Landmark trial of NHS staff by King’s College London reveals promising solution to improve mental health

[Sly Saint]

London, September 6, 2022: New research from the Institute of Psychiatry, Psychology, & Neuroscience (IoPPN) at King’s College London has found that the mental health and wellbeing of frontline NHS healthcare workers can be supported and improved through the use of the ‘Koa Foundations’ mental health and wellbeing smartphone application.

The study, published in the British Journal of Psychiatry, found that use of the app by clinical and non-clinical health care workers in England was associated with a statistically significant improvement in mental health and wellbeing, as well as a decrease in the likelihood of experiencing insomnia.

Over a thousand healthcare workers across England were recruited from staff currently participating in NHS Check, the UK's largest survey of the mental health and wellbeing of NHS staff during Covid-19. Around half of the participants were provided access to the Koa Foundations app and were followed up with surveys at four and eight weeks of use.

The researchers found that use of the app was associated with a significant reduction in symptoms of behavioural or intellectual distress at each of the follow ups, with the effects most strongly seen in women, clinical staff, and younger participants.

Professor Simon Wessely, Regius Professor of Psychiatry at King’s IoPPN and the study’s senior author said, “The Covid-19 pandemic introduced a period of unparalleled pressure on frontline healthcare workers; pressure which arguably remains today. Many organisations have admirably sought to support staff during the pandemic through a range of initiatives, however, there has so far been a lack of evidence as to what works and for whom. Our study established that a smartphone based mental health support for health workers can be of help”.

Koa Health | Landmark trial of NHS staff by King’s College London reveals promising solution to improve mental health

also here Landmark trial of NHS staff reveals promising solution to improve mental health (kcl.ac.uk)

paper here
Multicentre, England-wide randomised controlled trial of the ‘Foundations’ smartphone application in improving mental health and well-being in a healthcare worker population | Request PDF (researchgate.net)

 

[bobbler]

If this is workplace-based I can't help but feel 'other factors' need to be mapped into any claims regarding influence. e.g. if people with issues started getting sacked, disciplined etc more over the time period of the study that might account for 'improvement in responses' for reasons very different to any health issues actually improving. People also are no longer 'in lockdown'

A simplistic example, but intended to represent 'the gamut' of what we hear of going on in workplaces etc.

 

[chrisb]

What a ringing endorsement. "Can be of help". So it may not be. It all depends.

 

[BrightCandle]

This is Kings College, they are at the heart of rebellion against the NICE guidelines and trying to hide they are still using the BPS model by renaming their fatigue clinic to a physical alignments one, Dr Shepherd wrote to them just a couple of weeks ago (no response yet). Kings is dreadful for overuse of Psychology and research in ME/CFS, they aren't exactly big on quality research.

 

[Lilas]

In case anyone wants to read the full article, Wessely is one of the authors...

Here is a link

 

[rvallee]

Lmao. Welcome to the same dystopian nonsense. The worst thing to have happened to mental health is medicine getting involved decades before they understand anything. "Can be of help". What a giant scam.

 

[Trish]

This is the abstract of the published paper:

Multicentre, England-wide randomised controlled trial of the ‘Foundations’ smartphone application in improving mental health and well-being in a healthcare worker population

Abstract

Background
Healthcare workers (HCWs) have faced considerable pressures during the COVID-19 pandemic. For some, this has resulted in mental health distress and disorder. Although interventions have sought to support HCWs, few have been evaluated.

Aims
We aimed to determine the effectiveness of the ‘Foundations’ application (app) on general (non-psychotic) psychiatric morbidity.

Method
We conducted a multicentre randomised controlled trial of HCWs at 16 NHS trusts (trial registration number: EudraCT: 2021-001279-18). Participants were randomly assigned to the app or wait-list control group. Measures were assessed at baseline, after 4 and 8 weeks.

The primary outcome was general psychiatric morbidity (using the General Health Questionnaire). Secondary outcomes included: well-being; presenteeism; anxiety; depression and insomnia. The primary analysis used mixed-effects multivariable regression, presented as adjusted mean differences (aMD).

Results
Between 22 March and 3 June 2021, 1002 participants were randomised (500:502), and 894 (89.2%) followed-up. The sample was predominately women (754/894, 84.3%), with a mean age of 44⋅3 years (interquartile range (IQR) 34–53).

Participants randomised to the app had a reduction in psychiatric morbidity symptoms (aMD = −1.39, 95% CI −2.05 to −0.74), improvement in well-being (aMD = 0⋅54, 95% CI 0⋅20 to 0⋅89) and reduction in insomnia (adjusted odds ratio (aOR) = 0⋅36, 95% CI 0⋅21 to 0⋅60). No other significant findings were found, or adverse events reported.

Conclusions
The app had an effect in reducing psychiatric morbidity symptoms in a sample of HCWs. Given it is scalable with no adverse effects, the app may be used as part of an organisation's tiered staff support package. Further evidence is needed on long-term effectiveness and cost-effectiveness.

 

[Amw66]

No control group / other key sector workers involvement ?

 

[Trish]

No control group

Not a proper one. It also doesn't say whether the participants had a psychiatric diagnosis. I suspect it was offered to anyone feeling stressed, which must be most of the NHS during the pandemic.
The time scale was also far too short, and reporting of sleep and 'presenteeism' presumably subjective too.

 

[TiredSam]

Who defined "health workers' mental health" as the problem? Surely anyone concerned about the NHS should be looking at structural issues?

But of course it's an advert for an app, and seeing as the app "can be of help" for a thing, that thing has to be defined as the problem if you want to sell it. It isn't even a solution looking for a problem, because it won't commit itself to being a solution, it just "can be of help".

What a complete waste of time and an insult to anyone it may be foisted upon.

And what's so "Landmark" about it? It's just PR from a bunch of shysters trying to flog their latest dodgy app.

 

[RedFox]

My worry is that research like this is myopic. The concept of giving HCWs a minfullness app feels like a band-aid approach. Actually improving people's lives will improve their mental health more. If you truly want HCWs to stay stable in the middle of a pandemic, you need to give them sufficient pay, sane hours, sane staffing ratios, and PPE. But achieving this requires both money and systemic change.

 

[Arnie Pye]

The primary outcome was general psychiatric morbidity (using the General Health Questionnaire). Secondary outcomes included: well-being; presenteeism; anxiety; depression and insomnia.

Is presenteeism (turning up to work while sick) considered a good thing or a bad thing?

 

[rvallee]

Just randomly remembered some medical dude who was whining about how biomedical breakthroughs are very significant while biopsychosocial, uh, "work", I guess, isn't significant.

Biomedical breakthroughs: literally saved billions of lives combined, massively increased life expectancy and quality of life
Biopsychosocial "landmark studies": can be of help, "promising" despite being identical to work published 3+ decades ago and hundreds of studies and billions wasted in the process

I mean, yeah. This is the kind of research that backs the dystopian horror shown in the Amazon pictures I posted above with the mindfulness booths and cringy koans. It's the very best it can accomplish, while never actually delivering anything. Because this "can be of help" really isn't of actual help, it's not even clear what problem it's actually failing to solve, other than mostly arbitrary answers on awful questionnaires.

 

[Wonko]

It's probably cheaper than doing even the bare minimum to temporarily improve even 5 minutes of someone's day.

Quiet place, tea, cake - 10 minutes.

Obviously, for overworked staff, in an under resourced system, it's just so much cheaper and easier to just send them a link in an email saying to try this app if they are feeling stressed.

Coz otherwise...tea, cake, and paying for someone else to work that 10 minutes, it all mounts up - after a while, tax payers money don't y'know, inefficient use of resources.

Much more efficient to have staff over stressed, burning out, sick, leaving - coz of course, then there is less staff, meaning less wages, but somehow the same amount of work still gets done (and anyone who says differently is clearly antiNHS and against all of it's hard working staff) - less cost, same results - that's increased efficiency.

(It was deemed a long time ago that increased efficiency, at any cost, was a good thing, but it seems odd, to me, that after 40 years of increasing efficiency, the NHS barely function and it's staff, at least those below board level, seem to be......stressed.

Surely it should all be a mega efficient, smoothly running, medical machine by now, with lots of happy well paid staff skipping around, delighted?)

 

[bobbler]

No control group / other key sector workers involvement ?

no one ever really explaining in these things: how can an app logically be of help to mental distress?
So it can suggest try x or take a survey of symptoms but where is the’miracle extra bit’ that is offering support you’d think could make a difference

particularly if it’s for hcw who might have seen all sorts in horrid scary work conditions and feel ‘used’ at the end of all this having put themselves above and beyond with little support in return etc?

why is that never coming through in explanations?

 

[Wits_End]

That reminds me: something I read the other day suggested that the mindfulness practised in schools has had very little effect.