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CORDIS - EU research results

Integrating Technology into Mental Health Care Delivery in Europe

Periodic Reporting for period 3 - ICare (Integrating Technology into Mental Health Care Delivery in Europe)

Reporting period: 2018-09-01 to 2019-08-31

Mental illness represents an enormous personal, social, and societal burden for European citizens. Existing models of mental health care delivery need to be expanded to reduce this burden. The need to move to novel models to reduce the mismatch between need and provision of mental health services has been recognized for decades, yet only recently have there been increasing calls for novel models of delivering mental health care, including technology-based models of health care delivery.
The aim of ICare is to establish a novel, comprehensive model of mental health service delivery covering health promotion, risk detection, disease prevention, and self-help/treatment of common mental health disorders and related conditions delivered through an online platform. ICare will be integrated into different mental health services and other settings in Europe in collaboration with a network of established stakeholders. The feasibility, acceptance, efficacy and (cost-) effectiveness, reach, and dissemination of the included online interventions on the ICare platform will be compared in this project.
The overall objectives of the project are:
1. To assess the specific needs of stakeholders for the implementation and dissemination of prioritized interventions/programs by a survey carried out in each of the participating countries and to assess needs for future programs to be developed, evaluated and disseminated.
2. To adapt and implement a comprehensive and economic (diagnostic and prognostic) online screening across multiple mental health domains (depression, anxiety, alcohol use, eating and adjustment disorders and obesity).
3. To provide the technology for a common platform for all included online interventions.
4. To adapt, disseminate, and implement evidence-based online interventions for health promotion, prevention, and treatment into health services of different EU countries and compare their acceptance, feasibility, ease of use/dissemination, adherence and efficacy/effectiveness within each country as well as across countries along the dimensions of the RE-AIM framework.
5. To reduce health economic burden of common mental health conditions and disorders in and across different European countries.
6. To identify how and for whom included interventions in and across countries are most (cost-)effective.
The ICare consortium has addressed these objectives by conducting 7 multi-country, clinical studies as well as work packages across clinical studies (health economic evaluation; evaluation of moderators, mediators and adherence). ICare involves 6 countries in Europe (Germany, Austria, Switzerland, The Netherlands, Spain, UK), 8 universities, 4 research institutions and one SME.
A comprehensive stakeholder survey involving key players relevant across all interventions and settings (health systems, universities, schools) was conducted. This included 36 focus groups, 75 interviews and an online survey with 443 respondents.
7 different online interventions targeting depression, anxiety, disordered eating, adjustment disorders or promoting resilience were developed or adapted for new or different target groups, and implemented on the online platform. New intervention features based on stakeholder feedback were designed and developed, videos and audios to illustrate the interventions were produced, and interventions were translated into different languages and culturally adapted. For intervention delivery, coaches were trained, and coaching manuals developed. Beta-tests of the new interventions were conducted before the first participants were enrolled.
To evaluate the efficacy and effectiveness of the included online interventions, preparations for the clinical studies across the consortium were undertaken. This included 1. agreeing on common measures across all studies, 2. planning and programming of the assessments, 3. obtaining approval by 6 ethics committees, 4. study registration, 5. preparation and validation of randomization lists, 6. setting up data management scripts in order to generate analyzable datasets, 7. writing statistical analysis plans for each study and 8. agreeing on and preparing plans for data quality assurance and data protection for the whole consortium.
Over the course of the project, 7547 participants have been allocated to the interventions. Recruitment was even extended to additional, non-EU countries (Mexico, Argentina) in some trials to meet the target recruitment numbers.
The results of this project can impact the personal, social, and societal burden for European citizens in different ways: 1. A total of 7547 (92.9% of the targeted recruitment number) participants, patients and carers have been recruited for and included the 7 clinical trials across risk and symptom conditions for common mental health disorders (see Figure).
In four of the 7 clinical trials, we found significant effects for the intervention groups compared with the control groups in terms of achieving faster clinically significant changes in eating disorder symptomatology during waiting time for outpatient treatment, in reductions of weight concerns for participants who want to improve their body image, increase in resilience in students, and lower rates of onset of full-syndrome anxiety and depressive disorders in at-risk participants. Accordingly, interventions provided to thousands of participants, patients and carers in the trials have enabled case identification and minimizing of disease onset risk. The evidence regarding efficacy, effectiveness and cost-effectiveness is being disseminated among relevant stakeholder groups. 2. The project has demonstrated the feasibility of providing access to online mental health interventions suited to peoples’ mental health needs across levels of mental health symptom profiles and risk conditions for these disorders on one common platform. 3. The results have the potential to improve existing models of health services by creating independent, more cost-effective e-health services as adjunct to existing health services thus facilitating stepped-care models by integrating online interventions as first step in primary care. 4. The integration of stakeholders from science and practice (e.g. health care providers, policy, community organizations, and non-profit organizations) will facilitate the dissemination of interventions in “real life”. 5. The project will also provide information about the cost-effectiveness of implementing online prevention and treatment of mental health across different European countries for a range of health conditions, target group, countries, and disorder severity levels. 6. Finally, ICare addresses the need to promote a shift to interventions that are primarily centered on prevention, health promotion, and early intervention.
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Figure - Overall recruitment progress of all clinical trials in ICare (status as of 30.09.2019)