Effectiveness and cost‐effectiveness of online recorded recovery narratives in improving quality of life for people with non‐psychotic mental health problems: a pragmatic randomized controlled trial
Open accessAbstract
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.
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Of the eight studies where outcome assessors were not blinded, two collected primary outcome data online which meant blinded outcome assessors were not needed.
“Of the remaining eight studies, two collected primary outcome data online which meant blinded outcome assessors were not needed [25, 66].”
From Blinding outcome assessors in randomised controlled trials of psychological interventions: how is it done? A narrative review (2026) · cites this paper as [66]
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- Authors
- Slade, M., Rennick‐Egglestone, S., Elliott, R. A., Newby, C., Robinson, C., Gavan, S. P., Paterson, L., Ali, Y., Yeo, C., Glover, T., Pollock, K., Callard, F., Priebe, S., Thornicroft, G., Repper, J., Keppens, J., Smuk, M., Franklin, D., Walcott, R., Harrison, J., Smith, R., Robotham, D., Bradstreet, S., Gillard, S., Cuijpers, P., Farkas, M., Zeev, D. B., Davidson, L., Kotera, Y., Roe, J., Ng, F., Llewellyn‐Beardsley, J., & the NEON study group
- Affiliations
- University of Nottingham (GB)
- University of Manchester (GB)
- Queen Mary University of London (GB)
- DRT Software Nottingham UK
- University of Glasgow (GB)
- East London NHS Foundation Trust (GB)
- King's College London (GB)
- ImROC Nottingham UK
- NEON Lived Experience Advisory Panel Nottingham UK
- University of Maryland, College Park (US)
- McPin Foundation (GB)
- City, University of London (GB)
- Babeș-Bolyai University (RO)
- Boston University (US)
- School of Medicine University of Washington Seattle WA USA
- Yale University (US)
- ORCID
- Slade, Mike
- Rennick‐Egglestone, Stefan
- Elliott, Rachel A.
- Newby, Chris
- Gavan, Sean P.
- Paterson, Luke
- Ali, Yasmin
- Yeo, Caroline
- Glover, Tony
- Pollock, Kristian
- Callard, Felicity
- Priebe, Stefan
- Thornicroft, Graham
- Repper, Julie
- Keppens, Jeroen
- Smuk, Melanie
- Franklin, Donna
- Walcott, Rianna
- Harrison, Julian
- Smith, Roger
- Robotham, Dan
- Bradstreet, Simon
- Gillard, Steve
- Cuijpers, Pim
- Farkas, Marianne
- Davidson, Larry
- Kotera, Yasuhiro
- Roe, James
- Ng, Fiona
- Llewellyn‐Beardsley, Joy
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2024-01-12
- Volume
- 23
- Issue
- 1
- Pages
- 101-112
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC10785987
- OpenAlex
- W4390794651
- Cited by
- 32
- References
- 48
- Citations by year
- 2026: 12 · 2025: 9 · 2024: 11
- FWCI
- 12.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion, cc-by-sa)
- City Research Online (City University London) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Research Explorer (The University of Manchester) (submittedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Funders
- King's College Hospital NHS Foundation Trust
- National Institute for Health and Care Research (RP-PG-0615-20016, NIHR203310)
- Department of Health and Social Care
- King's College London
- National Institutes of Health (UL1TR001863)
- Medical Research Council (MR/S001255/1)
- NIHR Nottingham Biomedical Research Centre (NIHR203310, RP-PG-0615-20016)
- National Institute for Health Research Applied Research Collaboration South London
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- recovery narratives, mental health recovery, online intervention, self-guided intervention, recommender systems, mood and anxiety disorders, quality of life, psychological distress, hope, self-efficacy, meaning in life, cost-effectiveness, quality-adjusted life years, Meaning in Life Questionnaire
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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