Online Help for Diabetes Related Distress: Results of a proof of concept study Acknowledgement This research was funded by the 2013 RACGP Foundation/Diabetes Australia Research Grant 1
Background: 1 in 4 people with diabetes suffer from significant psychological distress related to their illness The incidence of depression in people with diabetes is 2-3 times higher than the general population Improved mental health leads to better diabetes self-care Time constraints and the complexity of disease management make it difficult to attend to the psychological needs of people with diabetes in primary care Online self-help for mild to moderate anxiety, depression and stress has been shown to be effective in the general community Question: Would a module specifically designed to address diabetes related psychological distress embedded in an evidence-based online self-help program be acceptable and useful to patients suffering from diabetes related distress? 2
mycompass Online program developed by mental health researchers at the Black Dog Institute Funded by the Commonwealth Department of Health Development and research led by Prof Judith Proudfoot mycompass Supported by an RCT with over 700 participants Launched in 2012 Free of charge Open access Interactive 3
Existing Modules Managing Fear and Anxiety Setting SMART Goals Increasing Pleasurable Activities Sleeping Well Managing Loss and Major Life Change Breathing and Relaxation Managing Stress and Overload Solving Problems Communicating Clearly Building Happiness and Wellbeing Taking Charge of Worry Tackling Unhelpful Thinking 4
Research Tasks Phase 1 Assess the perceived need for and desirable content of a diabetes specific online module Phase 2 Develop content and build the software for the module Phase 3 Pilot test the module with people with diabetes Phase 1: Need and Content General Practitioner focus groups Consumer focus groups Interviews with individual consumers 5
Phase 2: Content and software development Blend of CBT and ACT Focus on interactivity Software developed to match the look and feel of other modules in the mycompass suite with 3 short sessions and homework tasks between sessions 6
Phase 3: Pilot testing Participants Participants People with diabetes and mild depressive symptoms (on PHQ9) 18-75 years Australian resident Access to internet, computer and smart phone Valid email address Exclusion: Psychotic symptoms (psychosis screening questionnaire) Suicidality (Item 9, PHQ9) Recruitment Via diabetes specific media With the help of state based diabetes support organisations Through BDI websites Phase 3 Pilot testing Study Design Single group repeat measure design Participants assessed at baseline and 4 weeks Outcomes assessed with standard measures for - depression (PHQ9), - Generalised Anxiety (GAD-7) - diabetes related distress (PAID) Problem areas in diabetes questionnaire - Daily Functioning (WSAS) Work and Social Adjustment Scale - Confidence with diabetes management (SEDS) Self efficacy for diabetes scale - Confidence with mental health self management (MHSES) - Diabetes self management (DSCA) Diabetes self care activities measure - Glycaemic control (HHS) Hypergycaemia/Hypoglycaemia Scale 7
Characteristics of the Sample 1 - Demographics N=41 26-74 years (mean 46.9) 63.4% female 68.3% married or in defacto relationships 56.1% in full or part time work 63.4% Type 1 diabetes Characteristics of the Sample 2 - Clinical Profile (Mean Scores): Depression Moderate Anxiety Mild Diabetes related distress moderate Functional impairment moderate Diabetes self care poor (2 days a week exercise and dietary compliance on half the days of the week but BSL monitoring better at 5 days per week 8
Use of the Module Average number of logins 10.94 (more on the mobile site than the website) Average duration of use 15.23 days (over 4 weeks) Results: Satisfaction and acceptability Neutral Agree/strongly agree Easy to Use 31.8% 63.6% Easy to understand 27.3% 68.2% Relevant information 31.8% 63.6% Kept my interest and attention 40.9% 45.5% Helped improve my stress/low mood 45.5% 36.4% Taught me skills for a more balanced life 50.0% 36.4% I would complete the module again 45.5% 45.5% I would recommend the module to a friend 40.9% 54.5% 9
Results: Data at follow up No significant differences in baseline measures between those who did and those who did not complete follow up measures except for Non-completers were more likely to be smokers Non-completers had lower perceived confidence in managing their diabetes at baseline Non-completers had lower perceived confidence in managing their mental health at baseline Overall Results: - Preliminary analyses suggest that the module is associated with reduced: Depression Generalised anxiety Diabetes distress scores - Less impact on daily functioning - Improved engagement in diabetes self care behaviours though only in relation to diet. - One smoker who completed the follow up measures reported reduced cigarette consumption 10
Module Launched August 2015 Future research: More rigorous test of efficacy, i.e., randomised controlled trial Acceptability and feasibility in young people with diabetes Prevention?? Research Team Dr Jan Orman Dr Janine Clarke Ms Erin Whittle Cesar Anonuevo 11
Thanks again to RACGP Foundation and Diabetes Australia for making this project possible 12