Improving Treatment Decision-Making for Youth with Bipolar II Disorder

Researchers from the University of Sydney and Black Dog Institute have found that an online treatment decision-making tool for young people with Bipolar II Disorder is safe and effective, after receiving funding support from Australian Rotary Health (ARH).

Associate Professor Ilona Juraskova was awarded an ARH Mental Health Research Grant in 2017 to develop and evaluate the ‘Decision Aid’ website, a world-first online tool to help youth with Bipolar II Disorder (BPII) make informed decisions about their treatment.

Young people with a diagnosis of BPII were recruited to the study, with half given access to the new website whilst they were making their treatment decision, whilst the other half were given access to existing online information about bipolar treatments. Participants filled out questionnaires at the beginning of the study, soon after making a treatment decision, and three months after making their treatment decision.

“From looking at the answers to the questionnaires, we found that patients who had access to the website found it easier to make decisions about their treatment than the patients who were not given access to the website,” Associate Professor Juraskova said.

“They were more informed and felt better prepared to make decisions and they were more certain about the choices they made.”

Participants who used the Decision Aid website also experienced less regret about their choice of treatment/s three months later.

“It appears the website helped patients to learn about the different treatment options along with the benefits and costs of these options.”

“The patients who could access the website were also more likely to make high quality treatment decisions, that is, decisions based on a good knowledge of the available options and decisions that suited their personal values.”

This study also found that it was safe for people with BPII to access the Decision Aid website, and did not seem to increase anxiety or worsen BPII symptoms.

“Notably, most participants felt positively towards using the website. They found that it was easy to use and beneficial, and they trusted the information on the website,” Associate Professor Juraskova said.

Some of the features of the tool include plain language text, pictures, and interactive activities to engage the interest of users. All information was presented clearly, was easy to understand, and was based on evidence.

“Users could ‘weigh up’ different medication and psychological treatment options by rating how important the ‘pros’ and ‘cons’ were to them on a virtual scale.”

“We found that the website was informative; it appeared to increase users’ knowledge of the different evidence-based treatment options for people with BPII who want to reduce their risk of relapse in the future.”

Associate Professor Jusakova says treatments for bipolar II disorder are far less studied than those for bipolar I disorder, and yet this disorder is more common in the community and perhaps even more burdensome.

“It is my vision that we close the gap between mental health and physical health conditions when it comes to empowering patients to be active and informed decision-makers and consumers in their treatment and management,” she said.

“By promoting shared decision-making for people with bipolar II disorder, this world-first decision-aid website is a critical first step in closing this gap.”

With support from the Black Dog Institute, this website will be made available to people with Bipolar II Disorder worldwide.

The results from the final Randomised Controlled Trial (RCT) phase of this study will be submitted for publication in a well-regarded open-access peer-reviewed journal in April 2020.

The following two papers have already been published as a result of this study:

  1.  A paper presenting the Phase I findings in the international, well-regarded, Open-Access academic journal, PlosONE: Fisher A, Anderson J, Sharpe L, Manicavasagar V, Juraskova I. Development and pilot of a decision-aid for patients with bipolar II disorder and their families making decisions about treatment options to prevent relapse. (2018). PLOS ONE (Published 10 July 2018). doi:10.1371/journal.pone.0200490.6
  2. A protocol paper relating to Phase II of the project has been published in a with an international, well-regarded, peer-reviewed, Open-Access academic journal: Fisher A, Sharpe L, Anderson J, Manicavasagar V, Costa D, Juraskova I. A Phase II Randomised Controlled Trial of a decision-aid website to improve treatment decision-making for young adults with bipolar II disorder: A feasibility study protocol. (2018). Contemporary Clinical Trials Communications (Published 9 Nov 2018). doi:10.1016/j.conctc.2018.11.004.


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