Gleeson John, Lin Ashleigh, Koval Peter, Hopkins Liza, Denborough Paul, Lederman Reeva, Herrman Helen, Bendall Sarah, Eleftheriadis Dina, Cotton Sue, Perry Yael, Kaess Michael, Alvarez-Jimenez Mario
Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Australia.
University of Western Australia, Nedlands, Australia.
JMIR Ment Health. 2023 Sep 6;10:e47722. doi: 10.2196/47722.
Family carers of youth recovering from early psychosis experience significant stress; however, access to effective family interventions is poor. Digital interventions provide a promising solution.
Our objective was to evaluate across multiple Australian early psychosis services the effectiveness of a novel, web-based early psychosis intervention for carers.
In this cluster randomized controlled trial conducted across multiple Australian early psychosis services, our digital moderated online social therapy for carers (Altitudes) plus enhanced family treatment as usual (TAU) was compared with TAU alone on the primary outcome of perceived stress and secondary outcomes including mental health symptoms and family variables at the 6-month follow-up.
Eighty-six caregivers were randomized and data were available for 74 young people in their care. Our primary hypothesis that carers randomized to Altitudes+TAU would report greater improvements in perceived stress at follow-up compared with carers randomized to TAU alone was not supported, with the TAU alone group showing more improvement. For secondary outcomes, the TAU alone group showed improved mindfulness over time. Regardless of group assignment, we observed improvements in satisfaction with life, quality of life, emotional overinvolvement, and burden of care. In contrast, hair cortisol concentration increased. Post hoc analyses revealed more contact with early psychosis services in the intervention group compared to TAU alone and that improvements in perceived stress and social support were associated with use of the intervention in the Altitudes+TAU group. In this study, 80% (12/15) reported a positive experience with Altitudes and 93% (14/15) would recommend it to others.
Our trial did not show a treatment effect for Altitudes in perceived stress. However, our post hoc analysis indicated that the amount of use of Altitudes related to improvements in stress and social support. Additional design work is indicated to continue users' engagement and to significantly improve outcomes in problem-solving, communication, and self-care.
Australian and New Zealand Clinical Trials Registry ACTRN12617000942358; https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12617000942358.
早期精神病康复青年的家庭照顾者承受着巨大压力；然而，获得有效的家庭干预措施的机会却很少。数字干预提供了一个有前景的解决方案。
我们的目的是在澳大利亚多个早期精神病服务机构中评估一种新颖的、基于网络的针对照顾者的早期精神病干预措施的有效性。
在这项在澳大利亚多个早期精神病服务机构开展的整群随机对照试验中，将我们为照顾者提供的数字介导在线社交疗法（Altitudes）加常规强化家庭治疗（TAU）与单纯TAU相比较，以6个月随访时的感知压力主要结局以及包括心理健康症状和家庭变量在内的次要结局进行评估。
86名照顾者被随机分组，有74名他们所照顾的年轻人的数据可用。我们的主要假设，即与单纯随机分配到TAU的照顾者相比，随机分配到Altitudes+TAU的照顾者在随访时报告的感知压力改善更大，未得到支持，单纯TAU组显示出更多改善。对于次要结局，单纯TAU组随时间推移正念有所改善。无论分组如何，我们观察到生活满意度、生活质量、情感过度卷入和照顾负担均有改善。相比之下，头发皮质醇浓度增加。事后分析显示，与单纯TAU相比，干预组与早期精神病服务机构的接触更多，并且在Altitudes+TAU组中，感知压力和社会支持的改善与干预措施的使用有关。在本研究中，80%（12/15）报告对Altitudes有积极体验，93%（14/15）会向他人推荐。
我们的试验未显示Altitudes在感知压力方面有治疗效果。然而，我们的事后分析表明，Altitudes的使用量与压力和社会支持的改善有关。需要进行更多设计工作以持续提高用户参与度，并显著改善解决问题、沟通和自我护理方面的结局。
澳大利亚和新西兰临床试验注册中心ACTRN12617000942358；https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12617000942358 。
