The research behind MOST

2020 - Now

2024

A national evaluation of a multi-modal, blended, digital intervention integrated within Australian youth mental health services

This world first, large-scale evaluation of MOST analyses 32 months of service delivery to 5,709 young people across 262 youth mental health clinics across Australia.

It found young people seeking mental health support in Australia are experiencing significant benefits from the digital mental health service, showing high levels of satisfaction, sustained engagement and clinical improvements after only 12 weeks.

Key findings include:

• 93% of young people would recommend MOST to a friend
• 55% of MOST users were still active at six weeks (compared to only 3% of those who use popular commercially available mental health apps)
• Users experienced a significant reduction of depression and anxiety after 12 weeks
• 55% used MOST while waiting for care, 27% used it with a mental health professional in their service, and 11% as a treatment maintenance tool following discharge
• 68%  of young people wrote positive feedback about MOST, especially the closed social network where young people can safely share experiences and provide positive support to each other
• 72% of users logged into MOST for at least 14 days, 40% for 12 weeks, and 19% for 24 weeks.

Authors: Alvarez-Jimenez, M., Nicholas, J., Valentine, L., Liu, P., Mangelsdorf, S., Baker, S., Gilbertson, T., O'Loughlin, G., McEnery, C., McGorry, P.D., Gleeson, J.F., and Cross, S.P.
doi.org/10.1111/acps.13751

A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study

This was the first study to test an integrated face-to-face and digital transdiagnostic intervention for youth psychosis and borderline personality disorder, delivered via the MOST platform.

Findings indicated that the intervention was feasible, safe and acceptable, with the potential to increase therapeutic continuity, engagement, alliance, and intensity.

Authors: O'Sullivan, S., McEnery, C., Cagliarini, D., Hinton, J., Valentine, L., Nicholas, J., Chen, N., Castagnini, E., Lester, J., Kanellopoulos, E., D'Alfonso, S., Gleeson, J., Alvarez-Jimenez, M. 
JMIR Ment Helath 2023;11:e49217

2023

Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study

The objective of this study was to create a theory of change (TOC) framework to help explain how and why a complex intervention like MOST works and the conditions required for its success.

It serves as a strategic framework for refining MOST over time and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact.

Authors: Cross, S., Nicholas, J., Mangelsdorf, S., Valentine, L., Baker, S., McGorry, P., Gleeson, J., Alvarez-Jimenez, M.
JMIR Form Res 2023;7:e49846

The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment
Effects From First-Episode Psychosis Services: Results From the Horyzons
Randomized Controlled Trial

This research into the cost-effectiveness of digital mental health interventions shows online, mobile and social media interventions can be a cost-effective and promising ongoing treatment approach for young people experiencing mental ill-health.

The study was conducted alongside the Horyzons randomised control trial and evaluated its cost effectiveness based on change in social functioning plus a cost-utility analysis.  

Authors: Engel, L., Alvarez-Jimenez, M., Cagliarini, D., D’Alfonso, S., Faller, J., Valentine, L., Koval, P., Sarah Bendall, S., Shaunagh O’Sullivan, S., Rice, S., Miles, C., Penn, D., Phillips, J., Russon, P., Lederman, R., Killackey, E., Lal, S., Cotton, S., Gonzalez-Blanch, C., Herrman, H., McGorry, P., Gleeson J., and Mihalopoulos, C. (2023). 
Schizophrenia Bulletin, sbad071

2021

The Horyzons project: a randomised controlled trial of a novel online social therapy to maintain treatment effects from specialist first-episode psychosis services

This study was the first randomised controlled trial (RCT) to demonstrate that a digital intervention was effective in improving employment prospects and educational attainment – core components of social recovery. The trial also demonstrated that, in early psychosis, the digital intervention reduced reliance on emergency services, which is a key goal of specialised first-episode psychosis services.

Authors: Alvarez-Jimenez, M., Koval, P., Schmaal, L., Bendall, S., O’Sullivan, S., Cagliarini, D., D’Alfonso, S., Rice, S., Valentine, L., Penn, D. L., Miles, C., Russon, P., Phillips, J., McEnery, C., Lederman, R., Killackey, E., Mihalopoulos, C., Gonzalez-Blanch, C., Gilbertson, T., & Lal, S. (2021). 
World Psychiatry, 20(2), 233–243.

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Young people’s experience of online therapy for first-episode psychosis: A qualitative study. Psychology and Psychotherapy: Theory, Research and Practice 

This qualitative study found young people experience online therapy in a variety of ways. They may use it for on-demand help-seeking, mental health normalisation, as a positive distraction from distress, and to revise and practice therapeutic strategies. Some young people were motivated by the flexibility of online therapy, while others found the perceived choices to be overwhelming. 

The study found that on-demand help-seeking and positive distraction were unique to online therapy and may help explain the significant reduction of young people presenting to emergency departments and a non-significant trend for lower hospitalisations in the intervention group of the Horyzons RCT outlined previously.

Authors: Valentine, L., McEnery, C., O’Sullivan, S., D’Alfonso, S., Gleeson, J., Bendall, S., & Alvarez-Jimenez, M. (2021)., 95(1).

2020

Young People’s Experience of a Long-Term Social Media-Based Intervention for First-Episode Psychosis: A Qualitative Analysis

This qualitative study found that an online therapeutic social network can foster belonging and connection and normalise mental health experiences for young people. It also found that low usage of the platform is not necessarily linked to disinterest, but to the barriers young people face when trying to use it. Common barriers included social anxiety, internalised stigma, paranoia and pressure to provide peer support to others. 

Challenging the assumption that ‘low users’ are ‘disinterested users’, and instead exploring what factors inhibit people from engaging with an intervention as they wish to, could have direct implications for fostering engagement with digital mental interventions.

Authors: Valentine, L., McEnery, C., O’Sullivan, S., Gleeson, J., Bendall, S., & Alvarez-Jimenez, M. (2020). Journal of Medical Internet Research.

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A Novel Multimodal Digital Service (Moderated Online Social Therapy) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service 

This study revealed Moderated Online Social Therapy (MOST) to be a feasible, acceptable and safe online clinical service for young people with mental ill-health. The results support the therapeutic potential of MOST+ with significant improvements recorded in psychological distress, perceived stress, psychological well-being, depression, loneliness, social support and self-competence.

Authors: Alvarez-Jimenez, M., Rice, S., D’Alfonso, S., Leicester, S., Bendall, S., Pryor, I., Russon, P., McEnery, C., Santesteban-Echarri, O., Da Costa, G., Gilbertson, T., Valentine, L., Solves, L., Ratheesh, A., McGorry, P. D., & Gleeson, J. (2020). Journal of Medical Internet Research, 22(8), e17155. https://doi.org/10.2196/17155

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