iTreAD Project (Internet Treatment for Alcohol and Depression)

image - Itread Logo 300 Square
Date Commenced:
08/2014
Expected Date of Completion:
02/2017
Project Supporters:

NHMRC Project Grant

Drug Type:
Project Members: 
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Conjoint Associate Professor
Ph 02 4985 4309
image - Jenny Geddes From Cre Website
Ms Jenny Geddes
Manager
image - Sally Hunt Web Pic
Visiting Fellow
Ph +612 49854305
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Professor
Ph EA Jasmin Bartlett: 02 9385 0167 / j.bartlett@unsw.edu.au
Dr Mark Deady
Post-Doc Res Fellow (UNSW)
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Lecturer
Ph +61 (2) 8936 1010
Project Main Description: 

This project will conduct the first randomised controlled trial of an internet delivered treatment for comorbid depression and binge drinking in young people aged 18-30 years, augmented with social networking support. Young people with these conditions will be recruited through online advertising and randomly assigned to one of three conditions to examine the relative impact of:

  1. Monthly online self-assessment for 12 months (OSA);
  2. OSA + 12-months of access to a 4-week program of web-based intervention for binge drinking and depressed mood (DEpression ALcohol), DEAL);
  3. OSA + DEAL + 12-months access to a purpose-built social networking site (BreathingSpace).

All participants will undergo baseline assessment, and follow-up assessment at twenty-six, thirty-nine, fifty-two and sixty-four weeks post-baseline.

Project Collaborators: External: 

Professor Amanda Baker
Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle

Professor Kathleen Brady
Dept. of Psychiatry and Behavioural Sciences, Medical University of South Carolina

Associate Professor Terry Lewin
Priority Research Centre for Translational Neurosceince and Mental Health, University of Newcastle

Professor Bonnie Spring
Department of Preventative Medicine, Northwestern University

Associate Professor Bridgette Bewick
Leeds Institute of Health Sciences, University of Leeds

Rationale: 

This project focuses on a common clinical problem that causes substantial functional, economic and health impacts; comorbid depression and binge drinking. These conditions are under-treated and peak in young adulthood. This project offers a low cost, wide reach, youth-appropriate treatment, which will have profound implications for service design and health policy. It relates to current Commonwealth initiatives in e-health and e-Psychology. 

Aims: 
We will directly target young people with comorbid depression and binge drinking behaviours and, for the first time, evaluate an internet-based psychological treatment program, augmented with peer-driven social networking. This program can easily be translated into primary care, clinical and real world settings for use by young people experiencing these conditions. Via this study, we aim to:
  1. Demonstrate that young people, aged 18-30 years, who are experiencing low mood and are binge drinking will engage with web-based treatments that target their multiple problems simultaneously;
  2. Demonstrate that young people with these problems will benefit from web-based treatment targeting low mood and binge drinking simultaneously; and
  3. Demonstrate the additional benefit of peer-led social influence on engagement and mood and binge drinking outcomes for young people, when offered in conjunction with a web-based treatment for these conditions.
 
We will examine the relative impact of:
  1. Monthly online self-assessment (OSA) for 12 months; OSA
  2. OSA + 12-months of access to a 4-week program of web-based intervention for binge drinking and depressed mood (DEpression ALcohol - DEAL); OSA + DEAL
  3. OSA + DEAL + 12-months access to a purpose-built social networking site (BreathingSpace); OSA + DEAL + BreathingSpace 
 
Design and Method: 
A randomised controlled trial with 123 participants in each group:
  1. Monthly online self-assessment (OSA) for 12 months; OSA
  2. OSA + 12-months of access to a 4-week program of web-based intervention for binge drinking and depressed mood (DEpression ALcohol - DEAL); OSA + DEAL
  3. OSA + DEAL + 12-months access to a purpose-built social networking site (BreathingSpace); OSA + DEAL + BreathingSpace 
 
Progress/Update: 

At this stage the original recruitment target of 369 participants (corresponding to 123 in each treatment condition) has been exceeded and we have recruited 423 participants in the study. 3443 people have also completed the online iTreAD screening assessment.

Recruitment is closed and we have five months remaining to complete treatment and follow up for participants. Follow up assessments are continuing with an expected completed of February 2017. Presently some participants have completed their final 15 month assessment fulfilling all requirements for participation in the study.

Some of the key recruitment numbers are outlined in the figure below:

image - iTreAD Project (Internet Treatment for Alcohol and Depression)

In the last 12 months the process for recruiting participants in the iTreAD study has changed. Previously, telephone consent was sought and then participants undertook a combination of online and telephone assessments to become active participants in the study. Based on feedback received from potential participants the consent and baseline assessment process became fully online in February 2015 which streamlined the recruitment process and enabled the team to achieve much higher recruitment numbers in the study.

One challenge to the smooth running of the project was the unexpected closure of Viverae Health (formerly One Health) at the end of May 2015. Viverae Health provided the social media platform our social networking site Breathing Space.  Participants in Breathing Space were given one month notice of the change and transition to an alternative site, Café Well occurred at the beginning of June 2015. While Viverae Health looked and functioned like Facebook, CafeWell operates as an online discussion board. Our experience on each social networking site has highlighted the advantages and disadvantages of each social networking approach for our Breathing Space Community. While Viverae Health had a higher level of activity and a presence on the site, content could be missed in a participant’s news feed. The discussion boards of Café Well enables participants to scroll through content easily, however the appearance of lowered levels of activity or presence on the site of participants may have influenced member participation. We are also aware of some technical difficulties regarding the use of the Café Well app which may also present as a barrier to participation for our study population.  

Analytics has shown that the unexpected closure of Viverae Health and transition to Café Well has been associated with an overall reduction in activity from our Breathing Space members. The iTreAD team will continue to focus on engaging the breathing space community into regular discussions and self initiated posting of material till the treatment phase is completed. In the past year, similar to the 12 months prior, our Breathing Space participants engaged with project staff, and commented when prompted, but there continue to be lower levels of engagement with each other. There also continues to be fewer posts and blogs by the members themselves and iTreAD staff continue to encourage members to post themselves and comment on other member’s posts.

Difficulties providing follow up to participants where a suicide risk has been identified have been encountered. For all participants who are identified at baseline and follow up assessment as having an elevated suicide risk iTreAD staff attempt contact with the participant via telephone with the aim of conducting a comprehensive suicide risk assessment and providing information and referral if clinically indicated. Participants are made aware in written form when completing the baseline assessment that contact by an iTreAD clinician may be required. They are also given the option of requesting telephone contact. To date, making contact with participants has been challenging because participants regularly do not answer the phone, and do not return calls, or respond to SMS or emails.  Making referrals to local mental health services always occurs when a clinician identifies risk according to the suicide management plan, however this has not always resulted in provision of care from the mental health service, and has highlighted the challenges young people face in accessing crisis support and care. 

Output: 

Publications

To date, one protocol paper for the iTreAD study has been published:

Kay-Lambkin, F. J., Baker, A. L., Geddes, J., Hunt, S. A., Woodcock, K. L., Teesson, M., Oldmeadow, C., Lewin, T. J., Bewick, B. M., Brady, K., Spring, B., Deady, M., Barrett, E., and Thornton, L. (2015). The iTreAD project: A study protocol for a randomised controlled clinical trial of online treatment and social networking for binge drinking and depression in young people. BMC Public Health, 15, 1025.

Conference presentations

Integrating Web 2.0 tools to engage young people with comorbid depression and binge drinking in evidence based Cognitive Behaviour Therapy. World Congress of Behavioural and Cognitive Therapies (WCBCT). Melbourne, Australia. 23 June 2016.

What is the role of eHealth interventions in mental health and addictions treatment? Centre for Technology and Behavioural Health, Dartmouth College, New Hampshire. 15 April 2016.

What is the role of eHealth interventions in mental health and addictions treatment? Behavioral Health and Technology, University of Virginia, USA.  11 April 2016

The iTreAD Project: using online CBT and moderated social networking to engage and assist young people with depression and binge drinking problems. SMHR, Brisbane. 2 December, 2015.

Emerging perspectives in the management of comorbid mental and additive disorders.  The role of eHealth.  UCLA invited Presenter. CPDD Symposium, Arizona, USA.  16 June, 2015.

Benefits: 

The current research will increase the accessibility of this evidence-based treatment program and can facilitate ongoing research with the target group. The proposed project focuses on a common clinical problem that causes substantial functional, economic and health impacts; comorbid depression and binge drinking. These conditions are currently under-treated, contribute significantly to the global disease burden and are at their peak in young people. Offering treatments of low cost and with wide reach to affected people, will address current inequities of treatment access for these problems, and provide a youth-appropriate modality of treatment delivery. These results will have profound implications for service design and health policy, and speak to important questions about the nature of treatment effects in general.

It is hypothesised that all groups will report reductions in binge drinking frequency and depression over the treatment period, but that this will be greatest for those receiving DEAL (OSA + DEAL; OSA + DEAL + Breathing Space). It is also hypothesised that those receiving OSA + DEAL + Breathing Space will complete more web-based sessions and therefore report superior reductions

Drug Type: 
Project Status: 
Current