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

项目概要/摘要 对经历早期精神病的年轻人进行早期干预可显着改善长期症状 功能轨迹。然而，长期未经治疗的疾病会显着降低治疗的效果。 护理人员通常在寻求治疗、与提供者进行首次联系、说服患者等方面发挥着关键作用。 受影响的亲属进行此类接触，或确保受影响的个人继续接受护理。 然而，护理人员往往缺乏有关精神病、治疗和康复的准确信息，或者感觉 不知所措，无法帮助或与受影响的亲属沟通。在此期间，他们 特别容易受到对疾病有问题或适得其反的评估的影响，例如，灾难化 信念，或自责或患者的归因。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。专业家庭 干预措施可改善护理人员和受影响的年轻人的结果，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 未经治疗的患有 EP 的年轻人——可以说是最有可能出现不良结果的人——缺乏获得治疗的机会 他们需要的服务。护理人员经常转向在线资源来获取更多信息和社会支持。早期 检查网络平台的工作表明数字医疗技术是可行的， 可以接受，并且有可能提高护理人员的精神病相关知识和评估。手机 健康干预措施特别适合这项任务，因为它们可以提供个性化的、实时的、实时的 地方支持。然而，目前尚不清楚是否以及如何远程提供移动医疗 提高年轻 EP 患者的治疗参与度。 拟议的研究项目旨在开发和测试旨在改善的移动医疗干预措施 通过互动认知行为模块了解护理人员的疾病知识和护理技能，以及 通过这些改进，减少痛苦，改善应对方式，改善家庭沟通，增加 促进护理人员的治疗并减少未经治疗的精神病的持续时间。本提案将涉及（1）需求 与 EP 护理人员进行评估和用户共同设计会议，以了解他们的需求、兴趣和 面向护理人员的移动健康干预措施的偏好，(2) 对这一新方法进行为期一周的可用性现场试验 干预以确定可行性和功能，以及（3）远程试点随机对照试验 将这种新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 这种方法是否可以接受和可行，并探讨其有效性和对关键问题的影响 护理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.