Pilot randomized controlled trial of Bolster, an mHealth intervention for caregivers to young people with early psychosis.

Caregiver involvement is critical to outcomes for young people with early psychosis. Caregiver-focused interventions reduce caregiver distress, improve family communication, and increase likelihood of recovery, but many caregivers face barriers to access. Because mHealth interventions can be accessed remotely and require minimal staffing, they could address some of these challenges. Our team conducted a pilot trial of Bolster, an mHealth intervention for early psychosis caregivers, with sixty (N = 60) caregivers to young adults with early psychosis to determine the acceptability and preliminary efficacy of Bolster as well as the feasibility of this approach. Participants were randomized to receive (1) a list of extant online resources (control arm), or (2) these resources alongside the Bolster mobile app (intervention arm). Caregivers used Bolster frequently (30.2 % of days during the intervention period and 10.4 min per use day) and reported finding it usable and helpful in supporting their caregiving activities. Outcome analyses demonstrated improvements in multiple outcomes, including family communication (Cohen's d = 0.86) and caregiver psychological morbidity (d = 0.98). Improvements in the Bolster arm were larger than control for caregiver psychological morbidity (d = 0.61) and distress related to the loved one's illness (d = 0.72), and caregivers in the Bolster arm were more likely to report that their loved one accessed psychotherapy or counseling (aRR = 2.53 [95 % CI: 1.07 to 6.01]) and met with a medication provider (aRR = 2.91 [95 % CI: 1.10 to 7.65]). Results suggest that Bolster is acceptable to caregivers and has promising preliminary efficacy.