Narratives describing first-hand experiences of recovery from mental health problems are widely available. Emerging evidence suggests that engaging with mental health recovery narratives can benefit people experiencing mental health problems, but no randomized controlled trial has been conducted as yet. We developed the Narrative Experiences Online (NEON) Intervention, a web application providing self-guided and recommender systems access to a collection of recorded mental health recovery narratives (n=659). We investigated whether NEON Intervention access benefited adults experiencing non-psychotic mental health problems by conducting a pragmatic parallel-group randomized trial, with usual care as control condition. The primary endpoint was quality of life at week 52 assessed by the Manchester Short Assessment (MANSA). Secondary outcomes were psychological distress, hope, self-efficacy, and meaning in life at week 52. Between March 9, 2020 and March 26, 2021, we recruited 1,023 participants from across England (the target based on power analysis was 994), of whom 827 (80.8%) identified as White British, 811 (79.3%) were female, 586 (57.3%) were employed, and 272 (26.6%) were unemployed. Their mean age was 38.4±13.6 years. Mood and/or anxiety disorders (N=626, 61.2%) and stress-related disorders (N=152, 14.9%) were the most common mental health problems. At week 52, our intention-to-treat analysis found a significant baseline-adjusted difference of 0.13 (95% CI: 0.01-0.26, p=0.041) in the MANSA score between the intervention and control groups, corresponding to a mean change of 1.56 scale points per participant, which indicates that the intervention increased quality of life. We also detected a significant baseline-adjusted difference of 0.22 (95% CI: 0.05-0.40, p=0.014) between the groups in the score on the “presence of meaning” subscale of the Meaning in Life Questionnaire, corresponding to a mean change of 1.1 scale points per participant. We found an incremental gain of 0.0142 quality-adjusted life years (QALYs) (95% credible interval: 0.0059 to 0.0226) and a £178 incremental increase in cost (95% credible interval: –£154 to £455) per participant, generating an incremental cost-effectiveness ratio of £12,526 per QALY compared with usual care. This was lower than the £20,000 per QALY threshold used by the National Health Service in England, indicating that the intervention would be a cost-effective use of health service resources. In the subgroup analysis including participants who had used specialist mental health services at baseline, the intervention both reduced cost (–£98, 95% credible interval: –£606 to £309) and improved QALYs (0.0165, 95% credible interval: 0.0057 to 0.0273) per participant as compared to usual care. We conclude that the NEON Intervention is an effective and cost-effective new intervention for people experiencing non-psychotic mental health problems.

中文翻译：

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在线记录的康复叙述在改善非精神病性心理健康问题患者的生活质量方面的有效性和成本效益：一项务实的随机对照试验


描述从心理健康问题中恢复的第一手经验的叙述随处可见。新的证据表明，参与心理健康恢复叙述可以使经历心理健康问题的人受益，但尚未进行随机对照试验。我们开发了在线叙事体验 (NEON) 干预，这是一个网络应用程序，提供自助引导和推荐系统访问一系列记录的心理健康恢复叙事 (n=659)。我们通过进行一项务实的平行组随机试验，以常规护理作为对照条件，调查了 NEON 干预是否使经历非精神病性心理健康问题的成年人受益。主要终点是通过曼彻斯特短期评估 (MANSA) 评估的第 52 周的生活质量。次要结局是第 52 周时的心理困扰、希望、自我效能和生活意义。2020 年 3 月 9 日至 2021 年 3 月 26 日期间，我们招募了来自英格兰各地的 1,023 名参与者（基于功效分析的目标是 994 名），其中其中 827 人（80.8%）被认为是英国白人，811 人（79.3%）为女性，586 人（57.3%）有工作，272 人（26.6%）失业。他们的平均年龄为 38.4±13.6 岁。情绪和/或焦虑障碍（N=626，61.2%）和压力相关障碍（N=152，14.9%）是最常见的心理健康问题。第 52 周时，我们的意向治疗分析发现，干预组和对照组之间的 MANSA 评分存在 0.13 的显着基线调整差异（95% CI：0.01-0.26，p=0.041），对应于平均变化每个参与者 1.56 个量表点，这表明干预措施提高了生活质量。我们还检测到基线调整后的显着差异为 0.22（95% CI：0.05-0.40，p=0。014）在生命意义问卷的“存在意义”子量表上的分数在各组之间，对应于每个参与者 1.1 量表点的平均变化。我们发现每位参与者的质量调整生命年 (QALY) 增量增加了 0.0142 个（95% 可信区间：0.0059 至 0.0226），成本增量增加了 178 英镑（95% 可信区间：–154 至 455 英镑），产生与常规护理相比，每个 QALY 的增量成本效益比为 12,526 英镑。这低于英国国家卫生服务局使用的每 QALY 20,000 英镑的阈值，表明该干预措施将是卫生服务资源的一种具有成本效益的利用。在亚组分析中，包括在基线时使用过专业心理健康服务的参与者，干预措施既降低了成本（–98 英镑，95% 可信区间：–606 至 309 英镑），又改善了 QALY（0.0165，95% 可信区间：0.0057）与常规护理相比，每个参与者的费用减少至 0.0273）。我们的结论是，NEON 干预对于经历非精神病性心理健康问题的人来说是一种有效且具有成本效益的新干预措施。