Plain English Summary
Background and study aims
Approximately 1 in 100 people will experience mental health problems at some point in their lives.
Bipolar disorder, previously known as “manic depression”, is a disorder characterised by extreme mood swings, alternating between mania (extreme highs) and depression (extreme lows). People suffering from BD can also show signs of psychosis. Psychosis is a serious mental disorder in which thought and emotions are impaired, causing a person to lose touch with reality. These conditions are thought to affect more than 6 million people in the UK alone. Many relatives of people with psychosis or BD provide a large amount of vital unpaid care, but at huge personal cost in terms of high levels of distress, a significant practical, financial and emotional burden, and increased use of healthcare services. The UK Government recognises the need to support relatives in a caring role and NICE (National Institute for Health and Clinical Excellence) recommends that this is done by providing them with structured information and support. However, evidence shows that relatives often are not able to access the information and support they need. A recent review of the quality of mental health services has shown that improving support for relatives should be a national priority. REACT is an online resource which has been developed to provide relatives with the information and support they need. It works by providing information about how best to cope with a relative suffering from BD or psychosis, as well as providing a support network with other people in a similar situation. The aim of this study is to find out whether the REACT online toolkit is an effective and cost-effective way of supporting relatives of people suffering from BD or psychosis.
Who can participate?
Adults who are relatives or close friends with someone suffering from bipolar disorder or psychosis.
What does the study involve?
Participants are randomly allocated to one of two groups. Those in the first group are given login details to access to the REACT toolkit. The toolkit is divided into a number of different modules which provide information about psychosis and BD, ideas of strategies they could use to manage common problems and stories from other relatives about their experiences. Participants are also able to contact “REACT supporters” (people with experience caring for someone with psychosis or BD) throughout the 24 week study. Participants in the second group are given access to a “resource directory”, which lists details about how to access support that is currently available to relatives as well as information about how to get help through the NHS. Throughout the study, participants in both groups continue to receive any support or care that they usually receive. At the end of the study, participants complete questionnaires in order to measure their level of distress.
What are the possible benefits and risks of participating?
Participants may benefit from being able to talk about and explore their personal experiences. Additionally, the resource directly available to all participants could help them to develop a better understanding of bipolar disorder and psychosis and potential avenues for support as a relative of someone with mental health problems. Participants are given high-street voucher(s) in appreciation of their contribution to this research. The most likely risk to participants in this trial is increased distress (note that participants must be distressed in order to take part in the study).
Where is the study run from?
The study takes place online, and is run from Lancaster University (UK).
When is the study starting and how long is it expected to run for?
October 2015 to April 2016
Who is funding the study?
National Institute for Health Research (UK)
Who is the main contact?
1. Dr Heather Robinson (Public)
2. Professor Fiona Lobban (Scientific)
Dr Heather Robinson
Division of Health Research
Faculty of Health & Medicine
Prof Fiona Lobban
Spectrum Centre for Mental Health Research
School of Health and Medicine
Division of Health Research
+44 1524 593752
An online randomised controlled trial to evaluate the clinical and cost effectiveness of a peer supported self-management intervention for relatives of people with psychosis or bipolar disorder: Relatives Education And Coping Toolkit (REACT)
The aim of this study is to evaluate the clinical and cost effectiveness of an online peer supported self-management intervention (REACT) for relatives of people with psychosis or bipolar disorder.
RES Committee North West – Lancaster, 21/09/2015, ref: 15/NW/0732
Single-blind multi-centre randomised controlled trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet.
Topic: Mental Health, Primary Care; Subtopic: Bipolar affective disorder, Psychosis, Primary care; Disease: Bipolar affective disorder, Psychosis, All Diseases
Participants are randomly allocated to one of two groups. Participants in both groups continue to receive treatment as usual (TAU) throughout the duration of the study period (i.e. any support and/or help that they currently receive).
Group 1: Participants in this group receive the REACT intervention, a facilitated online intervention for relatives of people with psychosis/BD. The toolkit is comprehensive and modular in format so that the content is divided into manageable sections which can be used flexibly depending on the individual needs of the relative. Although the information is by necessity standardised, the toolkit is designed to help relatives tailor this information to make it more specific to their family. Case examples, activity tasks (including quizzes), and self-assessment tasks are used extensively to aid illustration. To enhance peer support and interactivity the toolkit inlcudes the REACT Group (a peer support discussion board) and an “Ask the Experts” facility, which will feed into a “Frequently Asked Questions” information page. The REACT website will be facilitated by “REACT Supporters” with experience of caring for someone with psychosis or BD.
Group 2: Participants receive a Resource Directory which lists details of how to access the full range of support currently available to relatives. The Directory will include websites of the main national organisations including MIND, Carers Trust, Rethink Mental Illness, Carers UK, SANE, Bipolar UK, Samaritans, and NHS Choices. It will also explain how to access support through NHS health services. This information is included in one of the modules on the REACT site but will be available to control participants via a separate link. This ensures that all relatives in the trial have access to current best practice.
The current treatments used for participants in both groups are assessed using the adapted CSRI which will include contact with health, social and voluntary sector services. No direct changes will be made to current treatment as part of the trial. Relatives will be informed that taking part in the trial will not affect any support or services that they, or their relative, receive. Therefore, this study compares the addition to treatment as usual of a standardised way to deliver this intervention via the REACT website (including Resource Directory), with treatment as usual plus a Resource Directory which signposts relatives to currently available support in the NHS and voluntary sector.
Both REACT and The Resource Directory will be available from the point at which people enter the study for at least the 6 month follow-up period, and then continuing to the end of the funded study.
Primary outcome measures
Relatives' distress is measured using the General Health Questionnaire (GHQ-28) at 24 weeks.
Secondary outcome measures
1. Relatives' well-being is measured using the Carers' Well-Being and Support Measure (CWS) at 24 weeks
1. Costs of delivering the intervention versus NHS and productivity cost savings in use of health services and paid work (adapted version of the CSRI) at baseline, 12 and 24 weeks
2. Cost effectiveness – cost of significant unit change (defined as 3 point reduction) in primary outcome (GHQ-28) at baseline, 12 and 24 weeks
3. Cost utility – marginal cost of any changes in marginal change in quality adjusted life years (QALYs) (making use of the EQ-5D-5L, as recommended by NICE) at baseline, 12 and 24 weeks
3. Mechanism of change for the REACT intervention is measured using the Brief Illness Perception Questionnaire (BIPQ) and Brief COPE at baseline, 12 and 24 weeks
Overall trial start date
Overall trial end date
Participant inclusion criteria
1. Aged 16 or over.
2. Are the relative or close friend of someone with a psychosis or bipolar disorder (friends are required to have a period of at least 6 months within the last 2 years during which there was regular contact)
3. Distressed (according to GHQ score)
4. Currently seeking help
5. Regular access to a computer which is connected to the internet
6. A good working knowledge of written and spoken English
Target number of participants
Planned Sample Size: 666; UK Sample Size: 666; Description: We require 666 relatives to take part based on our power calculation.
Participant exclusion criteria
1. Currently taking part in another research study evaluating an intervention for relatives of people with mental health problems
2. Living outside the UK
3. Living in any of the 6 areas involved in the IMPART study
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Division of Health Research Faculty of Health & Medicine Room C07 Furness Building
National Institute for Health Research
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
1. All products will be widely disseminated to all relevant stakeholders including service users, relatives, NHS managers and frontline clinical staff including GPs; clinical academics; the general public. A study website will additionally provide updates and outputs from the study and links to all publications and presentations.
2. A trial protocol paper will be submitted for publication before the end of the data collection period of the trial
3. A full report will be submitted to NIHR within 6 months of the end of the funding period
4. A main outcome paper will follow the end of the study
5. Additional papers describing health economic and mechanistic process will follow
Intention to publish date
Participant level data
To be made available at a later date
Results - basic reporting