Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with non-psychotic mental health problems: a pragmatic randomized controlled trial

Slade, M. et al. (2024) Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with non-psychotic mental health problems: a pragmatic randomized controlled trial. World Psychiatry, 23(1), pp. 101-112. (doi: 10.1002/wps.21176) (PMID:38214639) (PMCID:PMC10785987)

Abstract

Narratives describing first-hand experiences of recovery from mental health problems are widely available. Emerging evidence suggests that engaging with mental health recovery narratives can benefit people experiencing mental health problems, but no randomized controlled trial has been conducted as yet. We developed the Narrative Experiences Online (NEON) Intervention, a web application providing self-guided and recommender systems access to a collection of recorded mental health recovery narratives (n=659). We investigated whether NEON Intervention access benefited adults experiencing non-psychotic mental health problems by conducting a pragmatic parallel-group randomized trial, with usual care as control condition. The primary endpoint was quality of life at week 52 assessed by the Manchester Short Assessment (MANSA). Secondary outcomes were psychological distress, hope, self-efficacy, and meaning in life at week 52. Between March 9, 2020 and March 26, 2021, we recruited 1,023 participants from across England (the target based on power analysis was 994), of whom 827 (80.8%) identified as White British, 811 (79.3%) were female, 586 (57.3%) were employed, and 272 (26.6%) were unemployed. Their mean age was 38.4±13.6 years. Mood and/or anxiety disorders (N=626, 61.2%) and stress-related disorders (N=152, 14.9%) were the most common mental health problems. At week 52, our intention-to-treat analysis found a significant baseline-adjusted difference of 0.13 (95% CI: 0.01-0.26, p=0.041) in the MANSA score between the intervention and control groups, corresponding to a mean change of 1.56 scale points per participant, which indicates that the intervention increased quality of life. We also detected a significant baseline-adjusted difference of 0.22 (95% CI: 0.05-0.40, p=0.014) between the groups in the score on the “presence of meaning” subscale of the Meaning in Life Questionnaire, corresponding to a mean change of 1.1 scale points per participant. We found an incremental gain of 0.0142 quality-adjusted life years (QALYs) (95% credible interval: 0.0059 to 0.0226) and a £178 incremental increase in cost (95% credible interval: –£154 to £455) per participant, generating an incremental cost-effectiveness ratio of £12,526 per QALY compared with usual care. This was lower than the £20,000 per QALY threshold used by the National Health Service in England, indicating that the intervention would be a cost-effective use of health service resources. In the subgroup analysis including participants who had used specialist mental health services at baseline, the intervention both reduced cost (–£98, 95% credible interval: –£606 to £309) and improved QALYs (0.0165, 95% credible interval: 0.0057 to 0.0273) per participant as compared to usual care. We conclude that the NEON Intervention is an effective and cost-effective new intervention for people experiencing non-psychotic mental health problems.

• Item Type: Articles
• Additional Information: This study was funded by the UK National Institute for Health and Care Research (NIHR) (RP-PG-0615-20016). M. Slade and S. Rennick-Egglestone are supported by the NIHR Nottingham Biomedical Research Centre (NIHR203310). G. Thornicroft is supported by the NIHR Applied Research Collaboration South London at King’s College Hospital NHS Foundation Trust, and by the UK Medical Research Council.
• Keywords: NEON Intervention, recovery narrative, non-psychotic mental health problems, digital health intervention, quality of life, meaning in life, lived experience narrative.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bradstreet, Dr Simon and Callard, Professor Felicity
• Authors: Slade, M., Rennick-Egglestone, S., Elliott, R.A., Newby, C., Robinson, C., Gavan, S.P., Paterson, L., Ali, Y., Yeo, C., Glover, T., Pollock, K., Callard, F., Priebe, S., Thornicroft, G., Repper, J., Keppens, J., Smuk, M., Franklin, D., Walcott, R., Harrison, J., Smith, R., Robotham, D., Bradstreet, S., Gillard, S., Cuipers, P., Farkas, M., Ben Zeev, D., Davidson, L., Kotera, Y., Roe, J., Ng, F., and Llewellyn-Beardsley, J.
• College/School: College of Science and Engineering > School of Geographical and Earth Sciences > Geography
• Journal Name: World Psychiatry
• Publisher: Wiley
• ISSN: 2051-5545
• ISSN (Online): 2051-5545
• Published Online: 12 January 2024
• Copyright Holders: Copyright © 2024 World Psychiatric Association
• First Published: First published in World Psychiatry 23(1):101-112
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher