How are parenting practices associated with bullying in adolescents? A cross-sectional study.

BACKGROUND: Parenting styles have been previously associated with bullying, but some parenting practices have not received strong attention in the literature. We aimed to assess how parenting practices are associated with cyberbullying and traditional bullying involvement in adolescents. METHOD: A cross-sectional survey of 2,218 secondary-school students in London (UK) was conducted. The Olweus Bully/Victim Questionnaire and the Alabama Parenting Questionnaire (APQ-child form) were used. RESULTS: Positive parenting significantly protected against cyberbullying involvement but not against traditional bullying. Inconsistent discipline was associated with being a cyberbully but not being a traditional one. Lower levels of monitoring were associated with being a cyberbully, a cyberbully-victim, a traditional bully, or a traditional bully-victim. CONCLUSIONS: Parenting practices seem to be more relevant in cyberbullying than traditional bullying. Effective parenting practices such as positive parenting deserve attention as a potentially modifiable factor to protect against cyberbullying involvement. Ineffective parenting practices such as inconsistent discipline are relevant in cyberaggression, whereas poor monitoring is associated with both cyberbullying and traditional bullying. Clinical and research implications are discussed.

Salud mental en adolescentes víctimas y/o agresores de ciberbullying / Mental health in adolescent victims and/or aggressors of cyberbullying / Salut mental en adolescents víctimes i/o agressors de ciberassetjament

Los objetivos de este estudio son evaluar la asociación del ciberbullying en adolescentes con su salud mental y funcionamiento mediante una en­cuesta transversal de 2.218 estudiantes de secundaria de Londres (Reino Unido). Se encontraron síntomas emo­cionales, conductuales, somáticos y deterioro en el funcionamiento escolar y relacional en los involucrados en ciberbullying, más severo en los ciberagresores-cibervíctimas. El ciberbullying se asocia a consecuencias graves para la salud mental y el funcionamiento de los adolescentes

This study aims at assessing the asso­ciation of cyberbullying in adolescents with their mental health and functioning through a cross-sectional survey of 2,218 secondary school students in London (UK). Emotional, behavioural, somatic symptoms and impairment in school and relational functioning were found in those involved in cyberbullying, more severe in cyberbullying perpetrators- cyber victims. Cyberbullying is associated with serious consequences for adolescents' mental health and functioning

Els objectius d'aquest estudi són avaluar l'associació del ciberassetjament en adolescents amb la seva salut mental I funcionament mitjançant una enquesta transversal de 2.218 estudiants de secundària de Londres (Regne Unit). Es van trobar símptomes emocionals, conductuals, somàtics I deteriorament en el funcionament escolar I relacional en els involucrats en ciberassetjament, més sever en els ciberagressors-cibervíctimes. El ciberassetjament s'associa a conseqüències greus per a la salut mental I per al funcionament dels adolescents

Cyberbullying and post-traumatic stress symptoms in UK adolescents.

OBJECTIVE: Cyberbullying involvement carries mental health risks for adolescents, although post-traumatic stress (PTS) symptoms have not received strong attention in the UK. This study aimed to assess the overlap between cyber and traditional (ie, face-to-face) bullying, and the relationship to PTS symptoms in UK adolescents. DESIGN: A cross-sectional survey. SETTING: Four secondary schools in London,UK. PARTICIPANTS: 2218 secondary school students (11-19 years). MAIN OUTCOME MEASURES: The Olweus Bully/Victim Questionnaire and the Children Revised Impact of Events Scale. RESULTS: There was a significant overlap between traditional bullying and cyberbullying. However, cyberperpetrators were less frequently involved in concurrent traditional bullying. Of 2218 pupils, 46% reported a history of any kind of bullying (34% were involved in traditional bullying and 25% in cyberbullying), 17% as victims, 12% as perpetrators, and 4% as both victims and perpetrators. A significant proportion of those who were cybervictims (n=280; 35%), cyberbullies (n=178; 29.2%) or cyberbully-victims (n=77; 28.6%) presented clinically significant PTS symptoms. Cybervictims (both cyber-only and cyberbully-victims) suffered more intrusion (p=0.003; p<0.001) and avoidance (p=0.005; p<0.001) than cyberbullies. However, cyberbullies still suffered more PTS symptoms than the non-involved (intrusion: z=-3.67, p=0.001; avoidance: z=-3.57, p=0.002). Post-traumatic stress symptoms were significantly predicted (R2=13.6) by cyber and traditional victimisation. CONCLUSIONS: Cyberbullying, as victim only or as a victim-perpetrator, seems to be associated with multiple types of PTS symptoms. Cyber and traditional victimisation significantly predicted intrusion and avoidance. Paediatricians, general practitioners and mental health professionals need to be aware of possible PTS symptoms in young people involved in cyberbullying. Screening and early cost-effective treatments could be implemented.

OpenSIMPLe: A real-world implementation feasibility study of a smartphone-based psychoeducation programme for bipolar disorder.

BACKGROUND: Few evidence-based mental health apps are widely available to patients and, conversely, many of the available apps have not been appropriately evaluated. Given that the ultimate goal is to scale-up and open internet-based platforms (IBP), it is crucial to appropriately evaluate their real-world feasibility beforehand. We aimed to evaluate the implementation feasibility of a smartphone-based psychoeducational programme for bipolar disorder, exploring its long-term retention, usability, perceived helpfulness and satisfaction, alongside its impact on secondary health outcomes. METHODS: Participants were recruited via the project website after completing an online screening questionnaire. They were requested to complete web-based questionnaires before using the app and after 6 months of use which included sociodemographic, illness and treatment variables, the world health organisation-five well-being index (WHO-5) and the short form health survey (SF-36). The follow-up questionnaires also contained satisfaction and usefulness questions. RESULTS: 201 participants took part in the study. According to their retention, 66.2% of the participants were classified as noncompleters and 33.8% as completers. The only predictor significantly associated with higher odds of retention was older age (OR = 1.021, p < 0.001). 62% of the users reported they were satisfied with the programme with a higher percentage among completers. Who-5 baseline and follow-up scores showed a significant improvement as well as 6 out of 8 domains of the SF-36. LIMITATIONS: Screening and outcome measures were administered using exclusively self-reported online methods. CONCLUSION: The 6-month attrition rate of the programme was high. Positive outcomes regarding satisfaction were found predominantly among completers. The optimal dosage and retention of IBP mental health programmes remain challenging issues that need further research.

Is a SIMPLe smartphone application capable of improving biological rhythms in bipolar disorder?

BACKGROUND: Biological rhythms (BR) disturbance has been suggested as a potential mediator of mood episodes in Bipolar Disorder (BD). The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) was designed as an assessment tool to evaluate BR domains comprehensively. In the context of a trial evaluating a smartphone application delivering personalized psychoeducational contents for BD (SIMPLe 1.0), the main aim of this study is to evaluate the potential impact of SIMPLe 1.0 in BR regulation using the BRIAN scale. METHODS: 51 remitted BD patients were asked to use the application for 3 months. Paired t-test analyses were employed to compare baseline and follow-up BRIAN´s total and domains scores. The sample was divided into completers and non-completers of the study to evaluate differences between groups regarding BRIAN scores using ANCOVA analyses. RESULTS: The BRIAN's mean total score of the whole sample significantly decreased from baseline to post-intervention (35.89 (SD 6.64) vs. 31.18 (SD 6.33), t = 4.29, p = 0.001). At post-intervention, there was a significant difference between groups regarding the total BRIAN mean score (29.47 (SD 6.21) completers vs. 35.92 (SD 3.90) non-completers, t = 2.50, p = 0.02). This difference was maintained after conducting a one-way ANCOVA controlling for pre-intervention BRIAN scores, F (1, 46) = 10.545, p=0.002. LIMITATIONS: A limited sample, pre-post measures, and a short study timeframe could have affected the results. Additional factors affecting BR, such as medication, could not be ruled out. CONCLUSION: Our results suggest that there are potential positive effects of a psychoeducational smartphone application as an adjunctive to treatment as usual on BD patients' BR.

Psychoeducation in bipolar disorder with a SIMPLe smartphone application: Feasibility, acceptability and satisfaction.

BACKGROUND: During the last fifteen years, the possibility of delivering psychoeducation programs through Internet-based platforms have been explored. Studies evaluating those programs have shown good to acceptable retention rates. In this context, we developed a smartphone application (SIMPLe) collecting information about mood symptoms and offering personalized psychoeducation messages. The main aims of this study were to evaluate the feasibility, acceptability and satisfaction of the smartphone application. METHODS: The study was conducted from March to August 2015. Participation in the study was proposed to a consecutive sample of adult patients attending an outpatient mental health clinic. Sociodemographic data, clinical and functional assessments alongside smartphone ownership and uses were collected at baseline and at 3 months' follow-up. A 5 item Likert-scale satisfaction questionnaire was also employed. RESULTS: 51 participants were initially enrolled in the study, 36 (74%) remained actively using the application after 3 months. The whole sample interacted with the application a mean of 77 days (SD=26.2). During these days they completed 88% of the daily tests. Over 86% of the participants agreed that the experience using the application was satisfactory. LIMITATIONS: The diversity of smartphones operating systems led to a moderate, although representative, sample number. Additionally, the subjective data reporting, narrow time frame of use and stability of the patients could have affected the results. CONCLUSIONS: The results confirm that this particular intervention is feasible and represent a satisfactory and acceptable instrument for the self-management of bipolar disorder as an add-on to the usual treatment but future clinical trials must still probe its efficacy.

Internet-based psychological interventions for bipolar disorder: Review of the present and insights into the future.

BACKGROUND: In the last decade, there has been an increasing advent of innovative concepts in psychological interventions aimed at empowering bipolar patients by means of technological advancements and taking advantage of the proliferation of the Internet. Since the adoption of these technologies for behavioral monitoring and intervention is not trivial in clinical practice, the main objective of this review is to provide an overview and to discuss the several initiatives published so far in the literature related to the Internet-based technologies aimed to deliver evidence-based psychological interventions for bipolar disorder patients. METHODS: We conducted a comprehensive systematic review of the literature from multiple technological, psychiatric and psychological domains. The search was conducted by applying the Boolean algorithm "BIPOLAR AND DISORDER AND (treatment OR intervention) AND (online OR Internet OR web-based OR smartphone OR mobile)" at MEDLINE, SCOPUS, EMBASE, ClinicalTrials, ISI Web of Science and Google Scholar. RESULTS: We identified over 251 potential entries matching the search criteria and after a thorough manual review, 29 publications pertaining to 12 different projects, specifically focusing on psychological interventions for bipolar patients through diverse Internet-based methods, were selected. LIMITATIONS: Taking into consideration the diversity of the initiatives and the inconclusive main outcome results of the studies, there is still limited evidence available to draw firm conclusions about the efficacy of interventions using Internet-based technologies for bipolar disorder. CONCLUSIONS: However, considering the high rates of retention and compliance reported, they represent a potential highly feasible and acceptable method of delivering this kind of interventions to bipolar patients.

Self-monitoring and psychoeducation in bipolar patients with a smart-phone application (SIMPLe) project: design, development and studies protocols.

BACKGROUND: New technologies have recently been used for monitoring signs and symptoms of mental health illnesses and particularly have been tested to improve the outcomes in bipolar disorders. Web-based psychoeducational programs for bipolar disorders have also been implemented, yet to our knowledge, none of them have integrated both approaches in one single intervention. The aim of this project is to develop and validate a smartphone application to monitor symptoms and signs and empower the self-management of bipolar disorder, offering customized embedded psychoeducation contents, in order to identify early symptoms and prevent relapses and hospitalizations. METHODS/DESIGN: The project will be carried out in three complementary phases, which will include a feasibility study (first phase), a qualitative study (second phase) and a randomized controlled trial (third phase) comparing the smartphone application (SIMPLe) on top of treatment as usual with treatment as usual alone. During the first phase, feasibility and satisfaction will be assessed with the application usage log data and with an electronic survey. Focus groups will be conducted and technical improvements will be incorporated at the second phase. Finally, at the third phase, survival analysis with multivariate data analysis will be performed and relationships between socio-demographic, clinical variables and assessments scores with relapses in each group will be explored. DISCUSSION: This project could result in a highly available, user-friendly and not costly monitoring and psychoeducational intervention that could improve the outcome of people suffering from bipolar disorders in a practical and secure way. TRIAL REGISTRATION: Clinical Trials.gov: NCT02258711 (October 2014).

e-HCL-32: a useful, valid and user friendly tool in the screening of bipolar II disorder.

BACKGROUND AND OBJECTIVES: Bipolar type II (BDII) is a frequent disorder with high morbidity and mortality, characterized by depressive and hypomanic episodes. Early diagnosis can be effective in improving long-term prognosis. However, diagnosing BDII is challenging due to the difficulty in detecting past hypomanic episodes. The HCL-32 is a widely used and reliable screening instrument for the detection of past hypomanic episodes. Making this tool available to more patients could help diagnose and treat undetected cases of BDII earlier. New technologies such as the Internet have been previously used for this purpose with favorable outcomes. Accordingly, the objective of this study is to evaluate the acceptability, validity, reliability and equivalence of an online version of this questionnaire. METHODS: From May 2012 to March 2013, 52 participants attending an outpatient mental health clinic completed a paper version of the HCL-32 (HCL-32) and its online version (e-HCL-32) within two weeks. After its completion, they were asked to answer a brief satisfaction survey. RESULTS: No differences were found (HCL-32 mean total score=17.73 (SD=7.37), e-HCL-32 mean total score=18.28 (SD=7.09). T=-1.720, p=0.092, 95% CI=-1.21 to 0.09) between the results of the paper and pencil HCL-32 compared to its online version (e-HCL-32). The psychometric properties of the online version of the hypomania checklist (e-HCL-32) were good and comparable to the paper and pencil version. 80% of participants found online questionnaires to be easier to answer and more user-friendly. CONCLUSION: The results of this study support the use of an online screening tool for the detection of previous hypomanic episodes (necessary for BDII diagnosis) as it showed to have a similar validity and reliability to the traditional paper and pencil method.