Feasibility and Acceptability of a Novel Online Program for Mental Health Carers

Abstract

Objective: To evaluate the feasibility and acceptability of a new online program (Minds Together ) for carers of a person with depressive or anxiety symptoms. Methods: Using a two-arm randomised controlled trial design, 108 carers of a person with depressive or anxiety symptomology aged 16 years or over (89% female; mean age 50 years) received immediate or delayed access to the Minds Together program. Feasibility was measured using program activation and survey completion rates. Acceptability was measured using a project-specific satisfaction scale, semi-structured interviews, and program completion metadata. The study used intention-to-treat (ITT) analysis for participant-reported outcomes (carer burden, coping self-efficacy) across groups. Results: Feasibility and acceptability thresholds were consistent with similar studies: 59% activated their program account, 47% met the program completion threshold, and almost all reported satisfaction with the program. The ITT indicated trends in increased coping self-efficacy and reduced carer burden for the Intervention group, compared to the Waitlist control. Conclusions: The Minds Together program is a feasible and acceptable program for carers supporting a person with depressive or anxiety symptomology. Results support exploration of the program’s efficacy in a full-scale RCT.

Keywords:

carers caregivers depression anxiety mental health relatives

References

Aarons, G. A., Wells, R. S., Zagursky, K., Fettes, D. L., & Palinkas, L. A. (2009). Implementing evidence-based practice in community mental health agencies: A multiple stakeholder analysis. American Journal of Public Health, 99(11). https://doi.org/10.2105/AJPH.2009.161711

Alvarez-Jimenez, M., Bendall, S., Lederman, R., Wadley, G., Chinnery, G., Vargas, S., Larkin, M., Killackey, E., McGorry, P. D., & Gleeson, J. F. (2013). On the HORYZON: Moderated online social therapy for long-term recovery in first episode psychosis. Schizophrenia Research, 143(1). https://doi.org/10.1016/j.schres.2012.10.009

Arjadi, R., Nauta, M. H., Chowdhary, N., & Bockting, C. L. H. (2015). A systematic review of online interventions for mental health in low and middle income countries: a neglected field. Global Mental Health, 2. https://doi.org/10.1017/gmh.2015.10

Australian Bureau of Statistics. (2018). Disability, Ageing and Carers, Australia: Summary of Findings. https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release#carers

Bandura, A. (1989). Bandura, A. (1989). Regulation of Cognitive Processes Through Perceived Self-Efficacy. Developmental Psychology, 25(5). https://doi.org/10.1037/0012-1649.25.5.729 Regulation of Cognitive Processes Through Perceived Self-Efficacy. Developmental Psychology, 25(5).

Barnes, C. W., Hadzi-Pavlovic, D., Wilhelm, K., & Mitchell, P. B. (2015). A web-based preventive intervention program for bipolar disorder: Outcome of a 12-months randomized controlled trial. Journal of Affective Disorders, 174. https://doi.org/10.1016/j.jad.2014.11.038

Batterham, P. J. (2014). Recruitment of mental health survey participants using Internet advertising: Content, characteristics and cost effectiveness. International Journal of Methods in Psychiatric Research, 23(2). https://doi.org/10.1002/mpr.1421

Bögels, S. M., & Brechman-Toussaint, M. L. (2006). Family issues in child anxiety: Attachment, family functioning, parental rearing and beliefs. Clinical Psychology Review, 26(7). https://doi.org/10.1016/j.cpr.2005.08.001

Cardi, V., Albano, G., Ambwani, S., Cao, L., Crosby, R. D., MacDonald, P., Schmidt, U., & Treasure, J. (2020). A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa. Psychological Medicine, 50(15). https://doi.org/10.1017/S0033291719002824

Carers Australia. (2021). Response to the Productivity Commission: Final Report on the Inquiry into the role of improving mental health to support economic participation and enhancing productivity and economic growth. www.carersaustralia.com.au

Carter, G., Monaghan, C., & Santin, O. (2020). What is known from the existing literature about peer support interventions for carers of individuals living with dementia: A scoping review. In Health and Social Care in the Community (Vol. 28, Issue 4). https://doi.org/10.1111/hsc.12944

Chenoweth, L., Stein-Parbury, J., White, D., McNeill, G., Jeon, Y. H., & Zaratan, B. (2016). Coaching in self-efficacy improves care responses, health and well-being in dementia carers: a pre/post-test/follow-up study. BMC Health Services Research, 16(1), 1–16. https://doi.org/10.1186/S12913-016-1410-X/TABLES/6

Chesney, M. A., Neilands, T. B., Chambers, D. B., Taylor, J. M., & Folkman, S. (2006). A validity and reliability study of the coping self-efficacy scale. British Journal of Health Psychology, 11(3). https://doi.org/10.1348/135910705X53155

Choi, J. W., Hong, W., Abela, J. R. Z., & Cohen, J. R. (2021). Comorbid Depression and Anxiety Symptoms in Chinese Adolescents: Testing the Explanatory Power of a Diathesis-Anxiety Model. Research on Child and Adolescent Psychopathology, 49(4), 503–517. https://doi.org/10.1007/s10802-020-00730-8

Cidav, Z., Mandell, D., Pyne, J., Beidas, R., Curran, G., & Marcus, S. (2020). A pragmatic method for costing implementation strategies using time-driven activity-based costing. Implementation Science, 15(1). https://doi.org/10.1186/s13012-020-00993-1

Cormac, I., & Tihanyi, P. (2006). Meeting the mental and physical healthcare needs of carers. Advances in Psychiatric Treatment, 12(3), 162–172. https://doi.org/10.1192/APT.12.3.162

Dam, A. E. H., van Boxtel, M. P. J., Rozendaal, N., Verhey, F. R. J., & de Vugt, M. E. (2017). Development and feasibility of Inlife: A pilot study of an online social support intervention for informal caregivers of people with dementia. PLoS ONE, 12(9). https://doi.org/10.1371/journal.pone.0183386

Diminic, S., Hielscher, E., Lee, Y., Harris, M., Schess, J., Kealton, J., & Whiteford, H. (2016). The economic value of informal mental health caring in Australia. https://www.mindaustralia.org.au/sites/default/files/Mind_value_of_informal_caring_full_report.pdf

Donkin, L., Christensen, H., Naismith, S. L., Neal, B., Hickie, I. B., & Glozier, N. (2011). A systematic review of the impact of adherence on the effectiveness of e-therapies. In Journal of Medical Internet Research (Vol. 13, Issue 3). https://doi.org/10.2196/jmir.1772

Evans-Lacko, S., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bruffaerts, R., Chiu, W. T., Florescu, S., de Girolamo, G., Gureje, O., Haro, J. M., He, Y., Hu, C., Karam, E. G., Kawakami, N., Lee, S., Lund, C., Kovess-Masfety, V., Levinson, D., … Wojtyniak, B. (2018). Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: Results from the WHO World Mental Health (WMH) surveys. Psychological Medicine, 48(9). https://doi.org/10.1017/S0033291717003336

Everymind. (2013). How can we best support those who care? Research Paper Series: Summary Repo. https://everymind.imgix.net/assets/Uploads/2502-01_PID_Summary-Report_WEB-Pages_171016_152208.pdf

Eysenbach, G. (2005). The Law of Attrition. J Med Internet Res 2005;7(1):E11 Https://Www.Jmir.Org/2005/1/E11, 7(1), e402. https://doi.org/10.2196/JMIR.7.1.E11

Ezpeleta, L., Domènech, J. M., & Angold, A. (2006). A comparison of pure and comorbid CD/ODD and depression. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47(7). https://doi.org/10.1111/j.1469-7610.2005.01558.x

Fitzgeraldson, E., Fitzpatrick, S., Kay-Lambkin, F., Harding, T., McNaughton, K., Triandafilidis, Z., Heath, J., Lyford, B., & Charnley, J. (in press). Supports and Interventions for Carers of a Person with Depressive or Anxiety symptoms: A systematic Review. Europe’s Journal of Psychology.

Flynn, S., Hastings, R. P., Burke, C., Howes, S., Lunsky, Y., Weiss, J. A., & Bailey, T. (2020). Online Mindfulness Stress Intervention for Family Carers of Children and Adults with Intellectual Disabilities: Feasibility Randomized Controlled Trial. Mindfulness, 11(9). https://doi.org/10.1007/s12671-020-01436-0

Foster, K. (2011). “I wanted to learn how to heal my heart”: Family carer experiences of receiving an emotional support service in the Well Ways programme. International Journal of Mental Health Nursing, 20(1). https://doi.org/10.1111/j.1447-0349.2010.00710.x

Gandy, M., Karin, E., Fogliati, V. J., McDonald, S., Titov, N., & Dear, B. F. (2016). A feasibility trial of an Internet-delivered and transdiagnostic cognitive behavioral therapy treatment program for anxiety, depression, and disability among adults with epilepsy. Epilepsia, 57(11). https://doi.org/10.1111/epi.13569

Geraghty, A. W. A., Torres, L. D., Leykin, Y., Pérez-Stable, E. J., & Muñoz, R. F. (2013). Understanding attrition from international internet health interventions: A step towards global eHealth. Health Promotion International, 28(3). https://doi.org/10.1093/heapro/das029
Ghebreyesus, T. (2019). The WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health. http://www.who.int/iris/handle/10665/89966

Gilbody, S., Richards, D., Brealey, S., & Hewitt, C. (2007). Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): A diagnostic meta-analysis. Journal of General Internal Medicine, 22(11). https://doi.org/10.1007/s11606-007-0333-y

Gilliam, C. M., & Steffen, A. M. (2006). The relationship between caregiving self-efficacy and depressive symptoms in dementia family caregivers. Aging and Mental Health, 10(2). https://doi.org/10.1080/13607860500310658

Gleeson, J., Lederman, R., Koval, P., Wadley, G., Bendall, S., Cotton, S., Herrman, H., Crisp, K., & Alvarez-Jimenez, M. (2017). Moderated online social therapy: A model for reducing stress in carers of young people diagnosed with mental health disorders. Frontiers in Psychology, 8(MAR). https://doi.org/10.3389/fpsyg.2017.00485

Griffiths, K. M., Crisp, D. A., Barney, L., & Reid, R. (2011). Seeking help for depression from family and friends: A qualitative analysis of perceived advantages and disadvantages. BMC Psychiatry, 11. https://doi.org/10.1186/1471-244X-11-196

Guillamón, N., Nieto, R., Pousada, M., Redolar, D., Muñoz, E., Hernández, E., Boixadós, M., & Gómez-Zúñiga, B. (2013). Quality of life and mental health among parents of children with cerebral palsy: The influence of self-efficacy and coping strategies. Journal of Clinical Nursing, 22(11–12), 1579–1590. https://doi.org/10.1111/JOCN.12124/FORMAT/PDF

Hammarberg, K., Sartore, G., Cann, W., & Fisher, J. R. W. (2014). Barriers and promoters of participation in facilitated peer support groups for carers of children with special needs. Scandinavian Journal of Caring Sciences, 28(4). https://doi.org/10.1111/scs.12110

Hayes, L., Hawthorne, G., Farhall, J., O’Hanlon, B., & Harvey, C. (2015). Quality of Life and Social Isolation Among Caregivers of Adults with Schizophrenia: Policy and Outcomes. Community Mental Health Journal, 51(5). https://doi.org/10.1007/s10597-015-9848-6

Heynsbergh, N., Heckel, L., Botti, M., & Livingston, P. M. (2018). Feasibility, useability and acceptability of technology-based interventions for informal cancer carers: A systematic review. BMC Cancer, 18(1). https://doi.org/10.1186/s12885-018-4160-9

Highet, N., Thompson, M., & McNair, B. (2005). Identifying depression in a family member: the carers’ experience. Journal of Affective Disorders, 87(1), 25–33. https://doi.org/10.1016/J.JAD.2005.02.016

Hoyle, D., Slater, J., Williams, C., Schmidt, U., & Wade, T. D. (2013). Evaluation of a web-based skills intervention for carers of people with anorexia nervosa: a randomized controlled trial. The International Journal of Eating Disorders, 46(6), 634–638. https://doi.org/10.1002/EAT.22144

Hubbard, A. A., McEvoy, P. M., Smith, L., & Kane, R. T. (2016). Brief group psychoeducation for caregivers of individuals with bipolar disorder: A randomized controlled trial. Journal of Affective Disorders, 200. https://doi.org/10.1016/j.jad.2016.04.013

Jensen, K. B., Morthorst, B. R., Vendsborg, P. B., Hjorthøj, C., & Nordentoft, M. (2016). Effectiveness of Mental Health First Aid training in Denmark: a randomized trial in waitlist design. Social Psychiatry and Psychiatric Epidemiology, 51(4). https://doi.org/10.1007/s00127-016-1176-9

Jeong, J. S., Kim, Y., & Chon, M. G. (2018). Who Is Caring for the Caregiver? The Role of Cybercoping for Dementia Caregivers. Health Communication, 33(1). https://doi.org/10.1080/10410236.2016.1242030

Jorm, A. F. (2012). Mental health literacy; empowering the community to take action for better mental health. American Psychologist, 67(3). https://doi.org/10.1037/a0025957

Julious, S. A. (2005). Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics, 4(4). https://doi.org/10.1002/pst.185

Kolasa, K., & Kozinski, G. (2020). How to value digital health interventions? A systematic literature review. In International Journal of Environmental Research and Public Health (Vol. 17, Issue 6). https://doi.org/10.3390/ijerph17062119

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/J.1525-1497.2001.016009606.X

Kumar, K., & Gupta, M. (2014). Clinical and socio-demographic determinants of psychological health and burden in family caregivers of patients with unipolar depression. Asian Journal of Psychiatry, 9. https://doi.org/10.1016/j.ajp.2014.01.002

Lee, G. B., Woo, H., Lee, S. Y., Cheon, S. M., & Kim, J. W. (2019). The burden of care and the understanding of disease in Parkinson’s disease. PLoS ONE, 14(5). https://doi.org/10.1371/journal.pone.0217581

Liu, Z., Heffernan, C., & Tan, J. (2020). Caregiver burden: A concept analysis. International Journal of Nursing Sciences, 7(4), 438–445. https://doi.org/10.1016/j.ijnss.2020.07.012

Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Medical Care, 46(3).
https://doi.org/10.1097/MLR.0b013e318160d093

Marrinan, T., & Papworth, M. (2018). Low Intensity Cognitive Behaviour Therapy (S. Trefgarne & T. Hall, Eds.; 2nd ed.). SAGE Publishications. https://www.google.com.au/books/edition/Low_Intensity_Cognitive_Behaviour_Therap/TkBvDwAAQBAJ?hl=en&gbpv=1&dq=Marrinan+T,+Papworth+M.+Low+intensity+cognitive+behaviour+therapy.+SAGE%3B+2018.&printsec=frontcover

McKechnie, V., Barker, C., & Stott, J. (2014). The effectiveness of an internet support forum for carers of people with dementia: A pre-post cohort study. Journal of Medical Internet Research, 16(2). https://doi.org/10.2196/jmir.3166

Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2010). Dropout from internet-based treatment for psychological disorders. British Journal of Clinical Psychology, 49(4). https://doi.org/10.1348/014466509X472138

Metcalfe, A., Jones, B., Mayer, J., Gage, H., Oyebode, J., Boucault, S., Aloui, S., Schwertel, U., Böhm, M., Tezenas du Montcel, S., Lebbah, S., de Mendonça, A., de Vugt, M., Graff, C., Jansen, S., Hergueta, T., Dubois, B., & Kurz, A. (2019). Online information and support for carers of people with young-onset dementia: A multi-site randomised controlled pilot study. International Journal of Geriatric Psychiatry, 34(10). https://doi.org/10.1002/gps.5154

Mishra, D. K., & Shakya, U. (2021). Assessment of Anxiety and Depression among Caregivers of Mentally Ill Patients Attending Mental Hospital, Lalitpur, Nepal. Journal of Nepal Health Research Council, 18(4). https://doi.org/10.33314/jnhrc.v18i4.3006

National Survey of Mental Health and Wellbeing: Summary of Results, 2007 | Australian Bureau of Statistics. (n.d.). Retrieved November 12, 2021, from https://www.abs.gov.au/statistics/health/mental-health/national-survey-mental-health-and-wellbeing-summary-results/latest-release

Nicolaou, P. L., Egan, S. J., Gasson, N., & Kane, R. T. (2010). Identifying needs, burden, and distress of carers of people with Frontotemporal dementia compared to Alzheimer’s disease. Dementia, 9(2). https://doi.org/10.1177/1471301209354024

O’Neil, K. A., Podell, J. L., Benjamin, C. L., & Kendall, P. C. (2010). Comorbid depressive disorders in anxiety-disordered youth: Demographic, clinical, and family characteristics. Child Psychiatry and Human Development, 41(3). https://doi.org/10.1007/s10578-009-0170-9

Perlick, D. A., Jackson, C., Grier, S., Huntington, B., Aronson, A., Luo, X., & Miklowitz, D. J. (2018). Randomized trial comparing caregiver-only family-focused treatment to standard health education on the 6-month outcome of bipolar disorder. Bipolar Disorders, 20(7). https://doi.org/10.1111/bdi.12621

Pinquart, M., & Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychology and Aging, 18(2), 250–267. https://doi.org/10.1037/0882-7974.18.2.250

Priestley, J., & McPherson, S. (2016). Experiences of adults providing care to a partner or relative with depression: A meta-ethnographic synthesis. In Journal of Affective Disorders (Vol. 192). https://doi.org/10.1016/j.jad.2015.12.011

Proudfoot, J., Parker, G., Manicavasagar, V., Hadzi-Pavlovic, D., Whitton, A., Nicholas, J., Smith, M., & Burckhardt, R. (2012). Effects of adjunctive peer support on perceptions of illness control and understanding in an online psychoeducation program for bipolar disorder: A randomised controlled trial. Journal of Affective Disorders, 142(1–3). https://doi.org/10.1016/j.jad.2012.04.007

Radfar, M., Ahmadi, F., & Fallahi Khoshknab, M. (2014). Turbulent life: The experiences of the family members of patients suffering from depression. Journal of Psychiatric and Mental Health Nursing, 21(3). https://doi.org/10.1111/jpm.12077

Reblin, M., Ketcher, D., McCormick, R., Barrios-Monroy, V., Sutton, S. K., Zebrack, B., Wells, K. J., Sahebjam, S., Forsyth, P., & Byrne, M. M. (2021). A randomized wait-list controlled trial of a social support intervention for caregivers of patients with primary malignant brain tumor. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06372-w

Roddy, S., Onwumere, J., & Kuipers, E. (2015). A pilot investigation of a brief, needs-led caregiver focused intervention in psychosis. Journal of Family Therapy, 37(4). https://doi.org/10.1111/1467-6427.12054

SAS Institute Inc. (2013). SAS/ACCESS® 9.4 Interface to ADABAS (9.4). SAS Institute Inc.

Schaller, S., Marinova-Schmidt, V., Setzer, M., Kondylakis, H., Griebel, L., Sedlmayr, M., Graessel, E., Maler, J. M., Kirn, S., & Kolominsky-Rabas, P. L. (2016). Usefulness of a Tailored eHealth Service for Informal Caregivers and Professionals in the Dementia Treatment and Care Setting: The eHealthMonitor Dementia Portal. JMIR Research Protocols, 5(2). https://doi.org/10.2196/resprot.4354

Schene, A. H., Tessler, R. C., & Gamache, G. M. (1994). Instruments measuring family or caregiver burden in severe mental illness. Social Psychiatry and Psychiatric Epidemiology, 29(5), 228–240. https://doi.org/10.1007/BF00796381

Schmidt-Hantke, J., Vollert, B., Hagner, F., Beintner, I., Hütter, K., Nitsch, M., Jacobi, C., & Waldherr, K. (2021). Stakeholders’ perspectives on online interventions to improve mental health in eating disorder patients and carers in Germany. European Journal of Public Health, 31(31). https://doi.org/10.1093/eurpub/ckab057

Scott, K., & Beatty, L. (2013). Feasibility study of a self-guided cognitive behaviour therapy Internet intervention for cancer carers. Australian Journal of Primary Health, 19(4). https://doi.org/10.1071/PY13025

Scult, M., Haime, V., Jacquart, J., Takahashi, J., Moscowitz, B., Webster, A., Denninger, J. W., & Mehta, D. H. (2015). A healthy aging program for older adults: effects on self-efficacy and morale. In Advances in mind-body medicine (Vol. 29, Issue 1).

Sin, J., Henderson, C., Woodham, L. A., Hernández, A. S., & Gillard, S. (2019). A multicomponent ehealth intervention for family carers for people affected by psychosis: A coproduced design and build study. Journal of Medical Internet Research, 21(8). https://doi.org/10.2196/14374

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/ARCHINTE.166.10.1092

Stjernswärd, S., & Hansson, L. (2017). Outcome of a web-based mindfulness intervention for families living with mental illness–A feasibility study. Informatics for Health and Social Care, 42(1). https://doi.org/10.1080/17538157.2016.1177533

Stjernswärd, S., & Östman, M. (2011). Illuminating user experience of a website for the relatives of persons with depression. International Journal of Social Psychiatry, 57(4). https://doi.org/10.1177/0020764009358388

Tang, W. K., & Chan, C. Y. J. (2016). Effects of psychosocial interventions on self-efficacy of dementia caregivers: A literature review. In International Journal of Geriatric Psychiatry (Vol. 31, Issue 5). https://doi.org/10.1002/gps.4352

Teare, M. D., Dimairo, M., Shephard, N., Hayman, A., Whitehead, A., & Walters, S. J. (2014). Sample size requirements to estimate key design parameters from external pilot randomised controlled trials: A simulation study. Trials, 15(1). https://doi.org/10.1186/1745-6215-15-264

Thomas, D. R. (2016). A General Inductive Approach for Analyzing Qualitative Evaluation Data: Http://Dx.Doi.Org/10.1177/1098214005283748, 27(2), 237–246. https://doi.org/10.1177/1098214005283748

Udoh, E. E., Omorere, D. E., Sunday, O., Osasu, O. S., & Amoo, B. A. (2021). Psychological distress and burden of care among family caregivers of patients with mental illness in a neuropsychiatric outpatient clinic in Nigeria. PLoS ONE, 16(5 May). https://doi.org/10.1371/journal.pone.0250309

Vikas, A., Avasthi, A., & Sharan, P. (2011). Psychosocial impact of obsessive-compulsive disorder on patients and their caregivers: A comparative study with depressive disorder. International Journal of Social Psychiatry, 57(1). https://doi.org/10.1177/0020764009347333

Visa, B., & Harvey, C. (2019). Mental health carers’ experiences of an Australian Carer Peer Support program: Tailoring supports to carers’ needs. Health and Social Care in the Community, 27(3). https://doi.org/10.1111/hsc.12689

Wagenaar, K. P., Rutten, F. H., Klompstra, L., Bhana, Y., Sieverink, F., Ruschitzka, F., Seferovic, P. M., Lainscak, M., Piepoli, M. F., Broekhuizen, B. D. L., Strömberg, A., Jaarsma, T., Hoes, A. W., & Dickstein, K. (2017). ‘heartfailurematters.org’, an educational website for patients and carers from the Heart Failure Association of the European Society of Cardiology: objectives, use and future directions. European Journal of Heart Failure, 19(11). https://doi.org/10.1002/ejhf.917

Whitehead, A. L., Julious, S. A., Cooper, C. L., & Campbell, M. J. (2016). Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical Methods in Medical Research, 25(3). https://doi.org/10.1177/0962280215588241

Williams, F., Moghaddam, N., Ramsden, S., & de Boos, D. (2019). Interventions for reducing levels of burden amongst informal carers of persons with dementia in the community. A systematic review and meta-analysis of randomised controlled trials. In Aging and Mental Health (Vol. 23, Issue 12). https://doi.org/10.1080/13607863.2018.1515886

World Health Organization. (2017). Depression and Other Common Mental Disorders Global Health Estimates.
Ybarra, M. L., & Suman, M. (2006). Help seeking behavior and the Internet: a national survey. International Journal of Medical Informatics, 75(1), 29–41. https://doi.org/10.1016/J.IJMEDINF.2005.07.029

Zarit, S. H., Orr, N. K., & Zarit, J. M. (1985). The hidden victims of Alzheimer’s disease: Families under stress . New York University Press.

Cited by