A/Professor Judith Proudfoot

University of NSW
Mental Health Research 2007, 2008 and 2009
Judith Proudfoot is Associate Professor at the Black Dog Institute and School of Psychiatry, University of New South Wales. Her primary research interest is in the development and evaluation of online mental health programs. Currently she is managing a large research study evaluating the Black Dog Institute's web-based bipolar education program. Previous work has included the development and evaluation of a computer-based cognitive behaviour therapy program for adults with anxiety and/or depression, and a computer-based program for depressed adolescents.   

A/Professor Proudfoot’s other research area is general practice and particularly the care of patients with chronic illnesses within this setting. Prior to her post at the Black Dog Institute, she worked in the Centre for Primary Health Care & Equity at the University of New South Wales where she managed a number of research projects investigating the capacity of Australian general practices to support patient self-management and to deliver quality chronic disease care.
 
SUMMARY OF PROJECT:
Using the Web to improve knowledge and self-management of bipolar disorder: A randomised controlled trial
Previously known as manic depressive illness, bipolar disorder is characterised by extreme high and low changes in mood. People with bipolar disorder report feeling ‘sentenced’ by their condition and stigmatised. This can affect treatment compliance such as taking medication and their ability to self-manage their condition. This in turn exacerbates their problems. Consistent feedback from people whose condition improves is that the turning point in their illness is a shift from feeling controlled by their disorder, to taking control of it. With education, training and support, people with bipolar disorder can self-manage their condition. However, the challenge lies in delivering these services in a convenient, private and non-stigmatising manner.
A/Professor Judith Proudfoot from the University of NSW has received an Australian Rotary Health grant to evaluate a web-based education, self-management and support program for people with bipolar disorder, developed at the Black Dog Institute. The program consists of 9 modules, each having an audio-visual presentation, questions and answers, a personal perspective, advice from a well-known person with the disorder, and printouts. The program will be evaluated in a randomised controlled trial. It is expected that results of the study will be of significant international interest for the treatment of bipolar disorder, and for eHealth research overall.
PROGRESS REPORT:

Using the Web to improve knowledge and self-management of bipolar disorder: A randomised controlled trial
In 2007 an initial feasibility study was completed in which the online Bipolar Education Program was tested with people with bipolar disorder. Informed Supporters – people with bipolar disorder who have effectively managed their condition for the preceding 2+ years – were selected and trained. They provide practical advice and support via email to a random selection of research participants. A pilot study to test research procedures and outcome measures, while working with Informed Supporters, was completed. Twenty three people with newly diagnosed bipolar disorder who participated in the pilot study showed substantial improvements. Forty seven participants had been recruited for the randomised controlled trial by April 2007. Some changes to recruitment procedures and study methodology were made to increase the number of people participating in the study and to ensure the continuance of quality and safety standards
Trial Recruitment:   Since our Sept 2007 report, our recruitment efforts have yielded an additional 128 participants into the study, despite the fact that our potential pool of research participants is limited to people who have been diagnosed with bipolar disorder within the last 12 months (and not all want to acknowledge their condition).
Methodology and Procedures: The study methodology is rigorous, working well on a day-to-day basis and no changes have been necessary this year. We have an excellent Research Assistant and Administrative Officer working on the project, ensuring that it is delivered to a high quality and according to the research protocol. Supervision of the project staff and the Informed Supporters is carried out by A/Professor Judy Proudfoot, who also provides overall leadership of the study. Professor Gordon Parker provides executive oversight and clinical support to the study, A/Professor Vijaya Manicavasagar provides clinical input and advice, A/Professor Meg Smith provides community liaison and support, and the eHealth team at Black Dog Institute provides IT guidance and assistance. 
Preliminary Outcomes: Feedback from research participants who have completed the online program has been extremely positive, suggesting that providing education and support in a targeted, timely and accessible manner soon after diagnosis is likely to assist patients’ psycho-social adjustment. Qualitative analysis of participants’ emails to their Informed Supporters indicates that the study is providing an understanding of the personal and psychological issues experienced by patients after diagnosis. Such concerns and difficulties can undermine effective treatment, thwart self-management efforts and interfere with effective functioning. Thus the information arising from our study is important for clinicians when they work in partnership with patients to fine-tune treatments and help set up self-management plans.
Communication to Rotarians, the general public and practitioners:
Judy Proudfoot was delighted to accept an invitation to address Rotary Presidents on 12 Sept 2008 about the research study and the important role of Australian Rotary Health in funding mental health research in Australia. The investigators have also presented papers and posters about the study to the Australasian Society for Psychiatric Research (awarded Consumer Research Award), Royal Australian NZ College of Psychiatrists Conference (to invite delegates to refer their patients to the study), Medicine 2.0 conference. They have submitted a paper for publication, with another in preparation. 

FINAL REPORT:
This study provides the first insight into the subjective experience of individuals newly diagnosed with bipolar disorder, hence giving an insight into why many individuals with the disorder fail to seek adequate treatment. 
 
The results showed that significant improvements in levels of anxiety and depression, increased perceptions of control and decreased perceptions of stigmatisation from pre-to post-intervention occurred across all groups. 
 
The study also shows the variation in experience of recently diagnosed individuals with bipolar disorder.
 
Patients revealed their concerns post diagnosis were mainly to do with; uncertainty about taking medication, the impact of the bipolar symptoms of functioning, negative reactions to diagnosis, feelings of threatened self-identity, difficulty in identifying and addressing triggers, uncertainty about the future, and real or perceived stigma.
 
These findings suggest that in order to prevent individuals from disengaging from services, health practitioners should take a stance of acceptance with regards to their patient’s views about their bipolar disorder, rather than trying to help the patient to form a new understanding of their disorder.
 
Additionally, the online setting offered individuals more anonymity, which in turn lead them to feel more comfortable to self-disclose compared to a face-to-face setting.