A comparison of the characteristics and treatment outcomes of migrant and Australian-born users of a national digital mental health service
Tóm tắt
To explore the characteristics and compare clinical outcomes of non-Australian born (migrant) and Australian-born users of an Australian national digital mental health service.
The characteristics and treatment outcomes of patients who completed online treatment at the MindSpot Clinic between January 2014 and December 2016 and reported a country of birth other than Australia were compared to Australian-born users. Data about the main language spoken at home were used to create distinct groups. Changes in symptoms of depression and anxiety were measured using the Patient Health Questionnaire-9 Item (PHQ-9), and Generalized Anxiety Disorder Scale – 7 Item (GAD-7), respectively.
Of 52,020 people who started assessment at MindSpot between 1st January 2014 and 22nd December 2016, 45,082 reported a country of birth, of whom 78.6% (
Online treatment was associated with significant reductions in anxiety and depression in migrants of both English speaking and non-English speaking backgrounds, with outcomes similar to those obtained by Australian-born patients. DMHS have considerable potential to help reduce barriers to mental health care for migrants.
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Tài liệu tham khảo
OECD. International Migration Outlook 2018. 2018. Available from: http://www.oecd.org/migration/international-migration-outlook-1999124x.htm.
Australian Bureau of Statistics. 2071.0 - Census Population and Housing: Reflecting Australia - Stories from the Census, 2016 - Cultural Diversity in Australia, 2016. 2016. Available from: http://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/2071.0~2016~Main%20Features~Cultural%20Diversity%20Article~60.
Foo S, Tam W, Ho C, Tran B, Nguyen L, McIntyre R, et al. Prevalence of Depression among Migrants: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2018;15(9):1986.
Minas H, Kakuma R, Lay San Too, Vayani H, Orapeleng S, Prasad-Ildes R, et al. Mental health research and evaluation in multicultural Australia: Developing a culture of inclusion. In: Australia MHiM, editor. 2013.
Colucci E, Minas H, Szwarc J, Guerra C, Paxton G. In or out? Barriers and facilitators to refugee-background young people accessing mental health services. Transcultl Psychiatry. 2015;52(6):766–90.
Andrade LH, Alonso J, Mneimneh Z, Wells JE, Al-Hamzawi A, Borges G, et al. Barriers to mental health treatment: Results from the WHO World Mental Health surveys. Psychol Med. 2014;44(06):1303–17.
Logan S, Rouen D, Wagner R, Steel Z, Hunt C. Mental health service use and ethnicity: An analysis of service use and time to access treatment by South East Asian-, Middle Eastern-, and Australian-born patients within Sydney, Australia. Aust J Psychol. 2016;69(1):12–9.
Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: From innovation to implementation. World Psychiatry. 2019;18:20–8.
Choi I, Zou J, Titov N, Dear BF, Li S, Johnston L, et al. Culturally attuned Internet treatment for depression amongst Chinese Australians: A randomised controlled trial. J Affect Disord. 2012;136(3):459–68.
Kayrouz R, Dear BF, Karin E, Fogliati VJ, Titov N. A pilot study of a clinician-guided internet-delivered cognitive behavioural therapy for anxiety and depression among Arabs in Australia, presented in both English and Arabic languages. Internet Interv. 2016;5:5–11.
Cuijpers P, Eylem O, Karyotaki E, Zhou X, Sijbrandij M. 8 - Psychotherapy for depression and anxiety in low- and middle-income countries. 2019/01/01/. In: Global Mental Health and Psychotherapy. 2019; Academic Press. p. 173–92. Available from: http://www.sciencedirect.com/science/article/pii/B9780128149324000082.
Titov N, Dear B, Nielssen O, Staples L, Hadjistavropoulos H, Nugent M, et al. ICBT in routine care: A descriptive analysis of successful clinics in five countries. Internet Interv. 2018;13:108–15.
Titov N, Dear BF, Staples LG, Bennett-Levy J, Klein B, Rapee RM, et al. The first 30 months of the MindSpot Clinic: Evaluation of a national emental health service against project objectives. Aust N Z J Psychiatry. 2017;51(12):1227–39.
Dear BF, Staples LG, Terides M, Karin E, Zou J, Johnston L, et al. Transdiagnostic versus disorder-specific and clinician-guided versus self-guided treatment for Generalised Anxiety Disorder: A randomised controlled trial. J Anxiety Disord. 2015;36:63–77.
Titov N, Dear BF, Staples LG, Terides MD, Karin E, Sheehan J, et al. Disorder-specific versus transdiagnostic and clinician-guided versus self-guided treatment for major depressive disorder and comorbid anxiety disorders: A randomized controlled trial. J Anxiety Disord. 2015;35:88–102.
Hadjistavropoulos HD, Nugent MM, Alberts NM, Staples L, Dear BF, Titov N. Transdiagnostic Internet-delivered cognitive behaviour therapy in Canada: An open trial comparing results of a specialized online clinic and nonspecialized community clinics. J Anxiety Disord. 2016;42(Supplement C):19–29.
Titov N, Dear BF, Staples LG, Bennett-Levy J, Klein B, Rapee RM, et al. MindSpot Clinic: An accessible, efficient, and effective online treatment service for anxiety and depression. Psychiatr Serv. 2015;66(10):1043–50.
Titov N, Schofield C, Staples L, Dear BF, Nielssen O. A comparison of Indigenous and non-Indigenous users of MindSpot: an Australian digital mental health service. Australas Psychiatry. 2019;27(4):352–7.
Productivity Commission. Mental health: Draft report. Canberra: 2019.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ. 2007;335(7624):806–8.
Nielssen O, Dear BF, Staples LG, Dear R, Ryan K, Purtell C, et al. Procedures for risk management and a review of crisis referrals from the MindSpot Clinic, a national service for the remote assessment and treatment of anxiety and depression. BMC Psychiatry. 2015;15:304.
Australian Institute of Health and Welfare. Australia’s health 2018: Culturally and linguistically diverse populations Canberra. AHIW. Australia's health series 16. AUS 221. [Available from https://www.aihw.gov.au/getmedia/f3ba8e92-afb3-46d6-b64c-ebfc9c1f945d/aihw-aus-221-chapter-5-3.pdf.aspx.
Australian Bureau of Statistics. 1267.0 - Australian Standard Classification of Languages (ASCL), 2016. 2016. Available from: https://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/1267.02016?OpenDocument.
Lowe B, Decker O, Muller S, Brahler E, Schellberg D, Herzog W, et al. Validation and standardization of the Generalized Anxiety Disorder screener (GAD-7) in the general population. Med Care. 2008;46(3):266–74.
Long Q, Johnson BA. Variable selection in the presence of missing data: resampling and imputation. Biostatistics. 2015;16(3):596–610.
Zeger SL, Liang K-Y. Longitudinal Data Analysis for Discrete and Continuous Outcomes. Biometrics. 1986;42(1):121–30.
Karin E, Dear BF, Heller GZ, Gandy M, Titov N. Measurement of Symptom Change Following Web-Based Psychotherapy: Statistical Characteristics and Analytical Methods for Measuring and Interpreting Change. JMIR Ment Health. 2018;5(3):e10200.
Donohue MC, Edland SD. Longpower: Power and sample size calculators for longitudinal data. R package version 1.0-11. 2013. Available from: https://cran.r-project.org/web/packages/longpower.
Lee YC, Gao L, Dear BF, Titov N, Mihalopoulos C. The Cost-effectiveness of the Online MindSpot Clinic for the Treatment of Depression and Anxiety in Australia. J Ment Health Policy Econ. 2017;20(4):155–66.
Karin E, Dear BF, Heller GZ, Crane MF, Titov N. “Wish You Were Here”: Examining Characteristics, Outcomes, and Statistical Solutions for Missing Cases in Web-Based Psychotherapeutic Trials. JMIR Ment Health. 2018;5(2):e22.
Anikeeva O, Bi P, Hiller JE, Ryan P, Roder D, Han G-S. Review Paper: The Health Status of Migrants in Australia: A Review. Asia Pac J Public Health. 2010;22(2):159–93.
Australian Bureau of Statistics. 3418.0 - Personal Income of Migrants, Australia, Expereimental 2010-11. 2011. Available from: http://www.abs.gov.au/ausstats/[email protected]/Previousproducts/3418.0Main%20Features32010-11?opendocument&tabname=Summary&prodno=3418.0&issue=2010-11&num=&view=.
Gearing RE, Schwalbe CS, MacKenzie MJ, Brewer KB, Ibrahim RW, Olimat HS, et al. Adaptation and translation of mental health interventions in Middle Eastern Arab countries: A systematic review of barriers to and strategies for effective treatment implementation. Int J Soc Psychiatr. 2012;59(7):671–81.
Australian Bureau of Statistics. 2016 Census: Multicultural. 2016. Available from: http://www.abs.gov.au/ausstats/[email protected]/lookup/Media%20Release3.
Kayrouz R, Dear BF, Johnston L, Keyrouz L, Nehme E, Laube R, et al. Intergenerational and cross-cultural differences in emotional wellbeing, mental health service utilisation, treatment seeking preferences and acceptability of psychological treatments for Arab Australians. Int J Soc Psychiatr. 2014;61(5):484–91.