Enhancing mental health literacy in obsessive-compulsive disorder and reducing stigma via smartphone: A randomized controlled trial protocol

Meta-analysis of age at help-seeking and duration of untreated illness (DUI) in obsessive-compulsive disorder (OCD): The need for early interventions

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder that often begins early in childhood. Patients with OCD are known to seek help late after disorder onset, and therefore have a long duration of untreated illness (DUI), which is found to correlate with negative clinical outcomes. No meta-analysis has previously investigated this issue.

METHODS

Our protocol was pre-registered with PROSPERO (CRD42020165226). We followed PRISMA-guidelines and searched for relevant articles in four electronic databases. Meta-analyses of means based on random-effects (Der-Simonian-and-Laird-method) were used to derive the pooled estimates. Subgroup-analyses and meta-regressions were conducted to explore possible factors affecting help-seeking and DUI.

RESULTS

We included N = 31 studies in the quantitative synthesis, with 16 studies proving data for age at help-seeking and 16 studies providing data for duration of untreated illness. The pooled mean age at help-seeking was 28.66 years (95 % CI: 27.34-29.98), while the pooled mean interval between age at disorder onset and help-seeking was 6.97 (95 % CI: 5.69-8.24), and the pooled mean duration of untreated illness was 80.23 months (68.72-91.75), around 6.69 years, all with p < 0.001. Specific OCD-related factors affected help-seeking and duration of untreated illness.

CONCLUSIONS

Patients with OCD seek for help late in the course of the disorder and have a long duration of untreated illness, which is associated with more negative prognosis. This meta-analysis confirms the long duration of untreated illness in OCD and proposes possible factors associated with the length of the help-seeking process and DUI.

Acceptability, feasibility, and effectiveness of internet-based cognitive behavior therapy for obsessive-compulsive disorder (OCD-NET): a naturalistic pilot trial during the COVID-19 pandemic in a psychiatric outpatient department in Germany

BACKGROUND

Cognitive behavior therapy (CBT) is the gold-standard treatment for obsessive-compulsive disorder (OCD). However, access to CBT and specialized treatments is often limited. This pilot study describes the implementation of a guided Internet-Based CBT program (ICBT) for individuals seeking treatment for OCD in a psychiatric outpatient department in Leipzig, Germany, during the COVID-19 pandemic. The aim of the study was to investigate the acceptability, feasibility, and effectiveness of the ICBT program for OCD.

METHODS

In an open, naturalistic pilot trial, N = 57 patients with OCD received a 10-week ICBT program (called "OCD-NET"). It consisted of 10 different modules covering psychoeducation, cognitive restructuring, exposure with response prevention, and overall therapist support and guidance through the program. The primary outcome was feasibility and acceptance of the OCD-NET program assessed via recruitment and retention rate, adherence and user satisfaction. Secondary outcomes were OCD symptoms at the end of treatment, assessed using the self-report Obsessive Compulsive Inventory - Revised (OCI-R) and self-rated measures of depressive symptoms, quality of life, self-efficacy, and psychological distress. Additionally, treatment credibility, working alliance, and satisfaction were assessed.

RESULTS

On average, participants completed 6.30 (SD = 3.21) modules, and n = 19 (33.9%) participants completed all 10 modules of the program. Overall, n = 45 (78.9%) were treatment completers (minimum 4 modules completed), n = 11 (19.3%) were non-completers, and n = 1 (1.8%) was a dropout. Satisfaction with the program was high, with a majority of participants indicating that they would recommend it to others (n = 56, 98.2%) and that it provided the support they needed (n = 49, 86.0%).Mixed-effect models showed a significant reduction in OCD symptoms (OCI-R), with large within-group effect sizes in both intention-to-treat (ITT) and completer analyses. In ITT analyses, the OCI-R decreased significantly with a within-group effect size of d = 1.13 (95% CI 0.88 - 1.38). At post-treatment, n = 17 (29.8%) participants showed a treatment response on the OCI-R (≥ 40% reduction). The treatment also resulted in statistically significant improvements in depressive symptoms (d = 0.90 [0.65; 1.15]) and self-efficacy (d = -0.27 [-0.53; -0.00]). No significant differences were observed in quality of life (WHOQOL-BREF) or psychological distress (Mini-SCL GSI) scores between baseline and post-treatment, in either the ITT or completer analyses.

CONCLUSIONS

The OCD-NET program is overall highly acceptable and appears to meet patients' needs in routine care, even under pandemic constraints. ICBT with therapist guidance significantly reduces OCD and depressive symptoms in real world settings. The results also suggest that this ICBT program could be integrated into routine psychiatric outpatient treatments. However, future research should investigate how upscaling and sustainable implementation could be effectively achieved.

TRIAL REGISTRATION

German Clinical Trials register (DRKS): DRKS00021706, registration date: 15.05.2020.

Assessment of Public Stigma, Mental Health Literacy, and Help-Seeking Intentions Based on Different Dimensions of Obsessive-Compulsive Content: A Study of the Spanish Mental Health-Naïve Population

BACKGROUND

Obsessive-compulsive (OC) disorder is a debilitating disorder with a high delay in help-seeking that could be associated with two barriers that may differ between OC content dimensions: public stigma and mental health literacy.

OBJECTIVES

We aim to describe and analyze the differences among OC content dimensions in public stigma, social distance desire, mental health literacy, and help-seeking intention in a sample of the mental health-naïve population.

METHODS

A total of 487 participants from the Spanish community with no previous knowledge of or experience with OCD were randomly allocated one of six vignettes describing a person with OC symptoms of one out of six contents (i.e., aggression/harm; sexual; religious/blasphemous/immoral; contamination/washing; doubts/checking; or superstition/symmetry/order). After reading the vignette, participants completed the following questionnaires associated with their vignette: Attribution Questionnaire, General Help-Seeking Questionnaire, Social Distance Scale, and Mental Health Literacy Questionnaire.

RESULTS

There were significant differences among OC content dimensions on the variables of interest. Aggression/harm OC content was associated with the highest public stigma and discriminating desire, and together with the religious/blasphemous/immoral OC contents were associated with the highest social distance desire. Although no differences appear between contents on intention to seek for formal treatment, participants would request less informal support for their sexual OC content than for the other categories. Contamination, doubts/checking, and superstition/symmetry/order OC contents were more frequently identified as OCD, although only around 50% or less of the sample identified the sexual, superstition/symmetry/order, doubts/checking, and religious/blasphemous/immoral OC contents as a mental health problem.

CONCLUSIONS

Interventions to reduce stigma and increase help seeking are necessary and should consider OC heterogeneity.

Mental health literacy for public employees

PURPOSE

Although mental disorders are common in the workplace, they often go unnoticed. There is frequently a gap in the recognition and effective management of these disorders, leading to delayed recovery and worsening conditions. This study evaluates the level of Mental Health Literacy (MHL) among employees of the Finance and Planning Departments in the Federal District, Brazil, and proposes preventive measures and de-stigmatization strategies for mental health in the workplace.

METHODS

MHL among active employees was assessed using the Mental Health Literacy Scale (MHLS), developed by O'Connor and Casey (2015) and validated for Brazilian Portuguese by Buta et al. (2024). The data analysis included descriptive and inferential statistics, with nonparametric tests used to compare MHL across different groups.

RESULTS

The results showed that 27.6% of participants had adequate literacy, 67.9% had problematic levels, and 4.5% had inadequate levels. Women were observed to have higher literacy levels than men. Additionally, significant variations in literacy levels were noted among individuals with different health conditions; those diagnosed with cancer, depression, or other illnesses had higher literacy than those without diagnosed conditions.

CONCLUSION

To address MHL challenges, educational actions such as awareness campaigns, training, and consultancy programs are essential.

Online Mental Health Peer-support Forums for Youth: An Exploratory Study on Stakeholder Perspectives

Background

Youth in India carry a large proportion of the global burden of mental health disorders and subclinical distress. They prefer to seek mental health support from informal sources. One such source-online mental health peer-support forums (OMHPSFs)-is under-researched. This study aims to explore the perspectives of youth and mental health professionals and counselors (MHP&Cs) in terms of the scope and utility of and inclination to use OMHPSFs for maintaining youth mental well-being.

Methods

An exploratory, cross-sectional, mixed-methods study was conducted. A total of 141 Indian nationals aged 18-29 years were enrolled using convenience sampling and administered a survey. In the qualitative phase, six youth and seven MHP&Cs were interviewed.

Results

Ninety (63.8%) and 106 (75.2%) participants indicated a high inclination to use OMHPSFs to seek and provide support, respectively. More than three-quarters of the surveyed youth stated that OMHPSFs should be a space for emotional and informational support to deal with life challenges. A total of 127 (90.1%) participants reported that OMHPSFs would be useful to find out how others their age deal with similar life challenges. A thematic analysis of interviews revealed that anonymity, accessibility, appeal, and ease of use enhance youth inclination toward OMHPSFs. The role of MHP&Cs in training, supervision, and moderation and strategies to popularize OMHPSFs were outlined and recommended.

Conclusion

Sampled youth showed a high inclination to use OMHPSFs to seek and provide mental health support to their peers. Stakeholders consider OMHPSFs as relevant in scope and utility to alleviate mental health concerns among Indian youth.

A mobile app to challenge obsessional beliefs in adolescents: a protocol of a two-armed, parallel randomized controlled trial

BACKGROUND

Adolescence is a crucial stage for the development of OCD symptoms that, in most cases, persist into adulthood. This requires designing preventive strategies tailored to this population. Therefore, we aim to describe the study protocol that will be used to examine the effectiveness of a mobile health application to challenge obsessional beliefs in adolescents.

METHODS

A two-armed randomized controlled trial will be conducted on an adolescent sample from the general population. The experimental group will use the intervention module (GGOC-AD) of a mobile app on the GGtude platform for 14 days whereas the control group will use a non-active module (GGN-AD) of said app. Primary outcome measures will be obsessional beliefs and obsessive-compulsive symptoms, and secondary measures will be self-esteem and emotional symptoms. Three assessment points will be conducted at baseline, post-intervention, and one-month follow-up. A linear multiple regression model with an intention to treat approach will be used. The expected total sample size will be 55 participants.

DISCUSSION

We expect that the intervention group will show a reduction in obsessional beliefs and OCD-symptoms at post and follow-up in comparison with the control group. Additionally, we expect that the app will improve participants' self-esteem. This study could provide an accessible mobile health tool to prevent OCD-related symptoms in adolescents.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT06033391 . Registered September 4, 2023.

Can an app increase health literacy and reduce the stigma associated with obsessive-compulsive disorder? A crossover randomized controlled trial

BACKGROUND

Obsessive-compulsive disorder (OCD) is a disabling condition with a high delay in seeking treatment. esTOCma is an app developed to increase mental health literacy (MHL) about OCD, reduce stigma, and increase the intention to seek professional treatment. It is a serious game and participants are asked to fight against the "OCD stigma monster" by accomplishing 10 missions. The aim of this study is to evaluate the effectiveness of this app in a community sample.

METHODS

A randomized controlled trial with a crossover design was carried out. Participants were randomized to two groups: immediate use (iApp, n = 102) and delayed use (dApp, n = 106) of esTOCma. The iApp group started using the app at baseline until the game was over. The dApp group initiated at 10-days until the game finished. Participants were requested to complete a set of questionnaires at baseline and 10-day, 20-day and 3-month follow-ups.

RESULTS

The Time×Group interaction effect was significant for the primary outcome measures: there was an increase in MHL and intention to seek help, and a decrease in stigma and OC symptoms, with large effect sizes, only after using the app. Changes were maintained (or increased) at follow-up.

LIMITATIONS

The study did not include an active control group and some of the scales showed low internal consistency or a ceiling effect.

CONCLUSIONS

This study provides first evidence for the effectiveness of esTOCma as a promising intervention to fight stigma and reduce the treatment gap in OCD.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04777292. Registered February 23, 2021, https://clinicaltrials.gov/ct2/show/NCT04777292.

The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive Disorder: Pilot Questionnaire Study

BACKGROUND

Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people's lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma.

OBJECTIVE

This study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a mental health mobile app, esTOCma, developed to improve knowledge about OCD and its treatment, increase help-seeking intention, and reduce stigmatizing attitudes and social distance associated with OCD.

METHODS

We used preintervention, postintervention, and 3-month follow-up assessments in this single-arm pilot intervention. Overall, 90 participants were recruited from the community using the snowball sampling method. We used esTOCma to defeat the "stigma monster" over the course of 10 missions. The participants completed the sociodemographic information and Obsessive-Compulsive Inventory-Revised at preassessment and an acceptability questionnaire at postassessment. All other measures were completed at the preassessment, postassessment, and 3-month follow-up (ie, the Spanish Mental Illness Stigma Attribution Questionnaire-27, the General Help-Seeking Questionnaire, the Social Distance Scale, and the Mental Health Literacy Questionnaire).

RESULTS

Of the 90 participants from the community that were assessed for eligibility, 86% (n=78) were allocated to intervention. Of these 78 participants, 79% (n=62) completed the game and answered the postintervention assessment (completer group). Overall, 69% (43/62) of the participants also completed the 3-month follow-up assessment. The participants completing the study were older (P=.003) and had a higher baseline knowledge of OCD (P=.05). The participants took an average of 13.64 (SD 10.50) days to complete the intervention, including the pre- and postassessments. The participants spent an average of 4.56 (SD 3.33) days completing the 10 missions included in the app. Each mission took a mean of between 2 (SD 3.01) and 9.35 (SD 3.06) minutes. The app was rated as useful or very useful by the vast majority of participants 90% (56/62). Moreover, 90% (56/62) of the participants reported that they had learned or learned a lot, and 98% (61/62) of the participants reported that they would recommend the app to a friend. Repeated measures ANOVA (43/62, 69%) showed that after the intervention participants showed an increased knowledge of mental health and intention to seek help as well as fewer stigmatizing attitudes and less social distance.

CONCLUSIONS

Preliminary data show that esTOCma is a feasible and acceptable app, and after completing its 10 missions, there is an increase in the understanding of OCD and help-seeking intention along with a decrease in the social stigma and social distance associated with OCD that lasts for at least 3 months. The results support the potential of technology-based interventions to increase the intention to seek help and reduce the stigma associated with OCD. A larger, community-controlled study is also recommended.

Factors related to the severity of obsessive-compulsive symptoms and their impact on suicide risk in epileptic patients

OBJECTIVE

To explore relevant factors for the severity of obsessive-compulsive symptoms (OCSs) in adult epileptic patients and investigate whether the severity of OCSs is a mediator in the relationship between depressive/anxiety symptoms and suicide risk in epileptic patients.

METHODS

This was a cross-sectional study from a hospital in Northeast China. Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Neurological Disorders Depression Inventory for Epilepsy (NDDIE), Generalized Anxiety Disorder (GAD-7), and Nurses' Global Assessment of Suicide Risk (NGASR) were used to assess the severity of OCSs, depressive symptoms, anxiety symptoms, and suicide risk in epileptic patients, respectively. The independent factors of the severity of OCSs and their mediating effects in the relationship between depressive/anxiety symptoms and suicide risk were evaluated by regression analyses and mediator models, respectively.

RESULTS

NDDIE scores (β = 0.404, p < 0.001), GAD-7 scores (β = 0.247, p = 0.009), and polytherapy (β = 0.119, p = 0.032) were the independent factors of Y-BOCS scores. The Y-BOCS scores partially mediated the relationship between GAD-7 scores and NGASR scores (standardized coefficients of indirect effect = 0.109, Bootstrap 95% CI = 0.024 to 0.214). Still, they did not mediate the relationship between NDDIE scores and NGASR scores (standardized coefficients of indirect effect = 0.062, Bootstrap 95% CI = -0.024 to 0.169).

CONCLUSIONS

Depressive symptoms, anxiety symptoms, and polytherapy are independently associated with the severity of OCSs in epileptic patients. Depressive and anxiety symptoms mediate the effect of the severity of OCSs on suicide risk in epileptic patients completely.

Adaptation of digital navigation training for integrated behavioral health providers: Interview and survey study

Despite effective treatment options, people who experience mental health conditions often do not receive needed care. E-mental health, for instance the use of mobile apps, is emerging as a way to increase access to and extend care. However, little formal training is available to increase the digital literacy level among behavioral healthcare providers (BHPs), seeking to employ such technology. The purpose of this study was to explore the acceptability and usability of an adapted in-person Digital Navigation Training (DNT) curriculum into e-Learning modules focused on the integrated environment for BHPs. BHP confidence to serve as digital navigators was also explored. E-Learning modules were adapted from an existing in-person DNT. A purposeful sampling strategy was used to recruit BHPs (n = 8) to complete the modules. Acceptability, usability, and confidence were assessed via survey and semi-structured interviews. Descriptive statistics were calculated for survey data and qualitative data were analyzed using a directed content analysis approach. BHPs who completed the training (n = 8) felt the modules were usable, enjoyed the structure, and felt the amount of time to complete the modules was acceptable. All participants thought the structure of the training worked well and enjoyed learning new information. While participants' confidence in their digital navigation skills increased, they desired more information and/or experience with screening apps prior to increasing their use of apps within their care. E-Learning modules were an acceptable method of educating BHPs with digital navigation skills. Future research is needed to explore incentives needed for training along with if participating in these modules can increase use of quality mobile apps to augment care within BHP treatment plans.

Obsessional intrusive thoughts in children: An interview based study

OBJECTIVES

We aimed to investigate the experience of obsessional intrusive thoughts (OITs) in a sample of children aged 8 to 10 years old and to test the main tenets of the cognitive model of OCD. Specifically, we assessed: (1) the prevalence of OITs experienced by young children; (2) their frequency and content; (3) the emotions they evoke; (4) the reasons why they are upsetting; (5) how they are appraised (6) and what control strategies they use.

METHODS

Forty-nine children (28 girls, 21 boys; mean age 9.1 years) from the community completed two self-report questionnaires assessing anxiety and obsessive-compulsive symptoms. Children were interviewed using the Children's Anxious Thoughts Interview, which assessed their experiences of OITs.

RESULTS

From the 49 participants, 71.43% reported having experienced at least one OIT. The most frequent contents related to harm and doubt. Of the total sample, 28.6% reported having experienced one OIT recently with at least moderate frequency; these participants reported higher anxiety and obsessive-compulsive interference, described feeling nervous and anxious when experiencing their OIT, and rated their OIT as highly important and distracting. The most frequently reported control strategies were cognitive - suppression, distraction and thought replacement.

CONCLUSIONS

Almost two thirds of community children reported experiencing OITs. The findings from this study provide preliminary support for the application of the cognitive model of OCD in children. Subtle differences from previous research with adults are discussed.