A comparative study of strategies for identifying credible sources of mental health information online: Can clinical services deliver a youth-specific internet prescription?

BACKGROUND: Adolescents and young adults undertake internet searches before and after attending mental health consultations, but they express concerns about how they can identify reliable online mental health information (OMHI). This action research project examines how clinicians might direct young people towards credible OMHI by analysing which search strategies are most helpful for developing an 'internet prescription' targeted at a youth audience. METHODS: Recently qualified doctors undertook searches for OMHI about the diagnosis and treatment of seven mental health conditions. Rankings of websites in search results were compared with reliability and quality ratings derived from established evaluation instruments [the Brief DISCERN and the 12-item Health on the Net (HoN) tool]. RESULTS: Of 140 websites identified through seven Google searches, only 15% of those evaluated were categorized as high quality. About 17% of websites were selling a treatment or service and about 25% were regarded as untrustworthy. Also, higher rankings in the search results were not indicative of better quality OMHI (Wilcoxon signed rank test: Z = -5.28; p < .001). Although the HoN and DISCERN tools provided useful insights into the credibility of OMHI, investigators did not think either instrument could be recommended for independent use by youth. CONCLUSIONS: Our findings suggest that clinical services should take responsibility for identifying a range of credible sources of OMHI. The next step in translating the research strategy into clinical practice involves collaboration with young people to select those platforms most orientated to their needs and to develop rating instruments that enable youth to evaluate OMHI.

Predictive validity of objective measures of physical fitness for the new onset of mental disorders in adolescents and young adults.

AIM: To systematically review evidence that objectively assessed level of physical fitness is associated with future risk of adverse mental health outcomes during the peak age range for onset of adult mental disorders. METHODS: Searches of Electronic databases (EBSCOhost, SPORTDISCUS, EMBASE, MedLINE, Cochrane database, CINAHL, PsychInfo, and Dissertation Abstracts), supplemented by hand searches of journals, conference proceedings and citations. Random-effects meta-analysis models were used to pool the intervention effects. RESULTS: Eight studies of adolescents and young adults were included in the qualitative review and six studies derived from four independent cohorts were included in the statistical analyses. Most publications reported on large samples (including >1 million), but male conscripts were over-represented in the study cohorts; quality of included studies was modest, and heterogeneity was significant. Meta-analytic estimates were conducted for different adverse mental health outcomes, but all showed an inverse association between fitness and incidence of mental disorders or suicidality. Overall, higher level of physical fitness was associated with lower rates of onset of mental health problems (odds ratio: 0.59; 95% confidence intervals: 0.54, 0.65). CONCLUSIONS: All eligible studies were undertaken since 2010, suggesting this is an emerging but unfinished field of research. The study design and methodological limitations indicate that the reported results should be treated with caution. However, if the meta-analytic findings are reliably replicated for new cohorts of males and females, they have implications for research into the prevention of non-communicable diseases, as our review suggests that interventions should target physical and mental health in equal measure.

Improving the understanding of medication non-adherence among mental health professionals: findings from a series of UK training workshops.

BACKGROUND: Medication non-adherence has far-reaching consequences. Before utilising specialized interventions to target this problem, there is a need to improve the detection, understanding and management of non-adherence in routine clinical practice. AIMS AND METHOD: This study explored whether a 1-day workshop targeting attitudes, skills and knowledge about medication adherence could modify any aspect of clinical practice of mental health professionals. RESULTS: Five workshops were held with 134 participants. Baseline general knowledge in all professional groups was poor and interventions used not ideal. Post-workshop knowledge improved significantly. At 3-month follow-up, participants reported identifying more new cases of non-adherence and use of more effective strategies. Lack of time and support were identified as persisting barriers to change. CONCLUSIONS: It is possible to raise awareness, teach a model and simple techniques to effect change in clinical practice. This brief training was well received, although ongoing support is required to increase interventions for as well as identification of individuals at risk of medication non-adherence.

Medication adherence in crisis?

AIMS AND METHOD: We examined rates of medication non-adherence in 172 referrals to a crisis resolution home treatment service; we then explored any association between pattern of adherence and the treatment interventions recommended. RESULTS: Thirty percent of crisis referrals (95% confidence intervals (CI) 24%, 38%) reported sub-optimal medication adherence in the preceding month. These individuals were significantly more likely to have a dual diagnosis (odds ratio 2.9, 95% CI 1.4, 5.9) and assessment was significantly more likely to be followed by admission (odds ratio 2.5; 95% CI 1.0, 6.2); non-adherence remained a significant predictor of admission when the odds were adjusted for confounders (odds ratio 1.18; 95% CI 1.0, 1.3). CLINICAL IMPLICATIONS: Clinicians need to proactively identify and manage non-adherence as it is a potentially preventable trigger of relapse often present for months rather than days prior to the index crisis referral. Non-adherence is a meaningful target for improving clinical and cost-effectiveness of general adult mental health services.

Pharmacological interventions for acute bipolar mania: a systematic review of randomized placebo-controlled trials.

OBJECTIVES: We conducted a systematic review and meta-analysis of randomized, placebo-controlled trials in acute bipolar mania to summarize available data on drug treatment of mania. METHODS: We included trials of medications licensed in the USA or UK for the treatment of any phase of bipolar disorder. Outcomes investigated were changes in mania scores, attrition, extrapyramidal effects and weight change. Data were combined through meta-analyses. RESULTS: We included 13 studies (involving 3,089 subjects) and identified 2 studies for each of the following medications: carbamazepine, haloperidol, lithium, olanzapine, quetiapine, risperidone, valproate semisodium and aripiprazole. All drugs showed significant benefit compared with placebo for reduction in mania scores. Compared with placebo, for all antipsychotics pooled, response to treatment (> or =50% reduction in Young Mania Rating Scale scores) was increased more than 1.7 times [relative risk (RR) = 1.74, 95% confidence interval (CI) = 1.54, 1.96]; for all mood stabilizers pooled, response to treatment was doubled (RR 2.01, 95% CI = 1.66, 2.43). Overall withdrawals were 34% fewer (24-43%) with antipsychotics, and 26% fewer (10-39%) with mood stabilizers. However, for carbamazepine, aripiprazole and lithium an increase in risk of withdrawal could not be excluded. Small but significant increases in extrapyramidal side effects occurred with risperidone and aripiprazole. CONCLUSIONS: Antipsychotics and mood stabilizers are significantly more effective than placebo for the treatment of acute mania. Their effect sizes are similar. Small differences between effect sizes may be due to differences in the patients included in the studies or to chance. Carbamazepine and lithium may be more poorly tolerated, and antipsychotics cause more extrapyramidal side effects.

A pilot study of concordance therapy for individuals with bipolar disorders who are non-adherent with lithium prophylaxis.

OBJECTIVES: To assess the acceptability and feasibility of concordance therapy (CCT) in improving adherence with lithium prophylaxis in individuals with bipolar disorder. METHODS: Ten subjects with bipolar I disorder and self-reported problems with lithium adherence were recruited. Eight participated in a 6-month study of CCT delivered by an expert in cognitive therapy. Reliable and valid assessments of self-reported adherence with lithium, attitudes towards, and knowledge of lithium and serum plasma lithium levels were measured pre- and post-intervention. Subjects' views of CCT were also recorded. RESULTS: Statistically significant improvements in attitudes towards lithium (mean score baseline = 6.8; follow up = 4.1; Effect size = 1.6) were associated with improvements in self-reported adherence. Laboratory results demonstrated statistically significant increases in serum plasma lithium levels (mean increased from 0.41 to 0.6; effect size 1.7). Subjects viewed CCT as an acceptable intervention. However, only four of the 10 subjects completed all seven half-hour therapy sessions and homework tasks. CONCLUSIONS: This small open study suggests that CCT may represent a useful addition to the 'stepped care' package of treatment for individuals with bipolar disorders. Research is underway to assess its efficacy and to establish whether novice therapists can also apply the model effectively.