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著改善长期 功能轨迹然而，长期未治疗的疾病大大降低了治疗的效果。 照顾者往往在寻求治疗中发挥关键作用，与提供者进行第一次接触，说服医生， 受影响的亲属进行这种接触，或确保受影响的个人继续从事护理。 然而，照顾者往往缺乏准确的信息，精神病，治疗和恢复，或感觉 不知所措，无法帮助或与他们受影响的亲属沟通。在此期间，他们 特别容易受到有问题或适得其反的疾病评估的影响，例如， 信仰，或自我或病人责备归因。否定的认知模式认为， 互动可能会恶化症状和功能，同时阻碍寻求帮助。专门的家庭 干预措施改善了照顾者和受影响的年轻人的结果，但这些干预措施提供了 受影响的年轻成年人已经接受治疗的EP家庭。因此， 未经治疗的EP年轻成年人-可以说是最有可能出现不良结局的人-缺乏获得 他们需要的服务。照顾者经常转向在线资源以获得更多信息和社会支持。早期 对基于网络的平台的研究表明，数字医疗技术是可行的， 可以接受，并有潜力提高照顾者的精神病相关知识和评估。移动的 卫生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、真实的 位置支持。然而，目前尚不清楚是否以及如何远程提供mHealth 用于增加年轻EP患者的治疗参与度。 拟议的研究项目旨在开发和测试一种旨在改善 通过交互式认知行为模块提高护理人员的疾病知识和护理技能， 通过这些改善，减少痛苦，改善应对，改善家庭沟通， 护理人员治疗便利和减少未经治疗的精神病的持续时间。这一建议将涉及（1）需要 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 偏好在一个面向移动健康干预，（2）一个为期一周的可用性现场试验，这一新的 干预，以确定可行性和功能，和（3）远程试点随机对照试验 将这种新的干预措施与现有的在线支持资源进行比较。分析将决定 这种方法是否可以接受和可行，并探讨其有效性和对关键的影响， 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.