disorder. The primary outcome measure was the Suicidal Ideation Questionnaire, administered at baseline and weeks 4, 8 and 12. A series of linear mixed models was conducted to examine the relationship between Suicidal Ideation Questionnaire score and demographic characteristics, comorbid psychopathology, personality traits and alcohol use. Depression and anxiety symptom severity, and trait anxiety, independently predicted higher suicidal ideation, after adjusting for the effects of time, demographics, affective instability, non-suicidal self-injury and alcohol use. Both state and trait anxiety are important longitudinal correlates of suicidal ideation in depressed young people receiving cognitive behavioural therapy, independent of depression severity. Reducing acute psychological distress, through reducing depression and anxiety symptom severity, is important, but interventions aimed at treating trait anxiety could also potentially be an effective intervention approach for suicidal ideation in young people with depression.
Publisher: Wiley
Date: 26-02-2016
DOI: 10.1111/EIP.12226
Abstract: To determine how young people with depression rate their neurocognitive functioning during treatment, and whether these ratings are affected by depression severity, age, suicidal ideation and antidepressant status. Fifty young people (12-25 years) engaged in psychological therapy completed the Neuropsychological Symptoms Self-Report rating their neurocognitive functioning in a range of domains. In two domains, working memory/multitasking and motivation, more than 40% of the s le rated their functioning as improved, since commencing treatment. Ratings of neurocognitive functioning were affected by depression severity and suicidal ideation, particularly in the areas of wakefulness, attention and concentration, working memory/multitasking, and motivation. However, there were few differences related to age or antidepressant status. The Neuropsychological Symptoms Self-Report - a rapid measure of subjective neurocognitive functioning - can provide a snapshot of subjective changes in neurocognitive functioning during treatment for depression. This information may guide treatment approaches.
Publisher: Wiley
Date: 25-02-2015
DOI: 10.1111/EIP.12127
Abstract: To develop and examine the feasibility of an online monitoring tool of depressive symptoms, suicidality and side effects. The online tool was developed based on guideline recommendations, and employed already validated and widely used measures. Quantitative data about its use, and qualitative information on its functionality and usefulness were collected from surveys, a focus group and in idual interviews. Fifteen young people completed the tool between 1 and 12 times, and reported it was easy to use. Clinicians suggested it was too long and could be completed in the waiting room to lessen impact on session time. Overall, clients and clinicians who used the tool found it useful. Results show that an online monitoring tool is potentially useful as a systematic means for monitoring symptoms, but further research is needed including how to embed the tool within clinical practice.
Publisher: Wiley
Date: 05-11-2015
DOI: 10.1111/EIP.12280
Abstract: There is growing support for the role of inflammation and oxidative stress in the pathophysiology of major depressive disorder (MDD). This has led to the development of novel strategies targeting inflammation in the treatment of depression. Rosuvastatin and aspirin have well-documented, anti-inflammatory and antioxidant properties. The aim of the Youth Depression Alleviation: Augmentation with an anti-inflammatory agent (YoDA-A) study is to determine whether in iduals receiving adjunctive anti-inflammatory agents, aspirin and rosuvastatin experience a reduction in the severity of MDD compared with in iduals receiving placebo. YoDA-A is a 12-week triple-blind, randomized controlled trial funded by the National Health and Medical Research Council, Australia. Participants aged 15-25, with moderate-to-severe MDD, are allocated to receive either 10 mg/day rosuvastatin, 100 mg/day aspirin, or placebo, in addition to treatment as usual. Participants are assessed at baseline and at weeks 4, 8, 12 and 26. The primary outcome is change in the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to week 12. The study is planned to be completed in 2017. At date of publication, 85 participants have been recruited. Timely and targeted intervention for youth MDD is crucial. Given the paucity of new agents to treat youth MDD, adjunctive trials are not only pragmatic and 'real-world', but additionally aim to target shortfalls in conventional medications. This study has the potential to first provide two new adjunctive treatment options for youth MDD aspirin and rosuvastatin. Second, this study will serve as proof of principle of the role of inflammation in MDD.
Publisher: MDPI AG
Date: 08-12-2021
Abstract: General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm however, no studies have explored GPs’ perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges (2) screening and assessment tools can help to manage uncertainty and discomfort (3) going beyond tools–the dialogue and relationship are most important (4) there are limits to what we can offer in the time available (5) the service access and referral pathways lack clarity and coordination (6) the provision of mental health support should not fall on GPs alone and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.
Publisher: BMJ
Date: 09-2016
Publisher: Wiley
Date: 08-02-2018
DOI: 10.1111/EIP.12420
Abstract: Our aim was to develop an implementation guide that was informed by an analysis of context-specific barriers and enablers, behaviour change theory, as well as evidence about the effects of implementation interventions, for the establishment and scaling up of an early intervention model for psychosis (called Early Psychosis Prevention and Intervention Centre (EPPIC)). We used a systematic approach involving four steps. First, the target behaviours of the EPPIC model for implementation were specified. Second, a consultation was undertaken to explore the barriers and enablers to undertaking these priority minimum standard clinical behaviours. Third, an implementation strategy that included a range of behaviour change techniques tailored to address the identified barriers was developed. Finally, a tool to assess whether those implementing the EPPIC model maintained fidelity to the implementation strategy was designed. We identified a range of barriers that could act to dilute the core components of the EPPIC model and compromise its implementation. An implementation strategy using theory and evidence-based strategies for behaviour change was designed to address these barriers. The process we used in the development of the implementation strategy provided a unique opportunity to consider the essential areas to cover, how to make information easily understandable and accessible while noting the complexity of issues involved in not only implementation, but also the scaling up of the EPPIC model for services.
Publisher: JMIR Publications Inc.
Date: 26-09-2017
Abstract: ffective treatment of depression in young people is critical, given its prevalence, impacts, and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice. he objective of this study was to address the gap between guidelines about monitoring and real-world practice by codesigning an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician. e engaged young people aged 18 to 25 years who had experienced depression, suicidal ideation including those who self-harm, as well as clinicians in a codesign process. We used a human-centered codesign design studio methodology where young people designed the features of the app first in idually and then as a group. This resulted in a minimal viable product design, represented through low-fidelity hand-drawn wireframes. Clinicians were engaged throughout the process via focus groups. he app incorporated a mood monitoring feature with innovative design aspects that allowed customization, and was named a “well-being tracker” in response to the need for a positive approach to this function. Brief personalized interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (ie, responding in a timely manner) and will need to be addressed during the full implementation of the app into clinical services. he potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress and increasing access to timely and evidence-based interventions are desirable outcomes. To achieve positive outcomes for young people using technology- (app) based interventions, it is critical to understand and incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians.
Publisher: Wiley
Date: 13-08-2014
DOI: 10.1111/EIP.12166
Abstract: US authorities have recommended 'black-box' warnings for antidepressants because of the increased risk of suicidality for in iduals up to age 25. There is thus a clinical and ethical imperative to provide effective treatment for youth depression with an acceptable risk-benefit balance. Long-chain omega-3 polyunsaturated fatty acids (PUFAs) play an important role in a range of physiological processes in living organisms. Supplementation with omega-3 PUFAs has been shown to have a range of beneficial effects on both physical and mental health, and results of previous trials suggest that omega-3 PUFAs may be a safe and effective treatment for depression. However, conclusions from these trials have been limited by their relatively small s le sizes. This trial will test the effectiveness of a 12-week parallel group, double-blind, randomized, placebo-controlled trial of 1.4 g day(-1) omega-3 PUFAs in help seeking 15- to 25-year-olds (N = 400) presenting with major depressive disorder. The primary hypothesis is that young people will show greater improvement of depressive symptoms after 12 weeks of treatment with omega-3 PUFAs plus cognitive behavioural case management compared with treatment with placebo plus cognitive behavioural case management. Because of using a large s le, results from this study will provide the strongest evidence to date to inform the use of omega-3 PUFAs as first-line therapy in young people presenting with major depressive disorder. The study also heralds an important step towards indicated prevention of persistent depression, which may reduce the burden, stigmatization, disability and economic consequences of this disorder.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2019
DOI: 10.1007/S00787-018-1150-Z
Abstract: Trauma-focused cognitive behavioural therapy (TF-CBT) is an effective intervention for post-traumatic stress disorder, yet implementation may be hindered by practitioners' concerns about how treatment is experienced by users. This metasynthesis systematically reviews qualitative evidence on youth and caregivers' experiences of TF-CBT to better understand user perspectives on process and outcomes of treatment. A systematic review and metasynthesis were undertaken for qualitative studies of treatment experience related to TF-CBT. Data were extracted according to Evidence for Policy and Practice Information and Coordinating Centre guidelines, and studies were critically appraised using Critical Appraisal Skills Programme checklists. Findings from included studies were coded and synthesized using thematic synthesis methodology. Eight studies were selected after a full-text review of 39 papers. Findings were organised around nine sub-themes, under three broad thematic categories: 'engagement in TF-CBT' 'experience of treatment components' and 'therapeutic outcomes'. Youth were often unclear about what to expect from treatment and concerned about (in)compatibility with their therapist. Youth reports indicated how such misgivings can be addressed through early psychoeducation and efforts to strengthen the therapeutic alliance. Once underway, treatment was viewed as a place of refuge and validation, aided by therapist competence and confidentiality. Youth and caregivers felt that constructing a trauma narrative was instrumental for recovery. Cognitive-behavioural coping techniques were useful during treatment and in the long-term. While participants in TF-CBT may begin treatment with unclear expectancies, careful attention to early engagement and other process issues can optimise process and outcomes. Implications for clinical practice and further research are discussed.
Publisher: Wiley
Date: 04-04-2015
DOI: 10.1111/EIP.12142
Abstract: Recent findings from systematic reviews and primary research studies have shown more modest effects of cognitive behavioural therapy (CBT) for youth depression than previously shown, highlighting the need to further enhance the effectiveness of this intervention, or components of this intervention. Therefore, the aim of this review is to summarize the work that has been done to identify the different components of CBT and their varying effectiveness for young people with depression. Narrative overview of English language reviews/meta-analyses and primary intervention studies retrieved from searches of computerized databases as well as ancestry searches. Reviews of intervention studies of adults as well as young people with depression have shown that behavioural approaches are equally as effective as cognitive approaches in reducing depression symptoms. Post-hoc analyses of large studies in youth depression have also shown that behavioural approaches might be more suitable for young people. Behaviourally based approaches appear promising in treating youth depression however, further research is required. This research will represent an essential step towards refining interventions for youth depression, and enabling interventions to be targeted to particular subgroups, to optimize their effectiveness.
Publisher: Wiley
Date: 28-03-2023
DOI: 10.1111/EIP.13290
Abstract: Major depressive disorder (MDD) has far reaching impacts for young people, their families and society. Cognitive behavioural therapy (CBT) is one of the first‐line treatments for young people experiencing MDD however, there is limited research examining how young people with MDD experience CBT. The aim of this study was to explore their experience and their views of this intervention. We employed a qualitative research design, with semi‐structured interviews and thematic analysis. Eight participants aged between 17 and 24 years who received CBT for MDD in a randomized controlled trial were recruited. Five themes were identified: the importance of relationship with clinician the range of useful components within CBT the ability for CBT to accommodate different techniques and presenting issues the importance of checking in with clients during the process of therapy and the impacts of MDD on therapy. The findings highlight the importance of clinicians having a youth friendly and collaborative approach that allows a modular delivery of a range of CBT techniques to suit the client's presenting issue and formulation. There is a need to continually check how young people are responding to interventions, and to be aware of potential cognitive deficits and adjust therapy accordingly. This is a small study that provides insight into how young people with MDD experience CBT and avenues to explore for tailoring provision of CBT to enhance the therapeutic experience for this population.
No related grants have been discovered for Sarah Hetrick.