Background
MindStep™
Study aims
Methods
Study design
Setting
Participants and recruitment
Quantitative data collection and analysis
Data sources and variables
Defining criteria | |
---|---|
Measures | |
Recovery | Number of clients who were at or above caseness (PHQ-9 > 9 and/or GAD-7 > 7) before treatment, then below caseness in both PHQ-9 and GAD-7 after treatment |
Reliable improvement | Number of clients who demonstrated an improvement of ≥6 on PHQ-9 and/or ≥ 4 on GAD-7, regardless of whether this change meant that they were still in caseness. Reliable improvement refers to the improvement in the PHQ-9 and GAD-7 scores that is sufficient to conclude that the improvement in the scores is beyond that which could be attributed to measurement error. It is an important measure for showing improvement in clients with more severe baseline symptom scores |
Reliable recovery | Number of clients that both moved to recovery and showed reliable improvement |
Clinical software category | |
Completed all sessions | Client has completed at least assessment plus 2 or more treatment sessions (up to a total of 6) and deactivated as completed. |
Completed all sessions and stepped up to other services | Client completed up to 6 sessions plus assessment (and was considered as completed program) but also required to be stepped up to higher intensity mental health services. |
Not suitable at assessment | Client has complex or multi-morbid mental health conditions and deemed unsuitable for MindStep™. |
Client declined treatment | Client made an informed choice not to participate in MindStep™ after the first assessment or first treatment session. |
Stepped up | The service did not meet the clients’ level of clinical need following assessment and before receiving a minimum of 2 further sessions, and was stepped up to higher intensity mental health services. |
DNA | Client cancelled in advance of appointment or did not respond to contact attempts at the scheduled appointment. |
Deceased | Client is deceased post referral. |
Client drop out | Client drops out post-assessment before receiving a minimum of 2 further sessions; and unable to re-establish contact with no response from contact attempts. |
Statistical methods
Main analysis
Secondary exploratory analyses
Qualitative data collection
Qualitative data analyses
Results
Quantitative findings
Participants
Missing data
Sample characteristics
Completers (N = 427) | Non-completers (N = 253) | ||
---|---|---|---|
Demographic Characteristics | % (N) | % (N) | |
Gender N = 680 | Male | 59.5 (110) | 40.5 (75) |
Female | 64.0 (317) | 36.0 (178) | |
Marital status N = 442 | Married/DeFacto | 70.3 (163) | 29.7 (69) |
Never married | 70.9 (139) | 29.1 (57) | |
Divorced/Widowed | 78.6(11) | 21.4(3) | |
Employment status N = 575 | Employed | 61.8 (136) | 38.2 (84) |
Unemployed | 68.8 (159) | 31.2 (72) | |
Not stated | 67.7 (84) | 32.3 (40) | |
State N = 680 | Queensland | 62.5 (80) | 37.5 (48) |
Victoria | 62.7 (168) | 37.3 (100) | |
Western Australia | 66.7 (20) | 33.3 (10) | |
New South Wales | 61.8 (136) | 38.2 (84) | |
South Australia | 70.0 (14) | 30.0 (6) | |
Northern Territory | 100.0 (3) | 0.0 (0) | |
Australian Capital Territory | 100.0 (1) | 0.0 (0) | |
Tasmania | 50.0 (5) | 50.0 (5) | |
Mean (standard deviation) | |||
Age at referral N = 680 | 55.5 (15.6) | 52.1 (16.3) | |
SES (Decilea) N = 680 | 6.52 (2.9) | 6.47 (2.8) | |
Clinical Characteristics | % (N) | % (N) | |
ICD-10 N = 493 | Major depressive disorder | 61.3 (100) | 38.7 (63) |
Recurrent episodes of major depression | 53.3 (32) | 46.7 (28) | |
Anxiety disorder | 70.2 (66) | 29.8 (28) | |
Unspecified mental disorder | 49.3 (71) | 50.7 (73) | |
Others (F34/F38/F40/F43/F45) | 56.2 (18) | 43.8 (14) | |
PHQ-9 Symptom Severity N = 675 | No symptom (0–4) | 71.4 (60) | 28.6 (24) |
Mild symptom (5–9) | 73.6 (120) | 26.4 (43) | |
Moderate symptom (10–14) | 63.5 (115) | 36.5 (66) | |
Moderately severe (15–19) | 54.0 (87) | 46.0 (74) | |
Severe (20–27) | 52.3 (45) | 47.7 (41) | |
GAD-7 Symptom Severity N = 670 | None (0–4) | 72.4 (89) | 27.6 (34) |
Mild anxiety (5–10) | 65.4 (157) | 34.6 (83) | |
Moderate anxiety (11–15) | 60.7 (116) | 39.3 (75) | |
Severe anxiety (16–21) | 56.0 (65) | 44.0 (51) |
Main analysis
Analytic strategy | N | ES(PHQ) | ES(GAD) | N clinical cases | Recovery rate | Reliable recovery |
---|---|---|---|---|---|---|
PP | 427 | 1.03(0.92–1.16) | 0.99(0.88–1.11) | 301 | 0.66(0.61–0.72) | 0.62(0.57–0.68) |
mITTa | 584 | 0.88(0.79-0.98) | 0.82(0.71–0.90) | 410 | 0.60(0.55–0.65) | 0.56(0.51–0.61) |
ITT | ||||||
MI | 680 | 0.78(0.69–0.86) | 0.76(0.67–0.84) | 497 | 0.53(0.48–0.57) | 0.49(0.45–0.54) |
LOCF | 675 | 0.77(0.68–0.85) | 0.75 (0.66–0.83) | 497 | 0.51 (0.46–0.55) | 0.47 (0.43–0.51) |
Analysis | PHQ-9 |
p
| GAD-7 |
p
| |||
---|---|---|---|---|---|---|---|
Estimate | 95% CI | Estimate | 95% CI | ||||
LR | 0.59 | 0.52–0.66 | < 0.001 | 0.50 | 0.43–0.56 | < 0.001 | |
MI (MAR) | 0.59 | 0.52–0.66 | < 0.001 | 0.50 | 0.43–0.56 | < 0.001 | |
MI (MNAR) | |||||||
N(5, 5) | 0.59 | 0.52–0.67 | < 0.001 | N(4, 4) | 0.50 | 0.43–0.57 | < 0.001 |
N(10, 5) | 0.60 | 0.52–0.67 | < 0.001 | N(8, 4) | 0.51 | 0.44–0.58 | < 0.001 |
N(10, 20) | 0.60 | 0.50–0.69 | < 0.001 | N(8, 16) | 0.51 | 0.40–0.61 | < 0.001 |
Secondary exploratory analyses
Recovered % (N) | Did not recover % (N) | Statistical analyses | |
---|---|---|---|
PHQ-9 Symptom severity | |||
Moderate (10–14) | 80.8 (93) | 19.1 (22) | χ2 = 9.77, Cramer’s V = 0. 19, p = 0.008 |
Moderately severe (15–19) | 67.8 (59) | 32.1 (28) | |
Severe (20–27) | 57.7 (26) | 42.2 (19) | |
Total | 72.0 (178) | 27.9 (69) | |
GAD-7 Symptom severity | |||
Mild (8–10) | 80.8 (55) | 19.1 (13) | χ2 = 7.92, Cramer’s V = 0.18, p = 0.019 |
Moderate (11–15) | 68.1 (79) | 31.8 (37) | |
Severe (16–21) | 58.4 (38) | 41.5 (27) | |
Total | 69.0 (172) | 30.9 (77) |
Qualitative findings
I just found MindStep actually much more valuable sometimes, and I just thought if only I had done this first, four years ago, instead of going through all the other stuff, and dealing through traumas, I honestly believe that I would have had a different experience in my recovery. (Client 5)
Well I think the strengths (of the program) are it really is working. We’re hearing it with our clients. People are finding that it’s helping them so that’s pretty amazing and I’m sure that comes from the fact that it is structured and firmly within a specific scope. (Coach D)
She was very professional. We made a time and she’d ring on time and it was very well run. I can’t say enough about that…I had a tendency just to go off track and she was very good, she always pulled me back in and was obviously trained well. (Client 4)
It always felt like he was there for me, not just for getting his numbers, like it didn’t seem like it was just his job, it seemed like he cared as well. (Client 6)
I found it easier over the phone in my own time, in my own environment. It was a bit more relaxing that way. (Client 2)
I think the thing that has helped quite a lot were the two workbooks that I went through and that sort of showed me the larger body of work that makes it all hang together…Also, knowing that I’ve got those at my fingertips. I know where to look in my own time. (Client 7)
Yeah, sort of being in control and being able to work together in setting the program whereas I think some people might feel face-to-face the counsellor/psychiatrist are running the show so to speak. This way you got to be a part of your own plan. (Client 9)
…things like the maintenance cycle and the rationale which we do right at the beginning and the problem statement is often such a-they go like oh yes, you really heard me and that is my problem and yes that treatment-that would be amazing…It’s probably that trust and-it’s not rapport but you’ve sort of proven your worth quite early on which is a good engagement piece for the rest of the program. (Coach A)
…within that (structured framework) you still have the possibility to bring a bit of tailoring and individual personality and rapport building and things like the goal setting and getting to know your client that’s what makes it enjoyable and rewarding both as a coach and for the client I’d imagine. (Coach B)
Barriers
…for me it (scores) can change so quickly from moment to moment almost, that how I felt an hour ago might be completely different to how I feel now. (Client 14)
Coaches also reported that the process of completing homework, keeping a diary etc. can be overwhelming for some clients.Doing the measures each week-I haven’t actually heard from the clients too much but that’s annoying...some mention it. I think maybe as a coach you’re doing them every day, five or ten times, and it’s just painful. (Coach C)
I’ve been in and out of hospital and seen counsellors for quite a long time and I felt like the content wasn’t new, that I’d heard it before…If it was someone who is experiencing depression or anxiety as a result of perhaps a family death or one thing…that perhaps it might have been more beneficial for those groups. (Client 14)
The people who are going well, some of them are honestly so confident with what they’ve learnt that I do feel confident for them. But there’s also a big chunk who should a situation arise that’s particularly stressful or sad as it would be for anyone I don’t know if they’ve got the resilience there simply because of the chronic nature of what they’ve been through. (Coach A)
One coach suggested adding ‘crisis intervention’ planning after initial sessions to help cope and respond to future crisis. Additionally, another suggested better collaboration with traditional mental health service providers can enhance the acceptability and effectiveness of MindStep™.I’m introducing that (relapse prevention) at say session 6 or session 7-which is fine but you kind of want to really embed it and I do wonder for some of my clients whether they’re going to be able to pick that up and run with it. (Coach C)