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| Name | Class |
|---|---|
| Duke-NUS Graduate Medical School | OTHER |
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The purpose of this study is to compare the effectiveness of two different online education courses (Oxford-Online and Mind-Online) for preventing stress related conditions among paramedics who have been working during a period of COVID-19 occurrence in Singapore.
The study aims to:
Participants will:
Aim 1 (Primary): To compare the efficacy of a locally-adapted version of internet-delivered cognitive training for resilience (Oxford Online) to an existing educational online training (Mind Online) on depressive symptom severity in a sample of paramedics recruited during the COVID-19 pandemic in Singapore.
Aim 2 (Secondary): To compare the efficacy of Oxford-Online to Mind-Online for improving posttraumatic stress symptoms, resilience, general psychological distress, anxiety symptoms, social support, work engagement, and health-related quality of life in a sample of paramedics recruited during the COVID-19 pandemic in Singapore.
Aim 3 (Economic): To evaluate the incremental cost and cost-effectiveness of Oxford Online in a sample of paramedics recruited during the COVID-19 pandemic in Singapore.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Oxford-Online | Experimental | The Oxford-Online programme is a series of six modules that targets cognitive predictors of depression and posttraumatic stress disorder. |
|
| Mind-Online | Active Comparator | Mind-Online is a series of six modules available online where participants read information and advice about stress, depression, posttraumatic stress, sleep problems, anger, and mindfulness. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Oxford-Online | Behavioral | The Oxford Online programme targets cognitive predictors of depression and posttraumatic stress disorder. The core information is delivered in six 20-minute modules over a 6-week period. The modules include whiteboard videos to explain concepts, audio files for practicing concrete thinking, video testimonies and footage of paramedics on-call for use in experiential exercises. A trained online wellbeing coordinator will provide individual email feedback on participants' responses and send brief automated message reminders. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Depression Symptoms | Patient Health Questionnaire 9 (PHQ-9) | Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Posttraumatic Stress Symptoms | Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) | Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention |
| Change in Resilience |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gayathri Devi Nadarajan | SGH | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Duke-NUS Medical School | Singapore | 169857 | Singapore |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22206051 | Background | Sung SC, Rush AJ. A timely investment: coordinated care for depression and anxiety disorders. Ann Acad Med Singap. 2011 Oct;40(10):436-8. No abstract available. | |
| 21621849 | Background | Sung SC, Dryman MT, Marks E, Shear MK, Ghesquiere A, Fava M, Simon NM. Complicated grief among individuals with major depression: prevalence, comorbidity, and associated features. J Affect Disord. 2011 Nov;134(1-3):453-8. doi: 10.1016/j.jad.2011.05.017. Epub 2011 May 31. |
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| ID | Term |
|---|---|
| D013313 | Stress Disorders, Post-Traumatic |
| D003863 | Depression |
| D001008 | Anxiety Disorders |
| D000077062 | Burnout, Psychological |
| ID | Term |
|---|---|
| D040921 | Stress Disorders, Traumatic |
| D000068099 | Trauma and Stressor Related Disorders |
| D001523 | Mental Disorders |
| D001526 | Behavioral Symptoms |
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Parallel group block RCT design
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|
| Mind-Online | Behavioral | Mind Online is a series of six modules available online where participants read information and advice about stress, depression, posttraumatic stress, sleep problems, anger, and mindfulness. A trained online wellbeing coordinator will provide individual email feedback on participants' responses and send brief automated message reminders. |
|
Connor-Davidson Resilience Scale (CD-RISC)
| Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention |
| Change in Rumination | Response to Intrusions Questionnaire (RIQ-s) | Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention |
| Change in Anxiety Symptoms | Generalized Anxiety Disorder seven item scale (GAD-7) | Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention |
| Change in Psychological Distress | General Health Questionnaire (GHQ) | Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention |
| Change in Burnout | Physician Work-Life Study's Single Item (PWLS) | Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention |
| Change in Social Support | Multidimensional Scale of Perceived Social Support (MSPSS) | Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention |
| Change in Work Engagement | Utrecht Work Engagement Scale (UWES) | Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention |
| Change in Health-related Quality of Life | EuroQol 5 Dimensions Questionnaire (EQ-5D5L) | Change from baseline at post-intervention (6-8 weeks after baseline), 6 months and 12 months post-intervention |
| Change in Posttraumatic Growth | Posttraumatic Growth Inventory (PTGI-SF) | Change from baseline at 6 months and 12 months post-intervention (intervention completed 6-8 weeks after baseline). |
| 22687487 | Background | Sung SC, Haley CL, Wisniewski SR, Fava M, Nierenberg AA, Warden D, Morris DW, Kurian BT, Trivedi MH, Rush AJ; CO-MED Study Team. The impact of chronic depression on acute and long-term outcomes in a randomized trial comparing selective serotonin reuptake inhibitor monotherapy versus each of 2 different antidepressant medication combinations. J Clin Psychiatry. 2012 Jul;73(7):967-76. doi: 10.4088/JCP.11m07043. Epub 2012 May 29. |
| 34617698 | Background | Teo I, Sung SC, Cheung YB, Wong WHM, Abu Bakar Aloweni F, Ang HG, Ayre TC, Chai-Lim C, Chen R, Heng AL, Nadarajan GD, Ong MEH, Soh CR, Tan BH, Tan KBK, Tan BS, Tan MH, Tan PH, Tay KXK, Wijaya L, Tan HK. Burnout, anxiety and depression in healthcare workers during the early COVID-19 period in Singapore. Singapore Med J. 2024 Mar 1;65(Suppl 1):S26-S29. doi: 10.11622/smedj.2021156. Epub 2021 Oct 7. No abstract available. |
| 33979296 | Background | Yoon S, Goh H, Nadarajan GD, Sung S, Teo I, Lee J, Ong MEH, Graves N, Teo TL. Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study. J Med Internet Res. 2021 May 31;23(5):e26282. doi: 10.2196/26282. |
| Background | Sung SC, L.Y., Chen AM, Chay J, Tewani K, Yeo LF, Tan HK. , Psychological Resilience among Healthcare Workers during the COVID-19 Pandemic in Singapore, in SingHealth Duke-NUS Scientific Congress. 2021: Singapore |
| 32251513 | Background | Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH, Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore. Ann Intern Med. 2020 Aug 18;173(4):317-320. doi: 10.7326/M20-1083. Epub 2020 Apr 6. No abstract available. |
| 33256955 | Background | Tan BYQ, Kanneganti A, Lim LJH, Tan M, Chua YX, Tan L, Sia CH, Denning M, Goh ET, Purkayastha S, Kinross J, Sim K, Chan YH, Ooi SBS. Burnout and Associated Factors Among Health Care Workers in Singapore During the COVID-19 Pandemic. J Am Med Dir Assoc. 2020 Dec;21(12):1751-1758.e5. doi: 10.1016/j.jamda.2020.09.035. Epub 2020 Oct 5. |
| 27348599 | Background | Wild J, Smith KV, Thompson E, Bear F, Lommen MJ, Ehlers A. A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression. Psychol Med. 2016 Sep;46(12):2571-82. doi: 10.1017/S0033291716000532. Epub 2016 Jun 28. |
| Background | Wild, J., S. El-Salahi, and M. Degli-Eposti, The effectiveness of interventions aimed at improving wellbeing and resilience to stress in first responders: A systematic review. European Psychologist, in press |
| 30598484 | Background | Wild J, El-Salahi S, Tyson G, Lorenz H, Pariante CM, Danese A, Tsiachristas A, Watkins E, Middleton B, Blaber A, Ehlers A. Preventing PTSD, depression and associated health problems in student paramedics: protocol for PREVENT-PTSD, a randomised controlled trial of supported online cognitive training for resilience versus alternative online training and standard practice. BMJ Open. 2018 Dec 31;8(12):e022292. doi: 10.1136/bmjopen-2018-022292. |
| 18377119 | Background | Ehring T, Ehlers A, Glucksman E. Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study. J Consult Clin Psychol. 2008 Apr;76(2):219-30. doi: 10.1037/0022-006X.76.2.219. |
| 14557148 | Background | Ehlers A, Clark DM, Hackmann A, McManus F, Fennell M, Herbert C, Mayou R. A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Arch Gen Psychiatry. 2003 Oct;60(10):1024-32. doi: 10.1001/archpsyc.60.10.1024. |
| 16460669 | Background | Ehring T, Ehlers A, Glucksman E. Contribution of cognitive factors to the prediction of post-traumatic stress disorder, phobia and depression after motor vehicle accidents. Behav Res Ther. 2006 Dec;44(12):1699-716. doi: 10.1016/j.brat.2005.11.013. Epub 2006 Feb 7. |
| 24727342 | Background | Shepherd L, Wild J. Emotion regulation, physiological arousal and PTSD symptoms in trauma-exposed individuals. J Behav Ther Exp Psychiatry. 2014 Sep;45(3):360-7. doi: 10.1016/j.jbtep.2014.03.002. Epub 2014 Mar 26. |
| 23307756 | Background | Shepherd L, Wild J. Cognitive appraisals, objectivity and coping in ambulance workers: a pilot study. Emerg Med J. 2014 Jan;31(1):41-4. doi: 10.1136/emermed-2011-200511. Epub 2013 Jan 10. |
| 27157033 | Background | White R, Wild J. "Why" or "How": The Effect of Concrete Versus Abstract Processing on Intrusive Memories Following Analogue Trauma. Behav Ther. 2016 May;47(3):404-15. doi: 10.1016/j.beth.2016.02.004. Epub 2016 Feb 24. |
| 25902141 | Background | Pile V, Barnhofer T, Wild J. Updating versus Exposure to Prevent Consolidation of Conditioned Fear. PLoS One. 2015 Apr 22;10(4):e0122971. doi: 10.1371/journal.pone.0122971. eCollection 2015. |
| 27837579 | Background | Wild J, Warnock-Parkes E, Grey N, Stott R, Wiedemann M, Canvin L, Rankin H, Shepherd E, Forkert A, Clark DM, Ehlers A. Internet-delivered cognitive therapy for PTSD: a development pilot series. Eur J Psychotraumatol. 2016 Nov 8;7:31019. doi: 10.3402/ejpt.v7.31019. eCollection 2016. |
| D001519 | Behavior |
| D013315 | Stress, Psychological |