psych online sriskantharajah arun castro
Post on 20-Aug-2015
109 Views
Preview:
TRANSCRIPT
Social Media & Online Interventions in Psychiatry
S.Arun FY2 Doctor . Jersey Wessex Deanery
23/2/12
Health & the internet
• UK : 41.6 million internet users, 82.9% of pop.
• 58.8% of the 65 to 74 age group online
• Globally Facebook 800 million users
Online applications for health
• 2011 Hurricane Irene - 1.3 million twitter users • emergency public health advice via the CDC’s Twitter-
feed.
• surgical devices supplier Stryker 250,000 views on the You-Tube
Paediatric Emergency Drugs App
Evidence base for online interventions
• 70 randomised control trials of online interventions
• 20 systematic review and meta-analyses
• 5 Cost effectiveness Analyses
online interventions in health
• Addictions• alcohol abstinence , smoking cessation, substance misuse;
• health promotion • sexual health, • patient education in hypertension and diabetes;
• online cognitive behavioural therapy – anxiety disorders – Depression– pain management, – irritable bowel syndrome.
papers
Andrews et al. meta-analysis of 22 iCBT RCTs
• Andrews et al. meta-analysis of 22 RCTs of online and computer based cognitive behavioural therapy interventions for:
• major depression, • panic disorder, • general anxiety disorder • social phobia
Andrews et al. meta-analysis of 22 I CBT RCTs
• The overall mean effect size (Hedge's g) g=0.88, 95% CI 0.76 to 0.99,
• computerised CBT is more effective than controls (waiting list) at improving outcomes of self-reported symptoms.
• Computerised CBT and traditional face-to-face CBT were found to be equally beneficial (five RCTs).
• Computerised CBT for anxiety and depressive disorders, especially via the Internet, had the capacity to provide effective acceptable and practical health care for those who might otherwise remain untreated.
• The estimated NNT was 2.15 for the use of computerised CBT in the four psychiatric disorders.
• Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS ONE 2010; (10):e13196
Online interventions for addictions
Shabeb et al . Meta-analysis. Addictions
• Interactive on-line Smoking cessation interventions at six months follow-up
• increased abstinence rates by 17% (95% CI 12 to 21) vs. minimal controls RR 1.93, 95% CI 1.44 to 2.6; three trials
Khadjesari et al. computer-based interventions aimed at reducing alcohol consumption
• Systematic review of 19 RCTs
• Caution was applied to conclusions due to the recognition of the existence of considerable study heterogeneity.
• E.g intervention participant follow-up ranged from • 2 weeks to 52 weeks.
• Khadjesari Z, Murray E, Hewitt C, Hartley S, Godfrey C. Can stand-alone computer-based interventions reduce alcohol consumption? A systematic review Addiction 2011; 106(2): 267-282
•
Limitations of the evidence base
• selection of poor clinically relevant outcome measures
• lack statistical power due to sample sizes
• Attrition rates and reliance of participant-recall– Reporter bias.
• Failure to adequately blind participants
• Difficulty with minimising confounding – (contamination effects)
Rooke et al -systematic review of 34 RCTsfor alcohol and nicotine addictions (Why?)
• - online interventions aimed at reducing alcohol and tobacco use. • Problem: novel research field - broad inclusion criteria. • small overall effect of the reviewed interventions • d=0.20, 95% CI 0.13 to 0.27
• addictions to alcohol and nicotine are clearly distinct clinical scenarios, • known differences in physical and psychological dependency attributes
• limited value in any result that combines the two problems
• study highlights the need to psych services to collaborate with investigators• set narrower inclusion criteria • to improve understanding of which clinical scenarios are best suited to online
interventions.• Rooke S, Thorsteinsson E, Karpin A, Copeland J, Allsop D. Computer-delivered interventions for alcohol and tobacco
use: a meta-analysis. Addiction 2010; 105(8): 1381-1390
Limitations of digital solutions in a physical world
• The Disadvantaged and the Disconnected• - 3 major groups in society that do not use the internet: • 72.4% of >75’s • 36.8% of those who have disabilities.(ONS)
• ? Homeless/ MH Users
• Private Sector Dominance
• Quality control & e-Kitemarking
• Online Etiquette & Professional Conduct – BMA & RCN Social Media guidance for clinicians
Conclusion
• level of evidence supporting social media in health is weak
• methodologies for online interventions need refining
• Without a sound evidence base
Hype around online and social media interventions, may waste resources
+ the public’s health may be adversely affected
Any questions
top related