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

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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