The internet and its application in the management of bipolar affective disorder

Abstract

Aims This thesis has two major aims: i) to examine the quality of information on bipolar disorder on the Internet and ii) to undertake a randomized controlled trial of a web-based intervention for reducing relapse in patients with bipolar disorder. Methods Study 1: An instrument was designed to assess the quality of websites. This new tool (BWQC) was used in conjunction with the DISCERN. Three independent raters reviewed 15 websites using these two quality instruments. Study 2: This major component of the thesis comprised a 12-month RCT which examined the efficacy of an Internet-based relapse prevention program for bipolar disorder adjunctive to usual pharmacological management. The study program was predominantly psychoeducational. The control program was designed to be an attention placebo and took the participant to a variety of websites focused on healthy living. To recruit participants to the study directly via the Internet, an online screening tool was developed-the BDSQ. Results: Study 1: The Bipolar Disorder Website Quality Checklist demonstrated high inter-rater reliability (r = 0.89) and correlated strongly with the more generic DISCERN instrument (r = 0.78, p = 0.001). The ranking of the websites differed slightly depending upon the tool used; however, the top ranking website for both instruments was www.blackdoginsitute.org.au. Study 2: A series of survival analyses using various defined outcome criteria (hospitalization, the BDI-II, the Internal State Scale and the Sheehan Disability scale) demonstrated no significant differences in time to relapse between the study and control treatment groups. Conclusions Study 1: Overall the quality of websites on bipolar disorder was mixed. Several were excellent and provided comprehensive information about bipolar disorder and its treatment with many additional interactive features like chat rooms and support groups. Having an editorial board is a good indicator for quality. Mental health clinicians are encouraged to recommend those which best match individual need. Study 2: Possible reasons for the failure to demonstrate a significant benefit of the study treatment compared to the control treatment were: high morbidity of the study population (particularly with respect to depressive symptoms); an possible unpredicted active effect of the control intervention; a limited impact of the active study intervention; and the limitations of the self-report outcome measures employed.