Conectar
by Emma Morton, Andrew Kcomt, Erin E. Michalak
BackgroundSelf-management strategies can be used by individuals with bipolar disorder (BD) to cope with symptoms and improve quality of life (QoL). Peer-facilitated psychoeducation has potential to diversify delivery of self-management information by capitalising on the expertise of individuals who live well with BD. This protocol describes the process of co-designing a novel peer-facilitated, QoL-focused, group psychoeducation program for people living with BD, and plans for its pilot evaluation.
MethodsContent from two web-based, self-directed psychoeducational interventions was adapted to inform a peer-facilitated group program, using a community-based participatory research (CBPR) framework. The resultant program contains eight weekly two-hour sessions on topics related to QoL in BD, and contains a combination of education, opportunities for peer-to-peer knowledge exchange, and activities that facilitate practice of self-management strategies. A single-arm pilot evaluation of this program is planned: individuals who self-identify as living with BD (~n = 40) will be recruited from the community. Four groups (~n = 10) will be delivered online by peer facilitators. The primary outcome will be feasibility (session attendance). Data will also be collected on fidelity, intervention acceptability, and impacts (QoL, mood symptoms, self-stigma, subjective recovery, self-efficacy, self-compassion, social support). A subset of participants (~n = 12) and peer facilitators (~n = 4) will be invited to participate in a feedback interview post-intervention.
DiscussionRecovery-oriented healthcare frameworks emphasise a focus on patient-valued outcomes and the development on a peer workforce. By evaluating this novel intervention, we hope to lay the groundwork for peer-facilitated programs specific to the priorities of individuals with BD, that may be embedded in clinical settings.
Trial registrationClinicalTrials.gov NCT06878937
About 30% of depressed patients suffer from a protracted course in which the disorder continues to cause significant burden despite treatment efforts. While originally developed for relapse prevention, mindfulness-based cognitive therapy (MBCT) has increasingly been investigated in depressed patients with such ‘difficult-to-treat’ courses. This is a protocol for an individual participant data (IPD) meta-analysis aiming to determine efficacy and potential moderators of MBCT treatment effects in this group based on evidence from randomised controlled trials.
Systematic searches in PubMed, Web of Science, Scopus, PsycINFO, EMBASE and the Cochrane Controlled Trials Register for randomised controlled trials were completed on 17 June 2024. Authors of identified studies have contributed IPD, and data extractions have been completed. An update search will be conducted immediately before the start of data analyses. We will investigate the following outcomes: (a) self-reported and observer-reported severity of depression symptomatology, (b) remission and (c) clinically meaningful improvement and deterioration. One-stage and two-stage IPD-MA will be conducted with one-stage models using the observed IPD from all studies simultaneously as the primary approach. One-stage IPD models will include stratified study intercepts and error terms as well as random effects to capture between-study heterogeneity. Moderator analyses will test treatment-covariate interactions for both individual patient-level and study-level characteristics.
The results will inform understanding of the use of MBCT in patients with current ‘difficult-to-treat’ depression and will contribute to arguments in favour of or against implementing MBCT as a treatment for this group. They will be published in a peer-reviewed journal and made available to stakeholders in accessible formats. No local ethical review was necessary following consultation with the Ethics and Governance Board of the University of Surrey. Guidance on patient data storage and management will be adhered to throughout.
CRD42022332039.
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