Anthony F. Jorm|Amy J. Morgan|Annemarie Wright
A Comparison of Clinician, Youth, and Parent Beliefs About Helpfulness of Interventions for Early Psychosis
back table contents previous article next article articlefull accessa comparison clinician youth parent beliefs helpfulness interventions early psychosisanthony f jorm phd dscamy j morgan basc bappscannemarie wright bappsc mmedscanthony f jorm phd dscsearch papers authoramy j morgan basc bappscsearch papers authorannemarie wright bappsc mmedscsearch papers authorpublished online13 jan 2015aboutsectionspdfepub toolsadd favoritesdownload citationstrack citations shareshare onfacebooktwitterlinked inemail long delays onset psychotic symptoms receipt adequate treatment argued duration untreated psychosis causes unnecessary suffering patients adverse effects social networks achievement educational occupational goals 1 recent metaanalyses confirmed association duration untreated psychosis poorer outcome 2 3 although correlational evidence cannot show duration untreated psychosis cause poorer outcome supports investigation benefits early intervention barriers earlier help seeking one potential barrier knowledge attitudes sources professional help treatments 4 many countries first step seeking professional help psychotic disorder consult general practitioner however attitudes toward general practitioners source help psychosis schizophrenia vary country country generally favorable attitudes australia 5 6 switzerland 7 germany 8 less favorable attitudes japan 9 austria 10 members public asked health professionals psychiatrists seen fairly favorably many countries potential source help 6 7 8 9 however counselors rated highly psychiatrists potential source help australia japan 6 9 psychotherapists rated highly psychiatrists germany 8 antipsychotic medication cornerstone treatment psychosis surveys many countries show members public generally negative attitudes toward 6 7 10 negative attitudes associated concerns side affects belief medication deals symptoms rather causes 11 12 contrast counseling psychological treatments tend viewed favorably 6 8 9 10 inpatient admission often component management psychotic disorders surveys several countries found seen harmful members public 7 9 13 survey data suggest may major gaps public professional beliefs appropriate interventions psychotic disorders australia direct comparison public beliefs general practitioners psychiatrists clinical psychologists mental health nurses 14 15 although agreement found interventions public respondents much negative professionals antipsychotic medication admission psychiatric ward hand public respondents much favor taking vitamins following special diets reading selfhelp books similar study switzerland compared public psychiatrists psychologists nurses mental health professionals 7 agreement interventions public negative medication psychiatric hospitals hand public respondents positive psychotherapy benefits fresh air previous research public beliefs interventions psychosis involved adults however psychotic disorders often first onset adolescence early adulthood 16 age knowledge appropriate sources help interventions likely poorest parents important mediators help seeking particularly adolescents knowledge attitudes important well 17 reported herein data national surveys beliefs australian health professionals surveys covered beliefs wide range potential interventions mental disorders affecting young people beliefs health professionals compared australian young people parents elicited recent national survey 18 hypothesized would major gaps beliefs professionals youths parents gaps may impact help seeking treatment adherence basis previous research comparing adult members public clinicians expected young people parents would less favor medical interventions psychosis favor psychological lifestyle interventions methodsprofessional samples clinicians sent questionnaire based vignette describing psychosis depression depression alcohol misuse social phobia report subsample professionals received vignette psychosis ethics approval given university melbourne human research ethics committee details entire sample published elsewhere 19 surveys mailed 2006 428 psychiatrists listed medicare provider file medicare australias national governmentfunded health insurance program random sample 500 general practitioners listed file 407 australian members australian new zealand college mental health nurses random sample 500 psychologists listed victorian psychologists registration boards online database registered psychologists surveys completed anonymously separate response cards identification numbers used determine participation refusal general practitioners psychiatrists psychologists sent one reminder letter encourage participation completed surveys received 105 general practitioners 155 psychiatrists 106 mental health nurses 183 psychologists response rates 21 general practitioners 37 psychiatrists 26 mental health nurses 41 psychologists consent implied returning questionnaire youth parent samples professionals youths parents received interview based one four vignettes report subsample received psychosis vignettes details entire sample published elsewhere 18 20 2006 telephone survey carried national sample young australians ranging age 12 25 young person lived home parent one parent randomly invited interviewed well interviews completed 968 young people 531 coresident parents response rate entire sample young people 62 sample parents 69 possible determine separate response rates sample subset reported consent given orally parents also gave consent youths 18 years old survey questions survey based vignette young person early psychosis 20 vignette written meet minimum requirements dsmiv criteria schizophrenia professionals randomly given vignette describing 15 21yearold vignettes matched gender age group youths parents whereas professionals received vignettes portraying males smaller sample reading vignette professionals asked series questions assess recognition disorder described vignette beliefs first aid actions family friends could take help person interventions prevention also provided information sociodemographic characteristics study focused beliefs helpfulness different interventions described detail assessed following interventions consulting general practitioner family doctor teacher lecturer former 12 17yearold respondents latter 18 25yearold respondents counselor telephone counseling service kids helpline lifeline service varied age group psychologist psychiatrist mental health professionals occupational therapist social worker mental health nurse close family member close friend dealing problem taking vitamins st johns wort antidepressants tranquilizers antipsychotics sleeping pills becoming physically active getting relaxation training practicing meditation regular massages getting acupuncture getting early morning sunlight receiving counseling health professional receiving cognitivebehavioral therapy searching web site information problem reading selfhelp book problem joining support group people similar problems going local mental health service admitted psychiatric ward hospital using alcohol relax smoking cigarettes relax using marijuana relax cutting use alcohol cutting smoking cigarettes cutting use marijuana interventions selected basis published surveys 5 6 included complementary selfhelp interventions evidence base treatment depression anxiety 21 22 participants assessed interventions helpful harmful neither depends dont knowstatistical analysisratings intervention dichotomized helpful responses scored 1 responses scored 0 descriptive purposes percentage respondents giving helpful ratings calculated type intervention age subject vignette professional group examine differences ratings according clinician characteristics age vignette binary logistic regressions carried predictors profession general practitioner used reference category practitioners often first point professional contact gender clinician age clinician decades 2029 60 years clinician experience young people ages 1225 clinician experience adults ages 2664 clinician experience patients age 65 older variable clinician rated frequently treats age group 4point scale exclusively frequently sometimes never rarely age vignette 21 years reference category number comparisons examined effects significant p01 level reported data youth parent samples reported previously 18 presented form allows direct comparison clinician data major interest youths parents rate interventions clinician consensus helpfulness conversely clinicians rate interventions widely endorsed youths parents consensus varied degree selected interventions mean helpfulness rating across four professions 70 higher large sample youths parents even small differences ratings helpfulness could statistically significant therefore comparisons public professionals made terms effect sizes medium large effect sizes noted defined according cohens h 23 represents difference two proportions subjected arcsine squareroot transformation medium effect corresponds h5 large effect h8 23 resultsdifferences clinical professionswhen logistic regression used examine predictors helpfulness ratings several significant differences found compared general practitioners psychiatrists less likely recommend counselor or31 p001 telephone counseling or44 p005 psychologist or38 p004 meditation or24 p001 massages or15 p002 counseling health professional or41 p003 support group or24 p001 recommend reducing use alcohol or12 p001 cigarettes or41 p004 tables present percentages clinical profession endorsing intervention likely helpful available online supplements article pspsychiatryonlineorgcompared general practitioners psychologists less likely recommend use general practitioner or15 p005 teacher lecturer or33 p006 mental health professional or34 p002 family or31 p001 friend or37 p001 tranquilizers 24 p001 antipsychotics or15 p001 support group or35 p003 recommend reducing use alcohol or07 p001 cigarettes or38 p002compared general practitioners mental health nurses likely recommend vitamins or378 p006 less likely recommend counselor or38 p002 support group or39 p010differences clinician experience age genderthe frequency contact clinicians young people association youths intervention beliefs however clinicians greater contact adults likely advocate getting early sunlight or244 p004clinician age influence older clinicians less likely believe helpfulness psychologists or68 p001 mental health professionals or34 p002 friends or77 p004 relaxation training or77 p004 getting early sunlight or76 p004 clinician gender associations intervention beliefsdifferences age vignettefor 21yearold compared 15yearold portrayed vignette clinicians gave higher ratings helpfulness use antipsychotics or188 p009 hospitalization psychiatric ward or165 p005 lower ratings use teacher lecturer or26 p001differences public beliefs clinicians consensus although statistically significant differences clinical professions interventions low endorsement major interest interventions widely accepted likely helpful table 1 shows interventions endorsed helpful average 70 clinicians 70 youths parents table also indicates medium large differences clinicians youths parents table 1 interventions rated helpful 70 clinicians youths parents evaluated vignette describing youth adult psychosistable 1 interventions rated helpful 70 clinicians youths parents evaluated vignette describing youth adult psychosisenlarge tablethere number interventions high professional endorsement lower endorsement youths parents youths parents gave lower ratings seeing psychiatrist using antipsychotics seeking mental health servicesthere many interventions high youth parent endorsement lower clinician endorsement compared youths clinicians gave lower endorsement counseling health professional phone counseling counselor close friend close family support group physical activity relaxation training meditation getting early sunlight reading selfhelp book seeking web site information reducing use cigarettes compared parents clinicians gave lower endorsement counseling health professional professional counselor phone counseling close friend close family support group relaxation training physical activity meditation getting early sunlight reducing use cigarettesdiscussionthis study shows major gaps professional youth parent beliefs potential helpfulness interventions early psychosis general professionals favored medical specialist mental health services showed general agreement young person psychosis would benefit consulting general practitioner mental health specialist mental health services believed person would also benefit taking antipsychotic medication reducing use marijuana alcoholyoung people parents agreed professional consensus much less likely believe benefits specialist mental health interventions taking antipsychotics seeing psychiatrist using mental health services hand wide range general informal sources support young people parents believed professionals public particularly endorsed informal social supports help family friends support groups generic counseling general stress reduction methods relaxation training meditation increased physical activity young people also often endorsed informal sources information web sites selfhelp books survey presented vignettes portraying either adolescent young adult young people participated covered broad age range 1225 years however interventions often rated helpful examined neither clinicians young people parents differentiated responses vignette subjects age findings relevant controversy whether adolescents treated separately young adults child adolescent service model whether age groups offered common services youth model 24 findings show little basis splitting two age groups early psychosis intervention beliefs professionals compared recommendations clinical practice guidelines 25 26 interventions endorsed consistent guidelines however psychologists less likely endorse antipsychotic medication although psychologists may working mental health field position influence help seeking basic familiarity recommended practice recommending antipsychotic medication needs target continuing professional education widespread problem low level endorsement cognitivebehavioral therapy recommended practice guidelines 25 26 endorsed likely helpful half professionals indeed professionals showed slightly higher support generic counseling explicitly recommended one set guidelines schizophrenia 26 although cognitivebehavioral therapy similar low level endorsement young people parents finding likely due lack knowledge treatment label type intervention widely available would increase use evidencebased treatment also fulfill desire young people parents psychological interventions youths parents endorsed likely helpfulness stress reduction methods recommended clinical practice guidelines limited evidence support usefulness 27 28 given high acceptability interventions merit greater investigation researchers done reduce gap professional public beliefs interventions psychosis public attitudes toward psychosis treatment changed indicated substantial historical changes found australia germany recent years 29 30 31 reasons changes occurred unclear although public information campaigns reduce duration untreated psychosis focused things intervention beliefs 4 success shows mental health information campaigns effective also evidence individual training programs increase mental health literacy public change beliefs interventions psychosis 32 given informal help friends family seen important young people parents people play important role facilitating earlier help seeking however many members public lack appropriate firstaid skills 20 33 several helpful actions member public take assist someone becoming psychotic 34 training firstaid skills known improve helping behavior 32 training needs widely available given internet selfhelp books rated highly young people media could used promote earlier help seeking already work area web sites 35 study number limitations must acknowledged survey content designed public optimal professionals example tap staging interventions gave detail content quality interventions allow respondent record intensity agreement omitted describing specialized interventions difficult convey public simple questions cognitive remediation social skills trainingconclusionsthe study showed major gaps professional public beliefs young people parents less favor specialist mental health interventions favor general informal sources support gaps could barriers early appropriate treatment psychosis closing gaps twoway process requiring community education psychosis treatment broadening services offered better meet consumer expectationsacknowledgments disclosuresfunding provided grant 179805 national health medical research council program colonial foundation beyondblue national depression initiative claire kelly 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