The impact of communicating personal mental ill-health risk: A randomized controlled non-inferiority trial
File(s)EIP-2020-025.R2_Proof_hi.pdf (957.84 KB)
Accepted version
Author(s)
Type
Journal Article
Abstract
Aim
Risk algorithms predicting personal mental ill‐health will form an important component of digital and personalized preventive interventions, yet it is unknown whether informing people of personal risk may cause unintended harm. This trial evaluated the comparative effect of communicating personal mental ill‐health risk profiles on psychological distress.
Methods
Australian participants using a mood‐monitoring app were randomly allocated to receiving their current personal mental ill‐health risk profile (n = 119), their achievable personal risk profile (n = 118) or to a control group (n = 118) in which no risk information was communicated, in a non‐inferiority trial design. The primary outcome was psychological distress at four‐weeks as assessed on the Kessler Psychological Distress Scale.
Results
There was high attrition in the trial with 64% of data missing at follow up. Per‐protocol (completer) analysis found that the lower bounds of the confidence intervals of the estimated mean change of the current risk (m = 0.19, 95% CI: −2.59‐ 2.98) and achievable risk (m = −0.09, 95% CI: −2.84 to 2.66) groups were within the non‐inferiority margin of the control group's mean at follow up. Supplementary intention‐to‐treat analysis using Multivariate Imputation by Chained Equations (MICE) found that 98/100 imputed datasets of the current risk profile group, and all imputed datasets of the achievable risk profile group showed non‐inferiority to the control group.
Conclusions
This study provides preliminary support that providing personal mental health risk profiles does not lead to unacceptable worsening of distress compared to no risk feedback, although this needs to be replicated in a fully powered RCT.
Risk algorithms predicting personal mental ill‐health will form an important component of digital and personalized preventive interventions, yet it is unknown whether informing people of personal risk may cause unintended harm. This trial evaluated the comparative effect of communicating personal mental ill‐health risk profiles on psychological distress.
Methods
Australian participants using a mood‐monitoring app were randomly allocated to receiving their current personal mental ill‐health risk profile (n = 119), their achievable personal risk profile (n = 118) or to a control group (n = 118) in which no risk information was communicated, in a non‐inferiority trial design. The primary outcome was psychological distress at four‐weeks as assessed on the Kessler Psychological Distress Scale.
Results
There was high attrition in the trial with 64% of data missing at follow up. Per‐protocol (completer) analysis found that the lower bounds of the confidence intervals of the estimated mean change of the current risk (m = 0.19, 95% CI: −2.59‐ 2.98) and achievable risk (m = −0.09, 95% CI: −2.84 to 2.66) groups were within the non‐inferiority margin of the control group's mean at follow up. Supplementary intention‐to‐treat analysis using Multivariate Imputation by Chained Equations (MICE) found that 98/100 imputed datasets of the current risk profile group, and all imputed datasets of the achievable risk profile group showed non‐inferiority to the control group.
Conclusions
This study provides preliminary support that providing personal mental health risk profiles does not lead to unacceptable worsening of distress compared to no risk feedback, although this needs to be replicated in a fully powered RCT.
Date Issued
2021-08-01
Date Acceptance
2020-08-21
Citation
Early Intervention in Psychiatry: the development, onset and treatment of emerging mental disorders, 2021, 15 (4), pp.932-941
ISSN
1751-7885
Publisher
Wiley
Start Page
932
End Page
941
Journal / Book Title
Early Intervention in Psychiatry: the development, onset and treatment of emerging mental disorders
Volume
15
Issue
4
Copyright Statement
© 2020 John Wiley & Sons Australia, Ltd. This is the peer reviewed version of the following article, which has been published in final form at https://onlinelibrary.wiley.com/doi/10.1111/eip.13038. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000569109300001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Psychiatry
mental health
non-inferiority trial
psychological distress
risk algorithm
risk communication
GENERAL-PRACTICE ATTENDEES
PREDICTION ALGORITHM
MAJOR DEPRESSION
DISORDERS FINDINGS
CHAINED EQUATIONS
VALIDATION
POPULATION
ONSET
INTERVENTION
IMPUTATION
Publication Status
Published
Date Publish Online
2020-09-15