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Background New electronic health technologies are being rapidly developed to improve the delivery of mental health care for both health professionals and consumers and better support self-management of care. We developed a Web-based platform (the InnoWell Platform) that supports the prevention, early intervention, treatment, and continuous monitoring of mental health and maintenance of well-being in people aged 2 years and older. The platform is a customizable digital tool kit that operates through existing service providers who utilize the system to provide their consumers with access to evidence-based assessments and feedback, intervention options, and outcome monitoring. It does this by collecting, storing, and reporting personal and health information back to consumers and their health professionals to promote collaborative care partnerships that aim to improve the management of mental ill health and maintenance of well-being Objective The aim of this study was to describe the research protocol for a naturalistic prospective clinical trial wherein all consumers presenting for care to a traditional face-to-face or Web-based mental health service in which the InnoWell Platform is being offered as part of standard clinical care will be given the opportunity to use the platform. Methods The Web-based platform is a configurable and customizable digital tool that assists in the assessment, monitoring and management of mental ill health, and maintenance of well-being. It does this by collecting, storing, and reporting health information back to the person and his or her clinician to enable transformation to person-centered care. The clinical trial will be conducted with individuals aged 2 years and older presenting to participating services for care, including persons from the veteran community, Aboriginal and Torres Strait Islander people, people from culturally and linguistically diverse backgrounds, the lesbian, gay, bisexual, transgender, and intersex community, and those from broader education and workforce sectors, as well as people with disabilities, lived experience of comorbidity, complex disorders, and suicidality. Results Project Synergy was funded in June 2017, and data collection began in November 2018 at a youth mental health service. At the time of this publication, 5 additional services have also begun recruitment, including 4 youth mental health services and a veteran’s service. The first results are expected to be submitted in 2020 for publication. Conclusions This clinical trial will promote access to comprehensive, high-quality mental health care to improve outcomes for consumers and health professionals. The data collected will be used to validate a clinical staging algorithm designed to match consumers with the right level of care and reduce the rate of suicidal thoughts and/or behaviors and suicide by suggesting pathways to care that are appropriate for the ident...

Objectives:Disability in older adults is associated with a need for support in work, education, and community activities, reduced independence, and poorer quality of life. This study examines potential determinants of disability in a clinical sample of older adults across the continuum of cognitive decline, including sociodemographic, medical, psychiatric, and cognitive factors.Design:This is a cross-sectional study.Setting:Participants were recruited from a specialty clinic for adults “at risk” of or with early dementia (including subjective cognitive complaints, mild cognitive impairment, and early dementia).Participants:Four hundred forty-two older adults (mean age = 67.11, SD = 9.33) underwent comprehensive medical, neuropsychological, and mood assessments.Measurements:Disability was assessed via the self-report World Health Organization Disability Assessment Schedule 2.0. A stepwise (forward) linear regression model was computed to determine factors that contribute to disability within this group.Results:Depressive symptoms were the largest predictor, uniquely explaining 31.8% of the variance. Other contributing factors in the model included younger age, medical burden, and sleep quality, with all factors together accounting for a total of 50.4% of the variance in disability. Cognitive variables did not contribute to the model.Conclusions:Depressive symptoms account for a significant portion of the variance in disability, but other factors such as age, medical burden and sleep quality are also important contributors in older adults across the continuum of cognitive decline. The relative association of these variables with disability appears to differ for older (≥65 years) relative to younger (<65 years) participants. Given the relationship between disability and these risk factors, an integrative and multidisciplinary approach to risk reduction will likely be most effective, with potential carry over effects for physical and mental health.

BackgroundLate-life depression is associated with high rates of morbidity, premature mortality, disability, functional decline, caregiver burden and increased health care costs. While clinical and public health approaches are focused on prevention or early intervention strategies, the ideal method of intervention remains unclear. No study has set out to evaluate the role of neurobiological agents in preventing depressive symptoms in older populations at risk of depression.Methods/DesignSubjects with previously reported sub-threshold depressive symptoms, aged 60 to 74 years, will be screened to participate in a single-centre, double-blind, randomised controlled trial with three parallel groups involving omega-3 fatty acid supplementation or sertraline hydrochloride, compared with matching placebo. Subjects will be excluded if they have current depression or suicide ideation; are taking antidepressants or any supplement containing omega-3 fatty acid; or have a prior history of stroke or other serious cerebrovascular or cardiovascular disease, neurological disease, significant psychiatric disease (other than depression) or neurodegenerative disease. The trial will consist of a 12 month treatment phase with follow-up at three months and 12 months to assess outcome events. At three months, subjects will undergo structural neuroimaging to assess whether treatment effects on depressive symptoms correlate with brain changes. Additionally, proton spectroscopy techniques will be used to capture brain-imaging markers of the biological effects of the interventions. The trial will be conducted in urban New South Wales, Australia, and will recruit a community-based sample of 450 adults. Using intention-to-treat methods, the primary endpoint is an absence of clinically relevant depression scores at 12 months between the omega-3 fatty acid and sertraline interventions and the placebo condition.DiscussionThe current health, social and economic costs of late-life depression make prevention imperative from a public health perspective. This innovative trial aims to address the long-neglected area of prevention of depression in older adults. The interventions are targeted to the pathophysiology of disease, and regardless of the effect size of treatment, the outcomes will offer major scientific advances regarding the neurobiological action of these agents. The main results are expected to be available in 2017.Trial RegistrationAustralian and New Zealand Clinical Trials Registry ACTRN12610000032055 (12 January 2010)Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0762-6) contains supplementary material, which is available to authorized users.

BACKGROUND New electronic health technologies are being rapidly developed to improve the delivery of mental health care for both health professionals and consumers as well as to better support self-management of care. OBJECTIVE The objective of this paper is to describe the research protocol for a naturalistic prospective clinical trial wherein all consumers presenting for care to a traditional face-to-face or online mental health service utilising the InnoWell Platform as part of their standard clinical care will be offered the opportunity to use the platform. METHODS The web-based platform is a configurable and customisable digital tool that assists in the assessment, monitoring and management of mental ill health and maintenance of wellbeing. It does this by collecting, storing, analysing, and reporting health information back to the person and their clinicians to enable transformation to person-centred care. The clinical trial will be conducted with individuals aged two years and older presenting to participating services for care, including persons from the Veteran community, Aboriginal and Torres Strait Islander peoples, people from culturally and linguistically diverse backgrounds, the LGBTI community, and those from broader education and workforce sectors as well as persons with disabilities, lived-experience of comorbidity, complex disorders, and/ or suicidality. RESULTS Project Synergy was funded in June of 2017 and data collection began in November of 2018 in a youth mental health service. At the time of this publication, 4 additional services have also begun recruitment including 2 youth mental health services, a Veteran’s service and a national eating disorders tele-web service. The first results are expected to be submitted in mid-2019 for publication. CONCLUSIONS This clinical trial will promote access to comprehensive, high-quality mental health care in order to improve outcomes for consumers and health professionals. The data collected will be used to validate a clinical staging algorithm designed to match consumers with the right level of care and to reduce the rate of suicidal thoughts and behaviours and suicide by suggesting pathways to care that are appropriate for the identified level of need while simultaneously enabling a timely service response. CLINICALTRIAL Australian New Zealand Clinical Trial Registry ACTRN12618001676202