Development and Evaluation of Acceptability and Feasibility of a Web-Based Intervention for Patients With Bipolar Disorder in Iran: Implementation Study

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Abstract

Background

Psychoeducation for bipolar disorder has a significant impact on symptoms and treatment adherence. In Iran, as a low-resource setting, infrastructural barriers, such as inadequate mental health professionals, difficulties in transportation, and costs of care, may hinder optimum delivery of this evidence-based intervention to patients.

Objective

This study sought to explore the acceptability and feasibility of a web-based intervention for bipolar patients in Iran.

Methods

A website has been developed as a platform for providing psychoeducational content about bipolar disorder. Patients were chosen via a convenient sampling method in 2018-2019. The main component of the intervention included streaming 7 weekly video clips after attending a single in-person meeting, as well as a medication self-monitoring application. Information was collected about the feasibility and acceptability of the intervention.

Results

We invited 45 patients from the day center and the outpatient clinic of Roozbeh psychiatric hospital and some private clinics in Tehran. Of the 23 patients (51%) who attended the first in-person session and provided informed consent, 14 patients dropped out during the study. While 9 patients completed the course (attended 4 or more online sessions), only 5 watched all the video sessions. The rate of adherence to the intervention and frequency of exposure to the website were much higher for those recruited from the private and outpatient clinics.

Conclusions

This web-based intervention can be feasible and acceptable only for a subgroup of patients with specific educational status and socioeconomic level.

Related collections

Most cited references 23

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Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative.

Kathleen R Merikangas, Robert Jin, Jian-Ping He … (2011)

There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methods. To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder (BPS) in the World Health Organization World Mental Health Survey Initiative. Cross-sectional, face-to-face, household surveys of 61,392 community adults in 11 countries in the Americas, Europe, and Asia assessed with the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, a fully structured, lay-administered psychiatric diagnostic interview. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) disorders, severity, and treatment. The aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for BPS. Twelve-month prevalences were 0.4% for BP-I, 0.3% for BP-II, 0.8% for subthreshold BP, and 1.5% for BPS. Severity of both manic and depressive symptoms as well as suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across BP subtypes. Symptom severity was greater for depressive episodes than manic episodes, with approximately 74.0% of respondents with depression and 50.9% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least 1 other disorder, with anxiety disorders (particularly panic attacks) being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries, where only 25.2% reported contact with the mental health system. Despite cross-site variation in the prevalence rates of BPS, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior, and comorbidity across each diagnostic category provide evidence for the validity of the concept of BPS. Treatment needs for BPS are often unmet, particularly in low-income countries.

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A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission.

Anabel Martínez-Arán, Josep Maria Corominas, Carla Torrent … (2003)

Studies on individual psychotherapy indicate that some interventions may reduce the number of recurrences in bipolar patients. However, there has been a lack of structured, well-designed, blinded, controlled studies demonstrating the efficacy of group psychoeducation to prevent recurrences in patients with bipolar I and II disorder. One hundred twenty bipolar I and II outpatients in remission (Young Mania Rating Scale score <6, Hamilton Depression Rating Scale-17 score <8) for at least 6 months prior to inclusion in the study, who were receiving standard pharmacologic treatment, were included in a controlled trial. Subjects were matched for age and sex and randomized to receive, in addition to standard psychiatric care, 21 sessions of group psychoeducation or 21 sessions of nonstructured group meetings. Subjects were assessed monthly during the 21-week treatment period and throughout the 2-year follow-up. Group psychoeducation significantly reduced the number of relapsed patients and the number of recurrences per patient, and increased the time to depressive, manic, hypomanic, and mixed recurrences. The number and length of hospitalizations per patient were also lower in patients who received psychoeducation. Group psychoeducation is an efficacious intervention to prevent recurrence in pharmacologically treated patients with bipolar I and II disorder.

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Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011.

Vandad Sharifi, Masoumeh Amin-Esmaeili, Ahmad Hajebi … (2015)

No national information is available on the epidemiology of psychiatric disorders in Iran for the last decade.

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Author and article information

Contributors

Vandad Sharifi:

ORCID: https://orcid.org/0000-0002-1031-3049

Department of Psychiatry, Roozbeh HospitalTehran University of Medical SciencesSouth Kargar AvenueRoozbeh HospitalTehranIran98 912387586998 2155419113vsharifi@tums.ac.ir

Journal

Journal ID (nlm-ta): JMIR Form Res

Journal ID (iso-abbrev): JMIR Form Res

Journal ID (publisher-id): JFR

Title: JMIR Formative Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2561-326X

Publication date Collection: August 2021

Publication date (Electronic): 17 August 2021

Volume: 5

Issue: 8

Electronic Location Identifier: e23360

Affiliations

[1 ] Department of Psychiatry, Roozbeh Hospital Tehran University of Medical Sciences Tehran Iran

Author notes

Corresponding Author: Vandad Sharifi vsharifi@ 123456tums.ac.ir

Author information

Agaah Ashrafi https://orcid.org/0000-0003-1145-8001

Maryam Tabatabaee https://orcid.org/0000-0003-4625-9125

Vandad Sharifi https://orcid.org/0000-0002-1031-3049

Article

Publisher ID: v5i8e23360

DOI: 10.2196/23360

PMC ID: 8408757

PubMed ID: 34402794

SO-VID: 2681447e-a7a3-42e8-8272-fa8909b2cdfe

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

History

Date received : 10 August 2020

Date revision requested : 24 September 2020

Date revision received : 5 May 2021

Date accepted : 31 May 2021

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