Mental health recovery narratives increase meaning in life and quality of life:NEON-O Trial findings

Introduction: The Narrative Experiences Online (NEON) programme [https://www.researchintorecovery.com/research/neon/] investigated whether mental health recovery narratives are helpful for people affected by mental health problems.



Methods: We developed the NEON Intervention, a web-application providing access to a diverse collection of 659 recovery narratives [https://doi.org/10.2196/24417]. We evaluated the intervention in a parallel group online randomised trial recruiting adults in England experiencing non-psychosis mental health problems [NEON-O Trial, https://www.isrctn.com/ISRCTN63197153]. Intervention arm participants received immediate access, control arm participants received 52-week delayed access, participants were not masked to treatment allocation, and outcome assessment was through web-based questionnaires. The primary objective was to evaluate effectiveness in improving quality of life (QoL) at 52-week follow-up, controlling for usual care. The primary analysis was a linear regression model of outcome. The economic analysis compared costs and Quality Adjusted Life Years (QALYs) gained between arms, from a healthcare provider perspective. Analyses were baseline-adjusted, using a modified Intention To Treat principle [https://doi.org/10.1186/s13063-023-07246-8]. 



Results: 1,023 participants recruited from March 2020 to March 2021 (Intervention 507, control 516). 80.8% White British; 79.3% female; mean age 38.4±13.6 years. Mood disorders (61.2%) and stress-related disorders (14.9%) were the most common primary mental health problem. At week 52, we found a significant baseline-adjusted difference of 0.13 (95% CI: 0.01-0.26, p=0.041) in the Manchester Short Assessment score between arms, and a significant baseline-adjusted difference of 0.22 (95% CI: 0.05-0.40, p=0.014) in the Meaning in Life Questionnaire [presence subscale]. We found an Incremental Cost-Effectiveness Ratio of £12,526 per QALY, lower than a £20,000 threshold used by the NHS in England, indicating a cost-effective intervention.



Conclusion: We have provided first-in-field evidence that online mental health recovery narratives provide meaningful benefits to people experiencing non-psychosis mental health problems. The increased presence of meaning in life may protect against mental health distress. Future studies could examine alternative narrative delivery mechanisms.