Development and testing of a caregiver-facing mobile health intervention to reduce duration of untreated psychosis

项目摘要/摘要 对经历早期精神病的年轻人进行早期干预显著改善长期疗效 功能轨迹。然而，长期未治疗的疾病大大降低了治疗的影响。 照顾者通常在寻求治疗方面发挥关键作用，与提供者进行第一次接触，说服 受影响的亲属不得进行这种接触，或确保受影响的个人仍在接受护理。 然而，照顾者往往缺乏关于精神病、治疗和康复的准确信息，或者感觉 不堪重负，无法帮助受影响的亲属或与其沟通。在此期间，他们是 尤其容易受到有问题的或适得其反的疾病评估，例如，灾难 信仰，或自责或病人的归因。照顾的认知模型认为，消极的家庭 互动可能会恶化症状和功能，同时阻碍寻求帮助。专业户 干预措施改善了照顾者和受影响的年轻人的结局，但这些干预措施是提供的 向受影响的年轻人已经接受治疗的EP家庭提供帮助。因此，照顾者 未接受治疗的患有EP的年轻人--可以说是预后不佳的最大风险人群--无法获得 他们所需要的服务。照顾者经常求助于在线资源，以获得更多信息和社会支持。早些时候 对基于网络的平台的研究表明，数字医疗技术是可行的， 可接受的，并有可能改善照顾者的精神病相关知识和评估。莫比尔县 卫生干预特别适合于这项任务，因为它们可以提供个性化、实时、实时的 放置支撑物。然而，目前还不清楚mHealth能否以及在多大程度上远程提供 提高对患有EP的年轻人的治疗参与度。 拟议的研究项目旨在开发和测试旨在改善 通过交互式认知-行为模块了解照顾者的疾病知识和照看技能，以及 通过这些改进，减少痛苦，改善应对，改善家庭沟通，增加 照顾者治疗便利化和减少未治疗的精神病的持续时间。这项建议将涉及(1)需求 与EP照顾者进行评估和用户共同设计会议，以了解他们的需求、兴趣和 面向照顾者的mHealth干预中的偏好，(2)这一新的可用性现场试验为期一周 干预以确定可行性和功能性，以及(3)远程试验随机对照试验 将这种新的干预措施与现有的在线护理支持资源进行比较。分析将确定 这一方法是否可以接受和可行，以及探索其有效性和对关键 照看的认知模型的组成部分。

PROJECT SUMMARY / ABSTRACT Early intervention for young adults experiencing early psychosis significantly improves long-term functional trajectory. However, a long duration of untreated illness significantly reduces the impact of treatment. Caregivers often play a pivotal role in treatment-seeking, making first contact with providers, persuading the affected relative to make such contacts, or ensuring that the affected individual remains engaged in care. However, caregivers often lack accurate information about psychosis, treatments and recovery, or feel overwhelmed and unable to help or communicate with their affected relative. During this period, they are especially vulnerable to problematic or counterproductive appraisals of illness, for example, catastrophizing beliefs, or self- or patient-blaming attributions. The cognitive model of caregiving argues that negative family interactions can worsen symptoms and functioning while impeding help-seeking. Specialized family interventions improve outcomes for caregivers and affected young adults, but these interventions are provided to EP families in which the affected young adult has already presented to treatment. Thus, caregivers of untreated young adults with EP – arguably the individuals at greatest risk for poor outcomes – lack access to the services they need. Caregivers often turn to online resources for more information and social support. Early work examining web-based platforms has demonstrated that digital health technologies are feasible, acceptable, and have potential to improve caregivers’ psychosis-related knowledge and appraisals. Mobile health interventions are particularly well-suited to this task, as they can provide individualized, real-time, real- place support. It remains unclear at present, however, whether and how remotely delivered mHealth can be leveraged to increase engagement in treatment for young adults with EP. The proposed research project aims to develop and test an mHealth intervention designed to improve caregivers’ illness knowledge and caregiving skills through interactive cognitive-behavioral modules, and through these improvements, reduce distress, improve coping, improve family communication, increase caregiver treatment facilitation and reduce duration of untreated psychosis. This proposal will involve (1) needs assessment and user co-design sessions with EP caregivers to understand their needs, interests and preferences in a caregiver-facing mHealth intervention, (2) a one-week usability field trial of this new intervention to determine feasibility and functionality, and (3) a remote pilot randomized controlled trial comparing this new intervention to existing online caregiving support resources. Analyses will determine whether this approach is acceptable and feasible, as well as explore its effectiveness and impact on key components of the cognitive model of caregiving.