BlokeBooster - Curing depression in men without using the Internet
Abstract
Obtaining funding to carry out randomized controlled trials of non-pharmacological treatments is increasingly difficult due to the level of competition for funds from sources such as the NHMRC and recognition of the need for greater sophistication and more rigorous approaches to the design, implementation and analysis of such trials. This article uses the example of a targeted intervention for a common mental health problem to illustrate the development of a grant proposal in this field. It showcases key facets of design and grantsmanship aimed at ensuring that your proposal achieves unique status in the minds of assessors and grant panel members.
Detailed Background and Research Plan
1 Aims:
This study will evaluate the effect and relative effectiveness of Bloke_Booster (a participatory self-efficacy enhancement program) and y_Front (a male-oriented support package) on depressive symptoms. The study aims will be addressed in a randomized controlled trial with a factorial design in which participants are allocated to either the Bloke_Booster, y_Front, both Bloke_Booster and y_Front or a real-life control condition.
Primary hypotheses are as follows:
- Bloke_Booster will be associated with a greater reduction in depression from baseline to a bit later on than not doing Bloke_Booster.
- Participating in y_Front will be associated with a greater reduction in depression from baseline to a bit later on than not getting into y_Front.
- The Full_Package will outdo both Bloke_Booster and y_Front put together (even though that’s exactly what it is).
2 Background:
Significance of the project
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Figure 1 Prevalence of depression |
Lots of men are depressed and don’t seek treatment.
Projections of the results of epidemiological studies since the 1950s demonstrate that within a decade or so, all men will be depressed (see Figure 1). Rates are high in minority groups including, old blokes, dags, men with utes and/or dogs, men who drive red sports cars and even blonds. Only those working for mental health awareness organisations seem to be spared. Of course, as with every other disease, few men seek treatment, preferring to simply avoid eye contact in the mirror when shaving.
Men regard using the Internet for healthcare as a waste of bandwidth
Participant action research conducted by our group has revealed that men are very positive about the use of the Internet. They cite appropriate Internet use as using BitTorrent to download episodes of Top Gear not yet shown in Australia, interminable searching classified ads for cars that are not close by and that are unaffordable, downloading mp3s of thankfully forgotten ’70s bands, viewing pictures of women who wouldn’t look twice at them, and the exploration and contemplation of a wide variety of activities they could never afford and, even if they could, would never be allowed to do by their partners. Looking on the Internet for healthcare information was seen as a waste of bandwidth.
Men do not go to the doctor
Men regard doctors as people you should either be, play golf with, or unaccountably regain consciousness in the presence of. In contemplating primary care consultations, men fear things like entrapment into prostate examinations and having to talk about their feelings or, much, much worse, having to listen to their practitioner’s thinly disguised feelings.
Men regard psychologists with suspicion
And who could blame them?
Depression treatments must be devised with men in mind
We have developed interventions that are specifically targeted at men. Our interventions are experiential and are based on preferred masculine modalities of doing not saying. They are as follows:
Bloke_Booster
This intervention involves a mini shed kit (see Figure 2).
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Figure 2 Bloke Booster mini-shed kit |
New millennium living has robbed men of empowering, confirming experiences. Cars, wirelesses and toasters are resistant to domestic ‘fixing’. Sixteen year old males are vastly superior at interfacing with current technology such as DVD recorders and Xboxes. Construction of a Bloke Booster mini shed gives the depressed male something he can do (mostly), display and be proud of. This simple intervention has great promise in reducing male depression.
y_Front
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Figure 3 y_Front support program. |
This intervention
focuses on the provision and utilization of white y front jockey shorts (see
Figure 3). These are the underpants that our participants’ mothers bought
them as children; so did their wives (before they left). These garments
represent security and simplicity: There was no anxiety about choice – no-one
knew there was one – there was no possibility of failure because there was no
choice. There is no internal disquiet in being girt by another man’s name.
The full, snug enclosing nature of the garment provides a sense of security –
no worrying invasive rear central seam; no loose dangling feeling of
inadequacy. The unique construction of these garments not simply encourages,
but actually requires a man to get in touch
with himself. The high-waisted design, with consequent tendency for the
classical blue band to appear above the trouser line, provides a subtle means
for men to identify and bond with one another in an unspoken way.
The y_Front
intervention provides men with depression-busting emotional, spiritual and
physical support. This intervention is up and running (literally and
figuratively respectively).
3 Research Plan – Methods and techniques
3.1 Design: The study will involve a factorial RCT involving the two treatments: Bloke_Booster and y_Front and two measurement occasions: baseline and a bit later on.
3.2 Participants/recruitment: Participants will be recruited from posters put up in urinals. Given that most men visit these places we reckon we’ll get a lot of men and we probably don’t want the sort of men who don’t.
3.3 Interventions: The study involves the two active interventions and a real life placebo described below. Each is delivered in the mail in a plain envelope. The internet is not involved in any way. An instruction manual will be sent to participants prior to commencement of the study – you know; and we know; and they know that no-one will read it but you have to do these sorts of things.
3.4 Conditions: Participants will be randomized to one of four treatment conditions.
Condition 1. Bugger_All: Participants in this condition will receive absolutely nothing – zippo – nil. Just like life. This is the rather inappropriately named ‘placebo’ condition but what’s pleasing about it, other than being left alone, is beyond us.
Condition 2: Bloke_Booster: Participants in this condition receive the mini shed kit. Participants will be required to fully construct the mini shed and to display it prominently in ‘their’ homes. Should the participant experience difficulty in completing the shed he (isn’t it great to be able to use that pronoun?) will be permitted to ask for the assistance of his son, nephew or any small boy (less than seven years old) found wandering at the supermarket and may pay them up to $10 not to tell anyone. Participants living in drought-affect areas may also be sent the mini tank kit. Focus groups have highlighted the possibility that the final phase of the Bloke_Booster program – prominent display in the home – may be difficult to achieve for some men. In these cases, participants will have access to David Jones gift vouchers in increasing denominations which they will be able to offer to the domestic decision maker to win the right to display the mini shed.
Condition 3: y_Front: Participants in this condition
receive three pairs of white y front jockey shorts (see Figure 2). All y fronts
will be size 36. There is no need for any man to be bigger than this. This
will encourage fat men to lose weight by moving around which is hypothesized to
potentiate the antidepressant effect of the y fronts themselves. The package
will include instruction on the correct use of the 
.
The ‘dosage’ of this intervention was
determined by economic considerations and by pilot work undertaken by an
unpartnered doctoral student living in all-male share house who reported that
three garments could be made to last a whole week by a series of manoeuvres
including turning them inside out and an undocumented procedure called ‘going
commando.’
Condition 4: Full_Package Participants in this condition receive both Bloke_Booster and y_Front. The recommended sequence of using the interventions is to master y_Front first.
3.5 Assessments
We’re not going to ask these guys many questions. They don’t want that – just the basics and a few questions that will let them lie about (previous) sporting and sexual prowess. There may be some questions about dogs.
Outcome measure: We are developing a depression inventory especially for men. It is called the BLUIE (Blokes Living Unhappy, Intolerable Existences). It doesn’t ask about crying or feelings or other stuff like that, just what you’re doing or not doing. The responses are ‘No’ or ‘Maybe’. The BLUIE may or may not be internally consistent, but is 100% reliable.
3.6 Randomisation: will be carried out by two drunks using a pair of old pennies. That should take care of things.
3.7 Data analysis: Primary analysis will be undertaken on an intent-to-be-treated basis: if a guy wants to bugger off, that’s his business: no questions asked. We’ll use a method of analysis designed for testing fertilizer in paddocks. We’ll get formulae for this from old, yellow books that everyone cites and pretends to have read. We’ll even find and use some graph paper.
Power: Power will be tested using a Landrover with a winch and a tree stump.
3.8 Research design, feasibility and ethical issues
Feasibility: Do you have to ask? ’course we can do – no worries.
Potential for harm. Some men may fail to successfully construct the mini shed. This will almost always engender an acute sense of failure with consequent risk of suicide. Some men in the y_Front and Full_Package conditions may become aware of a lack of fullness in the front of their underpants. This will produce a chronic, unidentifiable unquiet in those affected and possible, unspeakable consequences. Hopefully, with repeated washing, this problem will decrease over time for most participants. Those for whom this does not occur should feel depressed.
Ethics of not offering treatment to the Control group: Bad luck – that’s just life. Men have to learn that they can’t just wait around expecting to be offered things, especially from two old drunks with nothing more than a couple of pennies to rub together.
4 Outcomes and significance
Reduced levels of depression in the community Men will be cured. Their wives, children and domestic animals will all be happier.
Men will have something to talk about Mini sheds are a great source of conversation.
Sales of y fronts will soar Men will no longer have to worry about all the different types of underpants. There will be one less thing in western society to worry about.
GPD will increase dramatically No longer depressed and not having to worry about clothes, men will be able to get on and do more things.
Reduction in global warming Depression will be cured without lengthy consultations or wordy therapies. There will be less need for people to talk endlessly about their feelings. There will be a lot less hot air about.
References
All the CIs paid their rent on time and the bond was refunded in full.
