1
|
Sablone S, Bellino M, Lagona V, Franco TP, Groicher M, Risola R, Violante MG, Grattagliano I. Telepsychology revolution in the mental health care delivery: a global overview of emerging clinical and legal issues. Forensic Sci Res 2024; 9:owae008. [PMID: 39229280 PMCID: PMC11369075 DOI: 10.1093/fsr/owae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/16/2023] [Indexed: 09/05/2024] Open
Abstract
Since the outbreak of the COVID-19 pandemic, remote healthcare delivery by technological devices has become a growing practice. It represented an unprecedented change in personal and professional activities, allowing health specialists to continue working online by assisting their patients from home. Psychological practice greatly benefited from this innovation, guaranteeing diagnostic and therapeutic effectiveness through cyber counseling. However, in many countries there have been no enactments of specific laws nor adaptations of the professional deontological code aimed at regulating this new psychological practice dimension, generally defined as telepsychology. This article aims to briefly review the scientific literature on this tool's effectiveness and especially analyze the legal and operational framework in which telepsychology has been to date practiced in Italy and other national realities, thus providing a global overview that may be useful to understand how to improve this valuable but still immature practice. Key points The coronavirus pandemic exposed to short- and long-term increase in psychological and psychiatric imbalances.Cyber counseling has been proven to be effective to treat a wide range of psychological disorders.Many of the current national and international legislations concerning the telepsychology practice are still immature. Ad hoc legal frameworks are required for each national context to guarantee a safe and effective cyber counseling delivery.
Collapse
Affiliation(s)
- Sara Sablone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, Bari, Italy
| | - Mara Bellino
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, Bari, Italy
| | - Valeria Lagona
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Bari Policlinico Hospital, University of Bari, Bari, Italy
| | - Tamara Patrizia Franco
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Matthew Groicher
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Roberta Risola
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Maria Grazia Violante
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| | - Ignazio Grattagliano
- Department of Educational Sciences, Psychology, and Communication, University of Bari, Bari, Italy
| |
Collapse
|
2
|
Wille L, Caporale-Berkowitz N, Woznicki N, Carmona Y, Parent MC. Cisgender Sexual Minority Women's Interest in Telemental Health Services: A Latent Class Analysis. Telemed J E Health 2024. [PMID: 39185555 DOI: 10.1089/tmj.2024.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Introduction: Telemental health is increasingly recognized for its potential to overcome barriers like cost and stigma, particularly for marginalized groups. Sexual minority women in particular may benefit from increased access to telemental health services, due to the unique health disparities faced by this population. However, very little research thus far has assessed the telemental health preferences of this group. Methods: The present study surveyed 1,092 cisgender sexual minority women regarding their demographic information, mental health, and telemental health preferences, using the Prolific.co research platform. Latent class analysis was conducted to identify subgroups within the sample based on their responses to the survey. Results: Results revealed diverse attitudes toward telemental health, with some that prefer in-person sessions, whereas others show a strong interest in virtual options. Latent class analysis identified five groups, termed the Neutral, Ambivalent, Inclined, Inclined Related to Travel, and Averse groups. There were statistically significant differences between groups on measures of rurality, socioeconomic status, previous therapy experience, and symptoms of depression and anxiety. Overall, sexual minority women demonstrated interest in telemental health, especially individuals with mobility challenges and those living in rural areas. Conclusion: This study underscores the importance of tailoring mental health services to diverse needs and suggests that telemental health could be a valuable tool in addressing health disparities among sexual minority women. Importantly, these data were conducted prior to the COVID-19 pandemic. Further research could examine how sexual minority women's attitudes toward telemental health have shifted since the COVID-19 pandemic and how telemental health services could be tailored for marginalized subgroups.
Collapse
Affiliation(s)
- Lexie Wille
- Counseling Psychology Program, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | | | - Nate Woznicki
- Human Development, Culture, & Learning Sciences, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Yaritza Carmona
- Counseling Psychology Program, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Mike C Parent
- Counseling Psychology Program, Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
3
|
Shaker AA, Simonsen E, Tarp K, Borisov RA, Sørensen JA, Bechmann H, Austin SF. Capturing Patients' and Clinicians' Experiences of Using Video Consultations in Mental Health Outpatient Services: Qualitative Thematic Analysis. JMIR Form Res 2024; 8:e50580. [PMID: 39167796 PMCID: PMC11375385 DOI: 10.2196/50580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/31/2024] [Accepted: 05/29/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Over the last decade, there has been an increase in the evidence base supporting the efficacy of video consultations (VCs) in mental health services. Furthermore, the potential of VC treatment was also demonstrated during the COVID-19 pandemic. Despite these promising results and conducive conditions for VCs, several studies have highlighted that the uptake and implementation of VCs continues to be slow, even after the pandemic. To facilitate and strengthen the implementation of VCs and exploit their potential as a useful tool for mental health disorder treatment, there is a need for a deeper understanding of the issues and experiences of implementing and using VCs as a treatment modality in clinical practice. OBJECTIVE The aim of this study was to investigate patients' and clinicians' experiences and attitudes toward using VCs in clinical practice. METHODS Treatment was conducted through the VC modality. Semistructured interviews were conducted individually with patients (n=10) and focus group interview were conducted with clinicians (n=4). Patients had participated in weekly VC treatment over 2 months as part of mental health outpatient services in Denmark. Data from these interviews were analyzed using thematic analysis. RESULTS Thematic analysis of the patient interviews yielded two main themes: (1) adjusting to the practicalities of the VC format and (2) the practice of therapy using VCs. Patients experienced that using VCs was easy and convenient, and it was possible to establish and maintain a therapeutic alliance. They also described the contact as different to in-person therapy. The thematic analysis conducted on clinicians' experiences of using VCs yielded three themes: (1) a shift in mindset from resistance to acceptance, (2) the contact is different when using the VC modality, and (3) adapting to a new way of working. Clinicians experienced that their initial concerns and resistance toward VC implementation gradually diminished over time as they gained clinical experience of using the modality. They expressed that contact with patients can be different when using the VC modality and that it took time to adjust to a new way of working therapeutically. CONCLUSIONS Both patients and clinicians experienced that VCs could enhance access to treatment and be meaningfully integrated into clinical practice. In addition, both groups described the contact when using the VC modality as being different to in-person therapy. Future research could examine patients' and clinicians' perceived differences regarding contact when using the VC modality and the implications for therapeutic interventions.
Collapse
Affiliation(s)
| | - Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
| | - Kristine Tarp
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - John Aasted Sørensen
- Research Unit: AI, Mathematics and Software, Department of Engineering Technology and Didactics, Technical University of Denmark, Ballerup, Denmark
| | - Henrik Bechmann
- Research Unit: AI, Mathematics and Software, Department of Engineering Technology and Didactics, Technical University of Denmark, Ballerup, Denmark
| | - Stephen F Austin
- Psychiatric Research Unit, Slagelse, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Ong T, Barrera JF, Sunkara C, Soni H, Ivanova J, Cummins MR, Schuler KR, Wilczewski H, Welch BM, Bunnell BE. Mental health providers are inexperienced but interested in telehealth-based virtual reality therapy: survey study. FRONTIERS IN VIRTUAL REALITY 2024; 5:1332874. [PMID: 39228388 PMCID: PMC11370306 DOI: 10.3389/frvir.2024.1332874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Virtual reality (VR) is an emerging technology that can enhance experiences and outcomes in mental healthcare. However, mental health therapists have been slow to adopt VR into practice. Implementation of telehealth-based VR therapy (tele-VR) could catalyze adoption and innovation in mental healthcare. To explore therapists' perspectives on tele-VR, we conducted a cross-sectional survey of practicing mental health providers in the United States in June-July 2023. We analyzed 176 completed surveys from therapists, of whom 51.14% had no prior experience with VR, only 6.25% had used VR clinically, and 56.82% had neutral impressions of VR for therapy. Despite therapists' general inexperience with VR, therapists indicated a wide variety of tele-VR simulations (e.g., social situations, flying, heights) and features (e.g., personalized spaces, homework, interactivity) would be moderately to extremely useful for their practices. Therapists also requested additional VR simulations and features for their telehealth clients such as behavioral skills training, exposure therapy, gender identity therapy, and psychological assessments in VR. Therapists rated Health Insurance Portability and Accountability Act compliance, the ability to try VR before buying, affordability for therapists, accessibility for clients, and insurance coverage as the five most influential implementation factors for tele-VR. Overall, therapists were generally inexperienced and neutral about VR for telehealth therapy, but were interested in tele-VR for specific applications. These findings provide actionable directions for future research and collaborative development of therapeutic VR content and features.
Collapse
Affiliation(s)
- Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Janelle F. Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Charvi Sunkara
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, United States
| | - Hiral Soni
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Julia Ivanova
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Mollie R. Cummins
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- College of Nursing and Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Kaitlyn R. Schuler
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | | | - Brandon M. Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Biomedical Informatics Center, Medical University of South Carolina, Public Health and Sciences, Charleston, SC, United States
| | - Brian E. Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| |
Collapse
|
5
|
Edwards AM, Petitt JC, Sajatovic M, Kumar S, Levin JB. The Efficacy of Telemental Health Interventions for Mood Disorders Pre-COVID-19: A Narrative Review. J Behav Health Serv Res 2024; 51:395-420. [PMID: 38698193 PMCID: PMC11180629 DOI: 10.1007/s11414-024-09884-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 05/05/2024]
Abstract
The onset of the COVID-19 pandemic saw a significant surge in the utilization of telemental health (TMH) services. This narrative review aimed to investigate the efficacy of TMH for serious mood disorders prior to the COVID-19 pandemic. A search across databases was conducted for randomized controlled trials focusing on TMH interventions for mood disorders, encompassing major depressive disorder (MDD) and bipolar disorder (BD). Study and patient characteristics, interventions, and outcomes were extracted. From a pool of 2611 papers initially identified, 17 met the inclusion criteria: 14 focused on MDD, while 4 addressed BD. Among these, 6 papers directly compared TMH interventions to in-person of same treatment, revealing improved access to care and higher rates of appointment follow-up with TMH. Additionally, 6 papers comparing TMH to treatment as usual demonstrated improvements in mood outcomes. Conversely, 3 papers comparing different TMH interventions found no discernible differences in outcomes. Notably, 3 studies evaluated TMH as an adjunct to usual care, all reporting enhancements in depression outcomes. Overall, preliminary evidence suggests that prior to COVID-19, TMH interventions for serious mood disorders facilitated improved access to care and follow-up, with comparable clinical outcomes to traditional in-person interventions. The discussion addresses limitations and provides recommendations for future research in this domain.
Collapse
Affiliation(s)
- Alyssa M Edwards
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jordan C Petitt
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Psychiatry, University Hospitals Cleveland Medical Center, W.O. Walker Bldg, 7th Floor, 10524 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Sanjana Kumar
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jennifer B Levin
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Psychiatry, University Hospitals Cleveland Medical Center, W.O. Walker Bldg, 7th Floor, 10524 Euclid Ave, Cleveland, OH, 44106, USA
| |
Collapse
|
6
|
Edelbluth S, Schwartz B, Lutz W. The Effects of Switching to Video Therapy on In-Session Processes in Psychotherapy During the COVID-19 Pandemic. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:428-438. [PMID: 38483750 PMCID: PMC11196328 DOI: 10.1007/s10488-024-01361-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE AND AIM This study aimed to assess the impact of switching from face-to-face (f2f) psychotherapy to video therapy (VT) due to the COVID-19 pandemic on in-session processes, i.e., the therapeutic alliance, coping skills, and emotional involvement, as rated by both patients and therapists. METHODS A total of N = 454 patients with mood or anxiety disorders were examined. The intervention group (IG) consisted of n = 227 patient-therapist dyads, who switched from f2f to VT, while the control group (CG) consisted of n = 227 patient-therapist dyads, who were treated f2f before the pandemic. To evaluate the effects of switching to VT on in-session processes, three longitudinal piecewise multilevel models, one per process variable, were fitted. Each process variable was regressed on the session number with a slope for the three sessions before switching to VT and a second slope for up to six VT sessions afterwards. RESULTS The therapeutic alliance significantly increased after switching from f2f to VT across the two groups (IG and CG) and raters (patients and therapists) with no differences between IG and CG. On average, patients rated the therapeutic alliance better than therapists. Coping skills significantly increased after switching from f2f to VT across the two groups and raters, but the CG rated coping skills higher than the IG after the switch. Overall, therapists rated coping skills higher than patients. Emotional involvement did not significantly increase after switching to VT across the two groups and raters and there was no significant difference between patient and therapist ratings. DISCUSSION In conclusion, the switch to VT had no negative impact on the therapeutic alliance and emotional involvement. However, more coping skills were reported in the CG than in the IG after the switch to VT, which was mainly due to a stagnation in patient-rated coping skills in the IG.
Collapse
Affiliation(s)
- Susanne Edelbluth
- Department of Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany.
| | - Brian Schwartz
- Department of Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany
| | - Wolfgang Lutz
- Department of Clinical Psychology and Psychotherapy, University of Trier, 54286, Trier, Germany
| |
Collapse
|
7
|
Kiely J, DePaul E, Rojas S, Cortes S, Schilling S, Dougherty S, Wood JN. Evaluation of Virtual Enhanced Child Adult Relationship Enhancement in Primary Care Intervention. J Dev Behav Pediatr 2024:00004703-990000000-00178. [PMID: 38905220 DOI: 10.1097/dbp.0000000000001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/25/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Because of COVID-19 pandemic social distancing requirements, the in-person Child Adult Relationship Enhancement in Primary Care (PriCARE) positive parenting intervention was adapted for virtual delivery. Objective was to evaluate the efficacy of the virtual PriCARE program to improve parenting capacity, decrease child behavioral problems, and decrease child maltreatment risk. METHODS Caregivers of children 2 to 6 years old recruited from pediatric primary care were randomized to PriCARE (n = 92) or waitlist control (n = 90). Dysfunctional parenting, positive parenting skills, child behaviors, and child maltreatment risk were measured at baseline and 2 to 3 months after intervention using the Parenting Scale (PS), Dyadic Parent-Child Interaction Coding System (DPICS), Eyberg Child Behavior Inventory (ECBI), and Child Abuse Potential Inventory (CAPI). Kruskal-Wallis test compared median change scores from baseline to follow-up by treatment arm. RESULTS Of 182 enrolled caregivers, 92% (168) were mothers and 67% (122) completed study measures at baseline and follow-up. The median decrease (improvement) in total PS score was greater in the PriCARE group compared with the control group (-0.3 [IQR 0.69] vs -0.1 [IQR 0.56], p = 0.028) as was the median decrease (improvement) in ECBI problem score (-3 [IQR 9] vs -1 [IQR 7], p = 0.045) and ECBI intensity score (-9 [IQR 21] vs 0 [IQR 25], p = 0.006). Improvements in 4 positive parenting skills measured by DPICS were greater in the PriCARE group compared with the control group (all p< 0.003). Median decrease in CAPI abuse score did not differ significantly by study arm (p = 0.055). CONCLUSION The PriCARE virtual adaptation demonstrated promise in promoting positive parenting and decreasing child behavior problems.
Collapse
Affiliation(s)
- Jenna Kiely
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Emily DePaul
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Stefany Rojas
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA
| | - SolRubi Cortes
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Susan Dougherty
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joanne N Wood
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA
- Safe Place: Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania
| |
Collapse
|
8
|
Schoenenberg K, Martin A. Empathy, working alliance, treatment expectancy and credibility in video and face-to-face psychotherapeutic first contact. Psychother Res 2024; 34:626-637. [PMID: 37436800 DOI: 10.1080/10503307.2023.2233685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/01/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Video-based therapy has been used increasingly since the onset of the COVID-19 pandemic. Yet, video-based initial psychotherapeutic contact can be problematic due to the limitations of computer-mediated communication. At present, little is known about the effects of video first contact on important psychotherapeutic processes. Method: Forty-three individuals (nvideo = 18, nface-to-face = 25) were recruited via an outpatient clinic waiting list and were randomly assigned to video or face-to-face initial psychotherapeutic sessions. Participants rated treatment expectancy before and after the session, and the therapist's empathy, working alliance, and credibility after the session and several days later. Results: Empathy and working alliance ratings of patients and therapists were high and did not differ between the two communication conditions after the appointment or at follow-up. Treatment expectancy increased to a similar extent for the video and face-to-face modalities from pre to post. Willingness to continue with video-based therapy increased in participants who had video contact, but not in those with face-to-face contact. Conclusion: This study indicates that crucial processes related to the therapeutic relationship can be initiated via video, without prior face-to-face contact. Given the limited nonverbal communication cues in video appointments, it remains unclear as to how such processes evolve.Trial registration: German Clinical Trials Register identifier: DRKS00031262..
Collapse
Affiliation(s)
- Katrin Schoenenberg
- Department for Clinical Psychology and Psychotherapy, University Wuppertal, Wuppertal, Germany
| | - Alexandra Martin
- Department for Clinical Psychology and Psychotherapy, University Wuppertal, Wuppertal, Germany
| |
Collapse
|
9
|
Davis KA, Zhao F, Janis RA, Castonguay LG, Hayes JA, Scofield BE. Therapeutic alliance and clinical outcomes in teletherapy and in-person psychotherapy: A noninferiority study during the COVID-19 pandemic. Psychother Res 2024; 34:589-600. [PMID: 37399573 DOI: 10.1080/10503307.2023.2229505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
Objective The current study aimed to inform the varied and limited research on clinical variables in the context of teletherapy. Questions remain about the comparative quality of therapeutic alliance and clinical outcome in the context of teletherapy compared to in-person treatment.Methods We utilized a cohort design and a noninferiority statistical approach to study a large, matched sample of clients who reported therapeutic alliance as well as psychological distress before every session as part of routine clinical practice at a university counseling center. A cohort of 479 clients undergoing teletherapy after the emergence of the COVID-19 pandemic was compared to a cohort of 479 clients receiving in-person treatment before the onset of the pandemic. Tests of noninferiority were conducted to investigate the absence of meaningful differences between the two modalities of service delivery. Client characteristics were also examined as moderators of the association between modality and alliance or outcome.Results Clients receiving teletherapy showed noninferior alliance and clinical outcome when compared to clients receiving in-person psychotherapy. A significant main effect on alliance was found with regard to race and ethnicity. A significant main effect on outcome was found with regard to international student status. Significant interactions on alliance were found between cohort and current financial stress.Conclusions Study findings support the continued use of teletherapy by demonstrating commensurate clinical process and outcome. Yet, it will be important for providers to be aware of existing mental health disparities that continue to accompany psychotherapy - in person and via teletherapy. Results and findings are discussed in terms of research and clinical implications. Future directions for researching teletherapy as a viable treatment delivery method are also discussed.
Collapse
Affiliation(s)
- Katherine A Davis
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Fanghui Zhao
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park, PA, USA
| | - Rebecca A Janis
- Counseling and Psychological Services, The Pennsylvania State University, University Park, PA, USA
| | - Louis G Castonguay
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Jeffrey A Hayes
- Department of Educational Psychology, Counseling, and Special Education, The Pennsylvania State University, University Park, PA, USA
| | - Brett E Scofield
- Counseling and Psychological Services, The Pennsylvania State University, University Park, PA, USA
| |
Collapse
|
10
|
Miguel-Álvaro A, Estupiñá Puig FJ, Larroy C. Provision of Telepsychological Care Via Email during COVID-19 Confinement: An Exploratory Study. THE SPANISH JOURNAL OF PSYCHOLOGY 2024; 27:e14. [PMID: 38766779 DOI: 10.1017/sjp.2024.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Within teletherapy, email interventions have been studied scarcely. For this reason, this exploratory study aims to characterize the assistance provided by email in a university telepsychology service and to compare the data with the assistance provided by telephone in the same service and period. For this purpose, the records of 81 users assisted via email during the COVID-19 pandemic lockdown in Spain were analyzed. The data were compared with those of the 338 users assisted by telephone in the same period. Despite its many limitations, results indicate high satisfaction with the email modality. Users express that they prefer a preference for using email when they do not feel safe in other ways. We found a lot of variation between the number of emails exchanged and the days that each case was active. Additionally, differences were found with telephone users in aspects such as age (email users being younger) and in a depression screening (email users scoring more positively). This study concludes on the high potential of this channel for the application of certain techniques (e.g., psychoeducation) or for people with certain characteristics.
Collapse
|
11
|
Abuyadek RM, Hammouda EA, Elrewany E, Elmalawany DH, Ashmawy R, Zeina S, Gebreal A, Ghazy RM. Acceptability of Tele-mental Health Services Among Users: A Systematic Review and Meta-analysis. BMC Public Health 2024; 24:1143. [PMID: 38658881 PMCID: PMC11040906 DOI: 10.1186/s12889-024-18436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Mental disorders are currently a global public health concern, particularly after the coronavirus disease 2019 (COVID-19) pandemic. Mental health services gradually transitioned to teleservices, employing various methods like texting and videoconferencing. This meta-analysis aimed mainly to quantify the acceptability of tele-mental health services among both beneficiaries and providers. Secondary objectives included quantifying the usability of and satisfaction with these services. METHODS We conducted a systematic search of the following databases PubMed Central, SAGE, Google Scholar, Scopus, Web of Science, PubMed Medline, and EBSCO according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022. RESULTS Out of 3366 search results, 39 studies fully met the inclusion criteria. The pooled acceptability of tele-mental health services among beneficiaries was [71.0% with a 95% confidence interval (CI) of 63.0 - 78.5%, I2 = 98%]. Using meta-regression, four key factors contributed to this heterogeneity (R2 = 99.75%), namely, year of publication, type of mental disorder, participant category, and the quality of included studies. While acceptability among providers was [66.0% (95%CI, 52.0 - 78.0%), I2 = 95%]. The pooled usability of tele-mental health services among participants was [66.0% (95%CI, 50.0 - 80.0%), I2 = 83%]. Subgroup analysis revealed statistically significant results (p = 0.003), indicating that usability was higher among beneficiaries compared to providers. CONCLUSIONS The study highlighted a high acceptability of tele-mental health services. These findings suggest a promising outlook for the integration and adoption of tele-mental health services and emphasize the importance of considering user perspectives and addressing provider-specific challenges to enhance overall service delivery and effectiveness.
Collapse
Affiliation(s)
- Rowan M Abuyadek
- Health Administration and Behavioral Sciences Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Esraa Abdellatif Hammouda
- Clinical Research Department, El-Raml Pediatric Hospital, Ministry of Health and Population, Alexandria, Egypt
| | - Ehab Elrewany
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
| | | | - Rasha Ashmawy
- Department of Clinical Research, Maamora Chest Hospital, MoHP, Alexandria, Egypt
- Clinical Research Administration, Directorate of Health Affairs, MoHP, Alexandria, Egypt
| | - Sally Zeina
- Department of Clinical Research, Maamora Chest Hospital, MoHP, Alexandria, Egypt
| | - Assem Gebreal
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
- Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| |
Collapse
|
12
|
Arens EA, Donnerstag L, Hofmann SG, Stangier U. [Video-Based Online Metta-Meditation Therapy for Depression: A Pilot Trial Evaluating the Acceptability and Feasibility]. VERHALTENSTHERAPIE 2024; 34:32-43. [PMID: 38645510 PMCID: PMC11025693 DOI: 10.1159/000534381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/28/2023] [Indexed: 04/23/2024]
Abstract
Background In the course of the Covid-19 pandemic, it has become clear what relevance non-contact psychotherapeutic online interventions in mental health care could possibly have in the future. The present pilot study aims to test whether a Metta-based group program is also an acceptable and feasible treatment when conducted as video-based intervention. Metta meditations aim at showing unconditional benevolence and kindness to oneself and to other people. Methods Eight patients with depressive disorder participated in a video-based implementation of the Metta-based group program. Quality of the therapeutic relationship, the implementation of methods as well as the acceptance of the video-based therapy on the part of the participants were surveyed as target variables. Results Data indicated good feasibility in terms of a sustainable therapeutic relationship, the possibility of teaching meditation techniques, and the establishment of a concentrated working atmosphere. Videobased therapy met with good acceptance among the participants. Potential indications for its clinical effectiveness are evident. Conclusion Teaching Metta meditation in a group program for the treatment of depression can be practicably implemented in a video-based therapy and meets with good acceptance by the patients. Further studies on moderators of acceptance and efficacy of video-based therapy are needed.
Collapse
Affiliation(s)
- Elisabeth A. Arens
- Abteilung für Klinische Psychologie und Psychotherapie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Lucas Donnerstag
- Abteilung für Klinische Psychologie und Psychotherapie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Stefan G. Hofmann
- Abteilung für Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg, Marburg, Deutschland
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Ulrich Stangier
- Abteilung für Klinische Psychologie und Psychotherapie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| |
Collapse
|
13
|
Gong W, Liu L, Li X, Caine ED, Shi J, Zeng Z, Cheng KK. Quality of asynchronous webchats vs in-person consultations for postpartum depression in China: a cross-sectional, mixed methods study using standardized patients. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 45:101053. [PMID: 38585173 PMCID: PMC10998204 DOI: 10.1016/j.lanwpc.2024.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
Background Prompt professional care for postpartum depression (PPD) is difficult to obtain in China. Though online consultations improve accessibility and reduce stigma, the quality of services compared to in-person consultations is unclear. Methods Five trained, undisclosed "standardized patients" (SPs) made "asynchronous webchats" visits and in-person visits with psychiatrists. Visits were made to 85 psychiatrists who were based in 69 hospitals in ten provincial capital cities. The care between online and in-person consultations with the same psychiatrist was compared, including diagnosis, guideline adherence, and patient-centeredness. False discovery rate (FDR) was used to adjust p values. Third visits using asynchronous webchats were made to psychiatrists who offered discrepant diagnoses. Thematic content analysis was used for the discrepancies. Findings The proportion of diagnostic accuracy was lower for online than in-person visits (76.5% [65/85] vs 91.8% [78/85]; pFDR = 0.0066), as were the proportions of completing questions involving clinical history (16.6% vs 42.7%; pFDR < 0.0001), and management decisions (16.2% vs 27.5%; pFDR < 0.0001) consistent with recommended guidelines. Patient-centeredness was lower online than in-person (pFDR < 0.0001). Fifteen of 16 psychiatrists completed third visits, most of them considered lack of nonverbal information online as a key barrier. Interpretation Online consultations using asynchronous webchats were inferior to in-person consultations, with respect to diagnostic accuracy, adherence to recommended clinical guidelines, and patient-centeredness. To fully realise the potential benefits of online consultations and to prevent safety issues, there is an urgent need for major improvement in the quality and oversight of these consultations. Funding China Medical Board, National Natural Science Foundation of China, and Swiss Agency for Development and Cooperation Global Cooperation Department.
Collapse
Affiliation(s)
- Wenjie Gong
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha 410078, China
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Lu Liu
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - Xiaoyu Li
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - Eric D. Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Jingcheng Shi
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhen Zeng
- HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| |
Collapse
|
14
|
Ong T, Ivanova J, Soni H, Wilczewski H, Barrera J, Cummins M, Welch BM, Bunnell BE. Therapist perspectives on telehealth-based virtual reality exposure therapy. VIRTUAL REALITY 2024; 28:73. [PMID: 39238767 PMCID: PMC11376200 DOI: 10.1007/s10055-024-00956-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/14/2023] [Indexed: 09/07/2024]
Abstract
Virtual reality (VR) can enhance mental health care. In particular, the effectiveness of VR-based exposure therapy (VRET) has been well-demonstrated for treatment of anxiety disorders. However, most applications of VRET remain localized to clinic spaces. We aimed to explore mental health therapists' perceptions of telehealth-based VRET (tele-VRET) by conducting semi-structured, qualitative interviews with 18 telemental health therapists between October and December 2022. Interview topics included telehealth experiences, exposure therapy over telehealth, previous experiences with VR, and perspectives on tele-VRET. Therapists described how telehealth reduced barriers (88.9%, 16/18), enhanced therapy (61.1%, 11/18), and improved access to clients (38.9%, 7/18), but entailed problems with technology (61.1%, 11/18), uncontrolled settings (55.6%, 10/18), and communication difficulties (50%, 9/18). Therapists adapted exposure therapy to telehealth by using online resources (66.7%, 12/18), preparing client expectations (55.6%, 10/18), and adjusting workflows (27.8%, 5/18). Most therapists had used VR before (72.2%, 13/18) and had positive impressions of VR (55.6%, 10/18), but none had used VR clinically. In response to tele-VRET, therapists requested interactive session activities (77.8%, 14/18) and customizable interventions components (55.6%, 10/18). Concerns about tele-VRET included risks with certain clients (77.8%, 14/18), costs (50%, 9/18), side effects and privacy (22.2%, 4/18), and inappropriateness for specific forms of exposure therapy (16.7%, 3/18). These results reveal how combining telehealth and VRET may expand therapeutic options for mental healthcare providers and can help inform collaborative development of immersive health technologies.
Collapse
Affiliation(s)
- Triton Ong
- Doxy.Me Research, Doxy.Me Inc, Rochester, NY, USA
| | | | - Hiral Soni
- Doxy.Me Research, Doxy.Me Inc, Rochester, NY, USA
| | | | - Janelle Barrera
- Doxy.Me Research, Doxy.Me Inc, Rochester, NY, USA
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Mollie Cummins
- Doxy.Me Research, Doxy.Me Inc, Rochester, NY, USA
- College of Nursing and Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Brandon M Welch
- Doxy.Me Research, Doxy.Me Inc, Rochester, NY, USA
- Biomedical Informatics Center, Medical University of South Carolina, Public Health and Sciences, Charleston, SC, USA
| | - Brian E Bunnell
- Doxy.Me Research, Doxy.Me Inc, Rochester, NY, USA
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| |
Collapse
|
15
|
Schneider J, Wiechers M, Burger M, Pogarell O, Übleis A, Padberg F, Strupf M. [Video-Assisted Psychotherapy For Refugees: A Pilot Study]. Psychother Psychosom Med Psychol 2024; 74:129-133. [PMID: 38552619 DOI: 10.1055/a-2238-4076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Global conflicts and humanitarian crises led to an increase in forced migration to Germany in recent years. To improve the mental health care system for refugees and asylum seekers in Germany perspectively, we aim to examine the feasibility of implementing the culturally sensitive group psychotherapy Empowerment for refugees with affective disorders in a video-assisted setting. METHODS Empowerment is a culturally sensitive, interpreter-assisted intervention for the treatment of depressive and stress-related symptoms in refugees. Four male refugees from Afghanistan participated in a pilot study. The intervention included 16 modules delivered via video over a 12-week period. RESULTS The internet connection was frequently unstable and led to organizational challenges. The therapy was feasible in terms of linguistic and interactional aspects. DISCUSSION The stability of the internet connection represents the major criterion for a successful implementation of the therapy. Implications for future studies are discussed. CONCLUSION Regarding the potential opportunities to improve the mental health care provision to refugees and asylum seekers in the future, the video-assisted therapy concept could be investigated in a randomized controlled trial.
Collapse
Affiliation(s)
- Johanna Schneider
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Maren Wiechers
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Max Burger
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Oliver Pogarell
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Aline Übleis
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Frank Padberg
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| | - Michael Strupf
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München
| |
Collapse
|
16
|
Belanger HG, Long LJ, Winsberg M, Sullivan S, Farchione TJ, O'Callaghan E. The utility of completing adjuvant video lessons based on the unified protocol during psychotherapy: A retrospective study using a telehealth platform in routine clinical care. Psychother Res 2024; 34:228-240. [PMID: 36878224 DOI: 10.1080/10503307.2023.2174460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 03/08/2023] Open
Abstract
Digital supplements to tele-psychotherapy are increasingly needed. The purpose of this retrospective study was to investigate the association between outcomes and the use of supplemental video lessons based on the Unified Protocol (UP), an empirically supported transdiagnostic treatment. Participants included 7,326 adults in psychotherapy for depression and/or anxiety. Partial correlations were calculated between number of UP video lessons completed and change in outcomes after 10 weeks, controlling for number of therapy sessions and baseline scores. Then, participants were divided into those who did not complete any UP video lessons (n = 2355) and those who completed at least 7/10 video lessons (n = 549), and propensity-matched on 14 covariates. Repeated measures analysis of variance compared these groups (n = 401 in each group) on outcomes. Among the entire sample, symptom severity decreased as the number of UP video lessons completed increased, with the exception of lessons on avoidance and exposure. Those watching at least 7 lessons showed significantly greater reduction in both depression and anxiety symptoms than those who did not watch any. Viewing supplemental UP video lessons in addition to tele-psychotherapy had a positive and significant association with symptom improvement and may provide an additional tool for clinicians to implement UP components virtually.
Collapse
Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., Oakland, CA, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Laura J Long
- Center for Anxiety and Related Disorders, Department of Psychology & Brain Sciences, Boston University, Boston, MA, USA
| | | | | | - Todd J Farchione
- Center for Anxiety and Related Disorders, Department of Psychology & Brain Sciences, Boston University, Boston, MA, USA
| | | |
Collapse
|
17
|
Tripoli G, Lo Duca S, Ferraro L, Zahid U, Mineo R, Seminerio F, Bruno A, Di Giorgio V, Maniaci G, Marrazzo G, Sartorio C, Scaglione A, La Barbera D, La Cascia C. Lifestyles and Quality of Life of People with Mental Illness During the COVID-19 Pandemic. Community Ment Health J 2024; 60:37-46. [PMID: 36781688 PMCID: PMC9925225 DOI: 10.1007/s10597-023-01095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
The COVID-19 pandemic has had a significant impact on the quality of life (QoL), daily lifestyle, and mental health of people suffering from a mental disorder. This study aimed to investigate the effects of the prolongation of the COVID-19 emergency on QoL and lifestyles in a sample of 100 outpatients at the Psychiatry Unit in Palermo University Hospital, Italy. QoL was measured through the 12-item Short Form Survey and the COV19-Impact on Quality of Life. Lifestyle changes during the pandemic were measured through the lifestyle change questionnaire. The majority of participants reported a great impact of COVID-19 on the QoL, and almost half reported worsened lifestyles. Worsened lifestyles were predictive of both poor mental and physical health related QoL. These results suggest that people with mental illness need interventions targeting lifestyles, and the mental health service in Italy should adjust to the ongoing pandemic, developing virtual treatments.
Collapse
Affiliation(s)
- Giada Tripoli
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy.
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, SE5 8AF, London, UK.
| | - Sofia Lo Duca
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
- Unit of Psychiatry, University Hospital "Paolo Giaccone", Via G. La Loggia 1, 90129, Palermo, Italy
| | - Laura Ferraro
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
| | - Uzma Zahid
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, SE5 8AF, London, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Headington, OX3 7JX, Oxford, UK
| | - Raffaella Mineo
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
| | - Fabio Seminerio
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
- Unit of Psychiatry, University Hospital "Paolo Giaccone", Via G. La Loggia 1, 90129, Palermo, Italy
| | - Alessandra Bruno
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
| | - Vanessa Di Giorgio
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
| | - Giuseppe Maniaci
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
- Unit of Psychiatry, University Hospital "Paolo Giaccone", Via G. La Loggia 1, 90129, Palermo, Italy
| | - Giovanna Marrazzo
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
- Unit of Psychiatry, University Hospital "Paolo Giaccone", Via G. La Loggia 1, 90129, Palermo, Italy
| | - Crocettarachele Sartorio
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
- Unit of Psychiatry, University Hospital "Paolo Giaccone", Via G. La Loggia 1, 90129, Palermo, Italy
| | - Alessandra Scaglione
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
- Unit of Psychiatry, University Hospital "Paolo Giaccone", Via G. La Loggia 1, 90129, Palermo, Italy
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
- Unit of Psychiatry, University Hospital "Paolo Giaccone", Via G. La Loggia 1, 90129, Palermo, Italy
| | - Caterina La Cascia
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Via G. La Loggia 1, 90129, Palermo, Italy
- Unit of Psychiatry, University Hospital "Paolo Giaccone", Via G. La Loggia 1, 90129, Palermo, Italy
| |
Collapse
|
18
|
Negaro SND, Hantman RM, Probst JC, Crouch EL, Odahowski CL, Andrews CM, Hung P. Geographic variations in driving time to US mental health care, digital access to technology, and household crowdedness. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad070. [PMID: 38756363 PMCID: PMC10986236 DOI: 10.1093/haschl/qxad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/02/2023] [Accepted: 11/30/2023] [Indexed: 05/18/2024]
Abstract
Rural residents face significant barriers in accessing mental health care, particularly as the demand for such services grows. Telemedicine has been proposed as an answer to rural gaps, but this service requires both access to appropriate technology and private space in the home to be useful. Our study documented longer travel time to mental health facilities in rural areas and greater barriers to digital devices for telemedicine access in those same areas. However, urban areas demonstrated greater household crowdedness than rural noncore areas when looking at private space within the home. Across ZIP Code Tabulation Areas located more than an estimated 30 minutes from the nearest outpatient care, 675 950 (13.1%) rural households vs 329 950 (6.4%) urban households had no broadband internet. The current Affordable Connectivity Program should target mental health-underserved communities, especially in rural America, where the scarcity of digital access compounds travel burdens to mental health care.
Collapse
Affiliation(s)
- Sophia N D Negaro
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
| | - Rachel M Hantman
- Department of Psychology, University of South Carolina, Columbia, SC 29208, United States
| | - Janice C Probst
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina,Columbia, SC 29210, United States
| | - Elizabeth L Crouch
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina,Columbia, SC 29210, United States
| | - Cassie L Odahowski
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina,Columbia, SC 29210, United States
| | - Christina M Andrews
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
| | - Peiyin Hung
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina,Columbia, SC 29210, United States
| |
Collapse
|
19
|
Dhaliwal R, Yap S, Talarico F, Al-Shamali H, Mcweeny R, Reeson M, Shalaby R, Chen T, Spronk E, Snodgrass R, Tu E, Erick T, Marshall T, Kennedy M, Greenshaw AJ, Winkler O, Burback L. Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review. J Med Internet Res 2023; 25:e40710. [PMID: 37921863 PMCID: PMC10656669 DOI: 10.2196/40710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. OBJECTIVE This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. METHODS This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. RESULTS From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. CONCLUSIONS In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.
Collapse
Affiliation(s)
- Raman Dhaliwal
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sidney Yap
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Fernanda Talarico
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Huda Al-Shamali
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Robert Mcweeny
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Matthew Reeson
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Teresa Chen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elena Spronk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rayven Snodgrass
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Eileen Tu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Taylor Erick
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tyler Marshall
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Andrew J Greenshaw
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
20
|
Raciborski RA, Hamerling-Potts KK, Mitchell EL, Sullivan SR, Kapil-Pair N, Landes SJ, Jager-Hyman S, Goodman M. Cost comparison of in-person and telehealth modalities for a suicide safety planning group intervention: interim results from the "Project Life Force" randomized clinical trial. Front Psychiatry 2023; 14:1215247. [PMID: 37915795 PMCID: PMC10617511 DOI: 10.3389/fpsyt.2023.1215247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/05/2023] [Indexed: 11/03/2023] Open
Abstract
Suicide prevention is a clinical priority for the US Veterans Health Administration. Evidence-based interventions, including developing a suicide safety plan, are recommended practices and are becoming more widespread. Adaptations to further augment safety planning include a manualized group intervention (Project Life Force, PLF) that combines safety planning with the teaching of skills to maximize use of the plan. A multi-year randomized controlled trial to test efficacy of PLF compared to treatment as usual is currently in progress. However, approximately a year into the study, in-person groups were converted to telehealth groups due to the COVID-19 pandemic. This study compares the per-veteran cost of PLF when delivered in-person versus by telehealth using preliminary trial data from the first 2.5 years of the trial. Cost to deliver PLF was obtained from the Veterans Health Administration's Managerial Cost Accounting data, which relies on activity-based costing. We found no significant differences in the average number of sessions or average group size between in-person and telehealth. However, the cost per group session was lower for the telehealth modality and this led to significant overall per-veteran savings. While efficacy data comparing from the two arms is still underway and we await the ongoing RCT results, our interim cost analysis highlights potential savings with the telehealth modality.
Collapse
Affiliation(s)
- Rebecca A. Raciborski
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Evidence, Policy, and Implementation Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
| | - Kyra K. Hamerling-Potts
- VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), James J. Peters Veteran Affairs Medical Center, Bronx, NY, United States
| | - Emily L. Mitchell
- VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), James J. Peters Veteran Affairs Medical Center, Bronx, NY, United States
- Department of Psychology, The Catholic University of America, Washington, DC, United States
| | - Sarah R. Sullivan
- VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), James J. Peters Veteran Affairs Medical Center, Bronx, NY, United States
| | - Nidhi Kapil-Pair
- VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), James J. Peters Veteran Affairs Medical Center, Bronx, NY, United States
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States
| | - Sara J. Landes
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Evidence, Policy, and Implementation Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Marianne Goodman
- VISN 2 Mental Illness, Research, Education, Clinical Center (MIRECC), James J. Peters Veteran Affairs Medical Center, Bronx, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
21
|
Mehrabi A, Naghavi A, Afsharzada ME, Afsharzada MS, Brailovskaia J, Teismann T. Trust in higher guidance and suicidality in Afghan students under the Taliban regime{fr}(Confianza en la orientación superior y suicidalidad en estudiantes afganos bajo el régimen Talibán). Int J Clin Health Psychol 2023; 23:100398. [PMID: 37521503 PMCID: PMC10384272 DOI: 10.1016/j.ijchp.2023.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023] Open
Abstract
Background/Objective After years of war, political instability and natural catastrophes high rates of PTSD and depression have been found in the Afghan population. On this background, it was investigated whether religious beliefs (trust in higher guidance; TIHG) moderated the association between PTSD symptoms and/or depression and suicidal ideation. Method A total of 279 Afghan university students (61.6% women; aged 18 to 30 years) took part in this cross-sectional study between July and November 2022. Self-report measures of PTSD, depression, suicidal ideation, trust in higher guidance were used. Results Severe PTSD symptoms were reported by 58.4%, clinically relevant depression symptoms were reported by 55.2% and current suicidal ideation was reported by 44.4% of the sample. TIHG moderated the impact of PTSD symptoms, on suicidal ideation. TIHG and depression were unrelated. Conclusion PTSD symptoms, depression and suicidal ideation show an alarmingly high prevalence in this specific sample of Afghan students. TIHG seems to be a resilience factor of special importance.
Collapse
Affiliation(s)
- Ali Mehrabi
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Iran
| | - Azam Naghavi
- Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Iran
| | | | | | - Julia Brailovskaia
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Massenbergstraße 11, Bochum 44787, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Massenbergstraße 11, Bochum 44787, Germany
| |
Collapse
|
22
|
Hippman C, Mah JWT, MacFadden M. Virtual Delivery of Parent Coaching Interventions in Early Childhood Mental Health: A Scoping Review. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01597-8. [PMID: 37740798 DOI: 10.1007/s10578-023-01597-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/25/2023]
Abstract
Parent-coaching interventions positively impact child development. Virtual delivery of such interventions is supported by literature reviews and a practice guideline, however, none of these focused on children under age six. A scoping review of virtually-delivered parent-coaching interventions for disruptive behaviour, anxiety, and parent-child relationship concerns in children under age six was conducted between Dec. 15, 2020 and April 22, 2021. Iterative searches of the databases PubMed, CINAHL, and PsycINFO were complemented by reference list searches and clinician expert review (N = 1146). After relevance screening and duplicate removal, collaboratively-developed inclusion criteria were applied to records, followed by data extraction from eligible articles (n = 30). Most literature documented behavioural-based interventions targeting disruptive behaviour which were delivered individually, by therapists, to White, non-Hispanic parents. Evidence supports feasibility and efficacy of virtually-delivered parent-coaching interventions to improve child disruptive behaviour (strong), anxiety (moderate), and parent-child relationship (weak). There is a significant gap in the literature regarding the virtual delivery of attachment-based parent-coaching interventions. In sum, virtual parent coaching can be an efficacious approach for children under age six, particularly for behavioural challenges.
Collapse
Affiliation(s)
- Catriona Hippman
- BC Children's Hospital, University of British Columbia (UBC), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Janet W T Mah
- BC Children's Hospital, University of British Columbia (UBC), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Megan MacFadden
- BC Children's Hospital, University of British Columbia (UBC), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| |
Collapse
|
23
|
von Wirth E, Willems S, Döpfner M, Kohl LT. Effectiveness of videoconference-delivered psychotherapy for children, adolescents, and their parents: A meta-analysis of randomized controlled trials. J Telemed Telecare 2023:1357633X231199784. [PMID: 37715649 DOI: 10.1177/1357633x231199784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Over the last years, videoconference-delivered psychotherapy (VCP) has found its way into clinical practice. This meta-analysis is the first to evaluate the effectiveness of VCP for children and adolescents with a mental disorder and their parents. METHODS A systematic literature search was performed to identify randomized controlled trials (RCTs) that compared the effectiveness of VCP for youths with a mental disorder to a control condition. Twelve studies were included. Two reviewers independently extracted data and rated study quality. RESULTS Effect size estimates for measures of children's symptoms of mental disorders were large for comparison between VCP and waitlist (posttreatment: Hedges's g = -1.26, k = 5) and negligible for comparisons between VCP and in-person treatment (posttreatment: g = 0.00, k = 6; follow-up: g = -0.05, k = 3). Similarly, effect size estimates for measures of children's functional impairments were large for comparison between VCP and waitlist (posttreatment: g = -1.10, k = 3) and negligible for comparisons between VCP and in-person treatment (posttreatment: g = -0.23, k = 3; follow-up: g = 0.04, k = 2). VCP more effectively reduced symptoms in children with an internalizing disorder (g = -0.88, k = 5) compared to externalizing disorders (g = 0.25, k = 2) or tic disorders (g = -0.08, k = 3). DISCUSSION The results provide preliminary evidence that VCP is an effective treatment for youths with a mental disorder and their parents. VCP was equally effective as in-person treatment in reducing children's symptoms and functional impairments. Limitations include the limited number of RCTs and incomplete reporting of methodological features.
Collapse
Affiliation(s)
- Elena von Wirth
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Sarah Willems
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lea Teresa Kohl
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
24
|
Lisi DM, Hawley LL, McCabe RE, Rowa K, Cameron DH, Richter MA, Rector NA. Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness. Clin Psychol Psychother 2023. [PMID: 37699581 DOI: 10.1002/cpp.2908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/13/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.
Collapse
Affiliation(s)
- Diana M Lisi
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lance L Hawley
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Margaret A Richter
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Büscher R, Teismann T, Hartleitner P, Klein JP, Baumeister H, Sander LB. Remote blended treatment for individuals with suicidal ideation: A single-arm proof-of-concept trial. Clin Psychol Psychother 2023. [PMID: 37658710 DOI: 10.1002/cpp.2905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023]
Abstract
INTRODUCTION New digital treatment formats may reduce barriers to treatment for individuals with suicidal ideation. This study aimed to investigate the feasibility of a remote blended care programme for this population, defined as acceptability, demand, practicality, adaptation, indications of efficacy and safety. METHODS We conducted a mixed-methods single-arm trial for proof-of-concept. Participants were eligible if they were at least 18 years old, had sufficient German proficiency, a Beck Scale for Suicidal Ideation score ≥2, internet access and lived near the outpatient clinic. The treatment consisted of 12 sessions of cognitive-behavioural videotherapy combined with online modules over 6 weeks. RESULTS We included 10 participants. All patients were satisfied with the treatment; most patients (80%) reported unpleasant memories resurfacing. All patients completed all therapy sessions and a mean of 13.7 modules (SD = 5.7); three patients switched to face-to-face treatment, in one case due to safety concerns. All patients and most therapists (83.3%) found the treatment overall practicable. Most patients (66.7%) and therapists (66.7%) considered remote treatment equivalent to face-to-face therapy. There were no serious adverse events. CONCLUSION While promising, the results suggest changes to the programme might be needed, particularly for patients' safety. A controlled feasibility trial should investigate temporary deteriorations.
Collapse
Affiliation(s)
- Rebekka Büscher
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
| | - Paula Hartleitner
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Philipp Klein
- Department of Psychiatry, Psychosomatics and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse B Sander
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
26
|
Cloutier B, Lecomte T, Diotte F, Lamontagne J, Abdel-Baki A, Daneault JG, Gélineau Rabbath ME, de Connor A, Perrine C. Improving Romantic Relationship Functioning Among Young Men With First-Episode Psychosis: Impact of a Novel Group Intervention. Behav Modif 2023; 47:1170-1192. [PMID: 37496322 PMCID: PMC10403962 DOI: 10.1177/01454455231186586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Previous research has highlighted many of the challenges faced by individuals with psychosis in romantic relationships. The present study aimed to evaluate the impact of a novel group intervention for men with first-episode psychosis (FEP) on dating success, romantic and sexual functioning, self-esteem, self-stigma, mentalizing skills, and symptomatology, while using a repeated single-case experimental design and comparing results across two treatment modalities (i.e., in-person or online). Twenty-seven participants from five treatment sites completed a 12-week group intervention. Qualitative data was also collected to assess participants' subjective experiences with the program. In both modalities, significant improvements were observed for romantic functioning, mentalizing skills, and symptomatology, with effect sizes ranging from small to large. Several participants also attended more dates and entered committed relationships after the intervention. Most participants were satisfied with the program and many felt that they had learned new skills and gained confidence in dating. Future research should replicate these findings in larger and more inclusive samples.
Collapse
Affiliation(s)
| | | | | | | | - Amal Abdel-Baki
- Centre hospitalier de l’Université de Montréal, Clinique JAP, QC, Canada
| | | | | | - Alexandre de Connor
- Centre hospitalier universitaire de Montpellier, Centre de rétablissement et de réhabilitation Jean-Minvieille, Montpellier, France
| | - Cécile Perrine
- Établissement public de santé mentale Caen, Unité de réhabilitation psychosociale Ariane, Caen, France
| |
Collapse
|
27
|
Shaker AA, Austin SF, Storebø OJ, Schaug JP, Ayad A, Sørensen JA, Tarp K, Bechmann H, Simonsen E. Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis. JMIR Ment Health 2023; 10:e44790. [PMID: 37277113 PMCID: PMC10357375 DOI: 10.2196/44790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/28/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses. OBJECTIVE This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment. METHODS A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome. RESULTS A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference -0.01, 95% CI -0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (-0.66, 95% CI -1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI -0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539). CONCLUSIONS This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357.
Collapse
Affiliation(s)
- Ali Abbas Shaker
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephen F Austin
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Ole Jakob Storebø
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Julie Perrine Schaug
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
| | - Alaa Ayad
- Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Slagelse, Denmark
| | - John Aasted Sørensen
- Department of Engineering Technology and Didactics, Research unit: AI, Mathematics and Software, Technical University of Denmark, Ballerup, Denmark
| | - Kristine Tarp
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Bechmann
- Department of Engineering Technology and Didactics, Research unit: AI, Mathematics and Software, Technical University of Denmark, Ballerup, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
| |
Collapse
|
28
|
Galvin E, Desselle S, Gavin B, Quigley E, Flear M, Kilbride K, McNicholas F, Cullinan S, Hayden J. Stakeholder perspectives and experiences of the implementation of remote mental health consultations during the COVID-19 pandemic: a qualitative study. BMC Health Serv Res 2023; 23:623. [PMID: 37312119 DOI: 10.1186/s12913-023-09529-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Remote mental health consultations were swiftly implemented across mental health services during the COVID-19 pandemic. Research has begun to inform future design and delivery of telemental health services. Exploring the in-depth experiences of those involved is important to understand the complex, multi-level factors that influence the implementation of remote mental health consultations. The aim of this study was to explore stakeholder perspectives and experiences of the implementation of remote mental health consultations during the COVID-19 pandemic in Ireland. METHODS A qualitative study was conducted whereby semi-structured, individual interviews were undertaken with mental health providers, service users, and managers (n = 19) to acquire rich information. Interviews were conducted between November 2021 and July 2022. The interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). Data were analysed thematically using a deductive and inductive approach. RESULTS Six themes were identified. The advantages of remote mental health consultations were described, including convenience and increased accessibility to care. Providers and managers described varying levels of success with implementation, citing complexity and incompatibility with existing workflows as barriers to adoption. Providers' access to resources, guidance, and training were notable facilitators. Participants perceived remote mental health consultations to be satisfactory but not equivalent to in-person care in terms of quality. Views about the inferior quality of remote consultations stemmed from beliefs about the inhibited therapeutic relationship and a possible reduction in effectiveness compared to in-person care. Whilst a return to in-person services was mostly preferred, participants acknowledged a potential adjunct role for remote consultations in certain circumstances. CONCLUSIONS Remote mental health consultations were welcomed as a means to continue care during the COVID-19 pandemic. Their swift and necessary adoption placed pressure on providers and organisations to adapt quickly, navigating challenges and adjusting to a new way of working. This implementation created changes to workflows and dynamics that disrupted the traditional method of mental health care delivery. Further consideration of the importance of the therapeutic relationship and fostering positive provider beliefs and feelings of competence are needed to ensure satisfactory and effective implementation of remote mental health consultations going forward.
Collapse
Affiliation(s)
- Emer Galvin
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | | | - Blánaid Gavin
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | - Fiona McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland
- Children's Health Ireland, Crumlin, Dublin, Ireland
- Lucena Child and Adolescent Mental Health Service (CAMHS), Rathgar, Dublin, Ireland
| | - Shane Cullinan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
29
|
Achtyes ED, Glenn T, Monteith S, Geddes JR, Whybrow PC, Martini J, Bauer M. Telepsychiatry in an Era of Digital Mental Health Startups. Curr Psychiatry Rep 2023; 25:263-272. [PMID: 37166622 PMCID: PMC10172730 DOI: 10.1007/s11920-023-01425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE OF REVIEW Telepsychiatry practiced by psychiatrists is evidence-based, regulated, private, and effective in diverse settings. The use of telemedicine has grown since the COVID-19 pandemic as people routinely obtain more healthcare services online. At the same time, there has been a rapid increase in the number of digital mental health startups that offer various services including online therapy and access to prescription medications. These digital mental health firms advertise directly to the consumer primarily through digital advertising. The purpose of this narrative review is to contrast traditional telepsychiatry and the digital mental health market related to online therapy. RECENT FINDINGS In contrast to standard telepsychiatry, most of the digital mental health startups are unregulated, have unproven efficacy, and raise concerns related to self-diagnosis, self-medicating, and inappropriate prescribing. The role of digital mental health firms for people with serious mental illness has not been determined. There are inadequate privacy controls for the digital mental health firms, including for online therapy. We live in an age where there is widespread admiration for technology entrepreneurs and increasing emphasis on the role of the patient as a consumer. Yet, the business practices of digital mental health startups may compromise patient safety for profits. There is a need to address issues with the digital mental health startups and to educate patients about the differences between standard medical care and digital mental health products.
Collapse
Affiliation(s)
- Eric D Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
30
|
Goh ZZS, Chan LG, Lai JY, Lee J, Lee ES, Soon WSW, Toh A, Griva K. Impact of COVID-19 on mental health and social service provision in Singapore: Learnings from a descriptive mixed-methods study for future resource planning. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:239-248. [PMID: 38904521 DOI: 10.47102/annals-acadmedsg.2022332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Introduction COVID-19 restrictions and lockdown measures have led to impact on the mental health and social service delivery, including the rapid adoption of digital solutions to mental healthcare delivery in Singapore. This study aims to rapidly document the quantitative and qualitative impact of the pandemic restrictions on mental health and social services. Method This descriptive mixed-methods study consisted of a survey arm and a qualitative arm. Providers and clients from eligible mental health organisations and social service agencies were recruited. The respondents completed a survey on changes to their service delivery and the extent of impact of the pandemic on their clients. In-depth interviews were also conducted with representatives of the organisations and clients. Results There were 31 organisation representatives to the survey, while 16 providers and 3 clients participated in the in-depth interviews. In the survey arm, all representatives reported pivoting to remote means of delivering care during the lockdown. An increase in new client referrals and more domestic violence were reported from primary and community health partners respondents who made up 55.5% of health partners respondents. Three distinct response themes were recorded in the in-depth interviews: impact on clients, impact on service provision and impact on mental health landscape. Conclusion Two key findings are distilled: (1) mental health and social services have been challenged to meet the evolving demands brought about by the pandemic; (2) more societal attention is needed on mental health and social services. The findings indicate a necessary need for extensive studies on COVID-19 that can inform policies to build a more pandemic-resilient nation.
Collapse
Affiliation(s)
| | - Lai Gwen Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Psychiatry, Tan Tock Seng Hospital, Singapore
| | | | - Jimmy Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Institute of Mental Health, Singapore
| | - Eng Sing Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Healthcare Group Polyclinics, Singapore
| | | | - Adrian Toh
- Department of Psychology, National University of Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| |
Collapse
|
31
|
Kathiravan S, Chakrabarti S. Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic. World J Psychiatry 2023; 13:60-74. [PMID: 36925949 PMCID: PMC10011942 DOI: 10.5498/wjp.v13.i2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/01/2022] [Accepted: 12/06/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The existing literature indicates that psychotherapeutic treatment, especially exposure and response prevention (ERP) is efficacious in treating obsessive-compulsive disorder (OCD). The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment. Moreover, the pandemic forced a global switch to telemental health (TMH) services to maintain the standards and continuity of care. Consequently, clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD. However, several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic. AIM To describe the formulation, implementation, feasibility, and usefulness of videoconferencing-based ERP (VC-ERP) treatment for OCD during the coronavirus disease 2019 pandemic. METHODS This prospective, observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (July 2020-June 2021). All patients with OCD were assessed using the home-based TMH services of the department. The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment. After a systematic evaluation of the available treatment options, an initial protocol for delivering VC-ERP was developed. Guidelines for clinicians and educational materials for patients and their families were prepared. The protocol was implemented among patients with OCD attending the TMH services, and their progress was monitored. The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders. Feasibility and efficacy outcomes were examined. RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases, 10th version criteria. Out of 115 patients who attended the services during the study period, 37 were excluded from the final analysis. Of the remaining 78 patients, VC-ERP was initiated in 43 patients. Six patients dropped out, and three were hospitalized for inpatient ERP. Eleven patients have completed the full VC-ERP treatment. One patient completed the psychoeducation part of the protocol. VC-ERP is ongoing in 22 patients. The protocol for VC-ERP treatment was developed and upgraded online. A large proportion of the eligible patients (n = 34/43; 79%) actively engaged in the VC-ERP treatment. Drop-out rates were low (n = 6/43; 14%). Satisfaction with the treatment was adequate among patients, caregivers, and clinicians. Apart from hospitalization in 3 patients, there were no other adverse events. Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol. Therefore, the feasibility of VC-ERP treatment in terms of operational viability, service utilization, service engagement, need for additional in-person services, frequency of adverse events, and user satisfaction was adequate. The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment. Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed. CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD. The results suggest that VC-ERP can be a useful option in resource-constrained settings.
Collapse
Affiliation(s)
- Sanjana Kathiravan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| |
Collapse
|
32
|
Ivey G, Denmeade L. Trainee psychologists’ experiences of learning and conducting psychodynamic therapy via telepsychology. PSYCHOANALYTIC PSYCHOTHERAPY 2023. [DOI: 10.1080/02668734.2022.2158210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Gavin Ivey
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Lesley Denmeade
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| |
Collapse
|
33
|
Abstract
Telemental health-the use of videoconferencing or audio only (telephone) in mental health care-has accelerated tremendously since the start of the covid-19 pandemic. Meta-analyses have examined the reliability (ie, concordance) of assessment and the efficacy/effectiveness of telemental health compared with in-person care. Results indicate that telemental health assessment and clinical outcomes are similar compared with in-person care but there is much unexplained variability, as well as evidence that patient clinical and demographic characteristics can influence these findings. Further, gaps exist in the literature regarding specific patient populations (eg, psychotic disorders, children/adolescents), treatment modalities (eg, group therapy), audio only telemedicine, and hybrid care that mixes in-person with telemental health care. These gaps provide important directions for the next generation of telemental health research. Comprehensive clinical guidelines from mental health organizations are available to telemental health practitioners and focus on five content themes: legal and regulatory issues, clinical considerations, standard operating procedures and protocols, technical requirements, and considerations of specific populations and settings.
Collapse
Affiliation(s)
| | - Alisa B Busch
- McLean Hospital, Harvard Medical School, Belmont, MA
| |
Collapse
|
34
|
Mseke EP, Jessup B, Barnett T. A systematic review of the preferences of rural and remote youth for mental health service access: Telehealth versus face-to-face consultation. Aust J Rural Health 2023. [PMID: 36606417 DOI: 10.1111/ajr.12961] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Telehealth has become an increasingly popular method to deliver mental health services to rural and remote youth who are challenged by distance and service availability. However, it remains unclear whether rural and remote youth would prefer to access mental health services via telehealth or by attending services in person. OBJECTIVE To systematically review the preferences of rural and remote youth for mental health service access via telehealth versus face-to-face consultation. DESIGN Systematic review of published research papers cited in databases CINAHL, MEDLINE and PubMed databases between 2000 and 2021. FINDINGS From a total of 225 articles identified, four were found to meet inclusion criteria. Three studies reported rural and remote youth preferred to access mental health services face-to-face over telehealth. However, three studies also reported youth viewed telehealth as an important adjunct to in person attendance, especially in situations of large travel times. DISCUSSION Although telehealth can facilitate mental health service access, rural and remote youth may prefer to see a mental health professional in person, with telehealth regarded as an adjunct to, not a replacement for, face-to-face consultation. CONCLUSION Whilst rural and remote youth may prefer to access mental health services in person rather than via telehealth, further well designed research is needed to better understand under what circumstances this preference holds true and why. Caution should be exercised in generalising this finding because of the few studies that met the inclusion criteria and different conditions under which youth made their choice to access mental health services.
Collapse
Affiliation(s)
- Edwin Paul Mseke
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia.,Department of Mathematics and Statistics, University of Dodoma, Dodoma, Tanzania
| | - Belinda Jessup
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Tony Barnett
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia
| |
Collapse
|
35
|
[Video-based psychotherapy: current framework conditions, developments, and recommendations for practical implementation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:154-159. [PMID: 36648497 PMCID: PMC9843682 DOI: 10.1007/s00103-022-03644-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/06/2022] [Indexed: 01/18/2023]
Abstract
Video-based psychotherapy is a digital way to deliver psychotherapeutic treatment when traditional on-site psychotherapy cannot be provided due to structural barriers, such as those related to the COVID-19 pandemic. The use of this digital approach has proven to be both effective and accepted among therapists and patients. Legal frameworks for German therapists and recommendations for practical implementation are summarized in this article.
Collapse
|
36
|
Galvin E, Desselle S, Gavin B, Quigley E, Flear M, Kilbride K, McNicholas F, Cullinan S, Hayden J. Patient and provider perspectives of the implementation of remote consultations for community-dwelling people with mental health conditions: A systematic mixed studies review. J Psychiatr Res 2022; 156:668-678. [PMID: 36399859 PMCID: PMC9637462 DOI: 10.1016/j.jpsychires.2022.10.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
Remote, or tele-, consultations became a necessary form of mental healthcare provision during the COVID-19 pandemic. As the prevalence of mental health problems rises, they may have a role in future mental health services. We aimed to review the literature on patient and provider perspectives on factors influencing the implementation of remote consultations for community-dwelling people with mental health conditions. We searched five electronic databases (PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO) for empirical research up to July 13th, 2022. Only studies of synchronous, interactive remote consultations conducted via video, phone, or live-messaging between patients and providers were included. Two reviewers independently assessed the quality of included studies using the Mixed Methods Appraisal Tool. We integrated qualitative and quantitative data from 39 studies into a single mixed-methods synthesis. We mapped reported factors to the domains of the Consolidated Framework for Implementation Research (CFIR). Acceptability was generally high among participants, despite concerns about the quality of care and the perceived impeded therapeutic relationship. A prominent facilitator was the increased accessibility and convenience of remote consultations, while lack of appropriate infrastructure and low patient comfort and competence were among the most prevalent barriers. This review highlights the importance of patient preferences and provider buy-in to the future of remote consultations.
Collapse
Affiliation(s)
- Emer Galvin
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | | | - Blánaid Gavin
- School of Medicine, University College Dublin, Dublin, Ireland.
| | - Etain Quigley
- National University of Ireland, Maynooth, Maynooth, Ireland.
| | - Mark Flear
- Queen's University Belfast, Belfast, United Kingdom.
| | | | | | - Shane Cullinan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - John Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
37
|
Margherita G, Muzii B, Caffieri A, Di Francia A, Somma B. 'Isolated together': online group treatments during the COVID-19 pandemic. A systematic review. RESEARCH IN PSYCHOTHERAPY (MILANO) 2022; 25:639. [PMID: 36373389 PMCID: PMC9893046 DOI: 10.4081/ripppo.2022.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
Considering the emerging need to face the negative impact of the pandemic on mental health, social support, and access to health services, it became a critical issue to adapt to online group settings and create new group interventions to face the developing distress during this time. The aim of the current study is to investigate the main findings on OPGI conducted during the COVID-19 pandemic from March 2020 until March 2022, with a particular focus on: i) the therapeutic group factors; ii) what kind of OPGI works and for whom; iii) settings and emerging dimensions. In accordance with PRISMA guidelines, we performed a systematic review on scientific databases (PsychINFO, PubMed, Web of Science and EBSCO) searching for studies published between March 2020 and March 2022. 'Group intervention' or 'group therapy' or 'group treatment' crossed with 'COVID-19' and synonymous, were used as keywords. Internet based intervention was used as an eligibility criteria during the full-text screening. A total of 1326 articles were identified, of which 24 met the inclusion criteria. Among all studies, with different participants and different orientations, data extracted supported psychological online group interventions as an effective approach to reducing psychological distress and increasing psychological resources in the interpersonal field. Our findings also showed that COVID-19 has led to new needs and issues, that require the investigation of new dimensions for online psychological interventions. Methodological and clinical implications will be discussed through a descriptive table related to setting characteristics. Recommendations are made for future research.
Collapse
Affiliation(s)
- Giorgia Margherita
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy,I.I.P.G., Italian Institute of Group Psychoanalysis and European Federation for Psychoanalytic Psychotherapy in the Public Sector, Rome, Italy,Department of Humanistic Studies, University of Naples Federico II, Naples, Italy.
| | - Benedetta Muzii
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Alessia Caffieri
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Adriana Di Francia
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Brenda Somma
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| |
Collapse
|
38
|
Qin M, Li L, Miranda J, Tang Y, Song B, Oosthuizen MK, Wei W. Experimental duration determines the effect of arbuscular mycorrhizal fungi on plant biomass in pot experiments: A meta-analysis. FRONTIERS IN PLANT SCIENCE 2022; 13:1024874. [PMID: 36407631 PMCID: PMC9671359 DOI: 10.3389/fpls.2022.1024874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Arbuscular mycorrhizal fungi (AMF) play various important roles in promoting plant growth. Numerous environmental and evolutionary factors influence the response of plants to AMF. However, the importance of the individual factors on the effects of AMF on plant biomass is not clearly understood. In this study, a meta-analysis using 1,640 observations from 639 published articles related to the influence of AMF on the plant shoot, root, and total biomass was performed; 13 different experimental setting factors that had an impact on the influence of AMF and their importance were quantitatively synthesized. The meta-analysis showed that AMF had positive effects on the plant shoot, root, and total biomass; moreover, the experimental duration, plant root-to-shoot ratio (R/S), AMF root length colonization, plant family, pot size, soil texture, and the soil pH all influenced the effects of AMF on the shoot, root, and total biomass. In addition, the plant root system and plant functional type had impacts on the effect of AMF on shoot biomass; AMF guild also impacted the effect of AMF on root biomass. Of these factors, the experimental duration, plant R/S, and pot size were the three most important predicting the effects of AMF on the plant shoot, root, and total biomass. This study comprehensively assessed the importance of the different factors that influenced the response of plants to AMF, highlighting that the experimental duration, plant R/S, and pot size should be taken into consideration in pot experiments in studies of the functions of AMF. Multiple unfavorable factors that may obscure or confound the observed functions of AMF should be excluded.
Collapse
Affiliation(s)
- Mingsen Qin
- Key Laboratory of Southwest China Wildlife Resources Conservation (Ministry of Education), China West Normal University, Nanchong, China
| | - Lei Li
- Key Laboratory of Southwest China Wildlife Resources Conservation (Ministry of Education), China West Normal University, Nanchong, China
| | | | - Yun Tang
- Key Laboratory of Southwest China Wildlife Resources Conservation (Ministry of Education), China West Normal University, Nanchong, China
| | - Bo Song
- Key Laboratory of Southwest China Wildlife Resources Conservation (Ministry of Education), China West Normal University, Nanchong, China
| | | | - Wangrong Wei
- Key Laboratory of Southwest China Wildlife Resources Conservation (Ministry of Education), China West Normal University, Nanchong, China
| |
Collapse
|
39
|
Cole MB, Lee EK, Davoust M, Carey K, Kim JH. Comparison of Visit Rates Before vs After Telehealth Expansion Among Patients With Mental Health Diagnoses Treated at Federally Qualified Health Centers. JAMA Netw Open 2022; 5:e2242059. [PMID: 36378314 PMCID: PMC9667322 DOI: 10.1001/jamanetworkopen.2022.42059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This cohort study assesses visit rates before and after telehealth expansion to assess whether telehealth availability at federally qualified health centers is associated with visit rates for patients with mental health diagnoses.
Collapse
Affiliation(s)
- Megan B. Cole
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Eun Kyung Lee
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Melissa Davoust
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Kathleen Carey
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - June-Ho Kim
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine & Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| |
Collapse
|
40
|
Chen GJ, Kunik ME, Marti CN, Choi NG. Cost-effectiveness of Tele-delivered behavioral activation by Lay counselors for homebound older adults with depression. BMC Psychiatry 2022; 22:648. [PMID: 36253766 PMCID: PMC9574809 DOI: 10.1186/s12888-022-04272-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/16/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Low-income homebound older adults have limited access to psychosocial treatments because of their homebound state and geriatric mental health workforce shortages. Little is known about cost effectiveness of lay-counselor-delivered, videoconferenced, short-term behavioral activation on this study population. The objective of this study was to assess the cost-effectiveness of lay-counselor-delivered, videoconferenced, short-term behavioral activation (Tele-BA) compared to clinician-delivered, videoconferenced problem-solving therapy (Tele-PST) and telephone support calls (attention control; AC) for low-income homebound older adults. METHODS We performed a cost-effectiveness analysis based on data from a recently completed, 3-group (Tele-BA, Tele-PST, and AC) randomized controlled trial with 277 participants aged 50+. We measured total costs of (1) intervention and (2) outpatient care, ED visits, and inpatient care using the Cornell Services Index. The effectiveness outcome was quality-adjusted life-years (QALY). We used EuroQol's EQ-5D-5L to assess each participant's health-related quality of life (HRQoL) at baseline and at 12, 24, and 36 weeks. The end-point measure of cost-effectiveness was the incremental cost-effectiveness ratio (ICER) of (1) Tele-BA versus AC, (2) Tele-PST versus AC, and (3) Tele-BA versus Tele-PST. RESULTS Relative to AC, both Tele-BA and Tele-PST are cost-saving treatment options. The ICERs for both Tele-BA and Tele-PST were well below $50,000, the lower-bound threshold for cost-effectiveness. Relative to AC, both Tele-PST, Tele-BA are cost-saving treatment options (i.e. lower costs and more QALYs). CONCLUSION Costs of tele- and lay-counselor-delivered depression treatment are modest and cost effective relative to providing telephone support. Though our results show that Tele-BA may not be cost effective relative to Tele-PST, a clinician-delivered psychotherapy, when a low bound ICER threshold of $50,000 would be used, lay counselors can fill the professional geriatric mental health workforce shortage gap and Tele-BA by lay counselors can improve homebound older adults' access to evidence-and skills-based, cost effective depression care. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02600754 (11/09/2015).
Collapse
Affiliation(s)
| | - Mark E. Kunik
- grid.39382.330000 0001 2160 926XHSR&D Center for Innovations in Quality, Effectiveness and Safety, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Houston, VA, TX USA ,Education and Clinical Center, VA South Central Mental Illness Research, Houston, TX USA
| | - C. Nathan Marti
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX USA
| | - Namkee G. Choi
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX USA
| |
Collapse
|
41
|
Bouchard S, Dugas MJ, Belleville G, Langlois F, Gosselin P, Robillard G, Corno G, Marchand A. A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference. J Clin Med 2022; 11:5924. [PMID: 36233791 PMCID: PMC9572194 DOI: 10.3390/jcm11195924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
Delivering psychotherapy by videoconference has been studied in a number of clinical trials, but no large controlled trial has involved generalized anxiety disorder (GAD). This multicenter randomized controlled non-inferiority trial was conducted to test if cognitive-behavior psychotherapy delivered by videoconference (VCP) is as effective as cognitive-behavior psychotherapy delivered face-to-face, using a strict margin of tolerance for non-inferiority. A total of 148 adults received a 15-session weekly manualized program. The treatment was based on the intolerance of uncertainty model of GAD. The impact of treatment was assessed using primary (GAD severity), secondary (worry, anxiety, and intolerance of uncertainty) and tertiary (general functioning) variables measured before and after treatment and at 6-month and 12-month follow-ups. Results showed that: (a) the treatment was effective; (b) VCP for GAD was statistically non-inferior to face-to-face psychotherapy on primary, secondary and tertiary measures at all assessment points; (c) change in intolerance of uncertainty significantly predicted change in the primary outcome measure over and above important clinical factors common to all psychotherapies (motivation, working alliance, perceived therapist competence, and client satisfaction). These findings support the use of VCP as a promising treatment option for adults with GAD. Clinical trial registry: ISRCTN#12662027.
Collapse
Affiliation(s)
- Stéphane Bouchard
- Département de Psychologie et de Psychoéducation, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
- Centre de Recherche du Centre de Santé et des Services Sociaux de l’Outaouais, Gatineau, QC J8T 4J3, Canada
| | - Michel J. Dugas
- Département de Psychologie et de Psychoéducation, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
- Centre de Recherche du Centre de Santé et des Services Sociaux de l’Outaouais, Gatineau, QC J8T 4J3, Canada
| | | | - Frédéric Langlois
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada
| | - Patrick Gosselin
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada
| | - Geneviève Robillard
- Département de Psychologie et de Psychoéducation, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
| | - Giulia Corno
- Département de Psychologie et de Psychoéducation, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
| | - André Marchand
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC H2L 2C4, Canada
| |
Collapse
|
42
|
O'Callaghan E, Mahrer N, Belanger HG, Sullivan S, Lee C, Gupta CT, Winsberg M. Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study. JMIR Form Res 2022; 6:e37746. [PMID: 36178727 PMCID: PMC9568811 DOI: 10.2196/37746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Suicide is a leading cause of death in the United States, and suicidal ideation (SI) is a significant precursor and risk factor for suicide. Objective This study aimed to examine the impact of a telepsychiatric care platform on changes in SI over time and remission, as well as to investigate the relationship between various demographic and medical factors on SI and SI remission. Methods Participants included 8581 US-based adults (8366 in the treatment group and 215 in the control group) seeking treatment for depression, anxiety, or both. The treatment group included patients who had completed at least 12 weeks of treatment and had received a prescription for at least one psychiatric medication during the study period. Providers prescribed psychiatric medications for each patient during their first session and received regular data on participants. They also received decision support at treatment onset via the digital platform, which leveraged an empirically derived proprietary precision-prescribing algorithm to give providers real-time care guidelines. Participants in the control group consisted of individuals who completed the initial enrollment data and completed surveys at baseline and 12 weeks but did not receive care. Results Greater feelings of hopelessness, anhedonia, and feeling bad about oneself were most significantly correlated (r=0.24-0.37) with SI at baseline. Sleep issues and feeling tired or having low energy, although significant, had lower correlations with SI (r=0.13-0.14). In terms of demographic variables, advancing age and education were associated with less SI at baseline (r=−0.16) and 12 weeks (r=−0.10) but less improvement over time (r=−0.12 and −0.11, respectively). Although not different at baseline, the SI expression was evident in 34.4% (74/215) of the participants in the control group and 12.32% (1031/8366) of the participants in the treatment group at 12 weeks. Although the participants in the treatment group improved over time regardless of various demographic variables, participants in the control group with less education worsened over time, after controlling for age and depression severity. A model incorporating the treatment group, age, sex, and 8-item Patient Health Questionnaire scores was 77% accurate in its classification of complete remission. Those in the treatment group were 4.3 times more likely (odds ratio 4.31, 95% CI 2.88-6.44) to have complete SI remission than those in the control group. Female participants and those with advanced education beyond high school were approximately 1.4 times more likely (odds ratio 1.38, 95% CI 1.18-1.62) to remit than their counterparts. Conclusions The results highlight the efficacy of an antidepressant intervention in reducing SI, in this case administered via a telehealth platform and with decision support, as well as the importance of considering covariates, or subpopulations, when considering SI. Further research and refinement, ideally via randomized controlled trials, are needed.
Collapse
Affiliation(s)
| | - Nicole Mahrer
- Psychology Department, University of La Verne, La Verne, CA, United States
| | - Heather G Belanger
- Brightside Health Inc, Oakland, CA, United States
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | | | | | | | | |
Collapse
|
43
|
Shaker AA, Austin SF, Sørensen JA, Storebø OJ, Simonsen E. Psychiatric treatment conducted via telemedicine versus in-person consultations in mood, anxiety and personality disorders: a protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e060690. [PMID: 36171023 PMCID: PMC9528631 DOI: 10.1136/bmjopen-2021-060690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Major advancements in technology have led to considerations how telemedicine (TM) and other technology platforms can be meaningfully integrated in treatment for psychiatric disorders. The COVID-19 pandemic has placed a further focus on use of TM in psychiatry. Despite the widespread use of TM, little is known about its effect compared with traditional in-person (IP) consultation. The objective of this systematic review is to examine if individual psychiatric outpatient interventions for adults using TM are comparable to IP in terms of (1) psychopathology outcomes, (2) levels of patient satisfaction, (3) working alliance and (4) dropout from treatment. METHODS AND ANALYSIS This review will only include randomised controlled trials for adult participants with mood disorders, anxiety or personality disorders. The primary outcome is psychopathology, and secondary outcomes include patient satisfaction, treatment alliance and dropout rate. Systematic searches were conducted in MEDLINE, APA PsycINFO, Embase, Web of Science and CINAHL. The inverse-variance method will be used to conduct the meta-analysis. Effect sizes will be calculated as standardised mean difference (Hedges' g) for the primary outcome, mean difference for patient satisfaction and working alliance, and risk ratio for the dropout rate. Effect sizes will be supplemented with 95% CI. We will calculate the I² statistic to quantify heterogeneity and Chi-square statistic (χ²) to test for heterogeneity for the primary outcome. Potential clinical and methodological heterogeneity moderators will be assessed in subgroup and sensitivity analysis. The risk of bias will be assessed by Cochrane Risk of Bias Tool V.2, and confidence in cumulative evidence will be assessed by Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION No ethical approval is required for this systematic review protocol. Data sets will be deposited in the Zenodo repository. The findings of this study will be published in a peer-review scientific journal. PROSPERO REGISTRATION NUMBER CRD42021256357.
Collapse
Affiliation(s)
- Ali Abbas Shaker
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephen F Austin
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | | | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
44
|
Sherrill AM, Wiese CW, Abdullah S, Arriaga RI. Overcoming Clinician Technophobia: What We Learned from Our Mass Exposure to Telehealth During the COVID-19 Pandemic. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 7:547-553. [PMID: 36034538 PMCID: PMC9391067 DOI: 10.1007/s41347-022-00273-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/05/2022] [Accepted: 08/12/2022] [Indexed: 05/22/2023]
Abstract
Mental health clinicians have migrated to telehealth during the COVID-19 pandemic and have reported their use of telehealth may be permanent. Understanding how stakeholders overcame hesitancy regarding the use of telehealth can potentially reveal how stakeholders can adopt future clinical technologies. The exposure therapy conceptual framework provides one explanation of how mental health clinicians can face their concerns about technologies that promise to improve clinical outcomes and worker well-being. We review available literature published since the start of the pandemic on the extent to which clinicians migrated to telehealth and their reactions to their transitions. In particular, we review available literature that describes negative attitudes and worries by clinicians as one of many barriers of telehealth implementation. We introduce the perspective that the necessary transition to telehealth at the start of the pandemic functioned as an exposure exercise that changed many clinicians' cognitive and emotional reactions to the use of telehealth technologies. Next, we provide guidance on how clinicians can continue taking an exposure approach to learning emerging technologies that are safe and can benefit all stakeholders. Clinicians can now reflect on how they overcame hesitancy regarding telehealth during the pandemic and identify how to build on that new learning by applying strategies used in exposure therapy. The future of clinical work will increasingly require mental health clinicians to better serve their patient populations and enhance their own well-being by overcoming technophobia, a broad term for any level of hesitancy, reluctance, skepticism, worry, anxiety, or fear of implementing technology.
Collapse
Affiliation(s)
- Andrew M. Sherrill
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | | | | | | |
Collapse
|
45
|
Kaihara T, Scherrenberg M, Intan-Goey V, Falter M, Kindermans H, Frederix I, Dendale P. Efficacy of digital health interventions on depression and anxiety in patients with cardiac disease: a systematic review and meta-analysis . EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:445-454. [PMID: 36712158 PMCID: PMC9707908 DOI: 10.1093/ehjdh/ztac037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023]
Abstract
Aims Depression and anxiety have a detrimental effect on the health outcomes of patients with heart disease. Digital health interventions (DHIs) could offer a solution to treat depression and anxiety in patients with heart disease, but evidence of its efficacy remains scarce. This review summarizes the latest data about the impact of DHIs on depression/anxiety in patients with cardiac disease. Methods and results Articles from 2000 to 2021 in English were searched through electronic databases (PubMed, Cochrane Library, and Embase). Articles were included if they incorporated a randomized controlled trial design for patients with cardiac disease and used DHIs in which depression or anxiety was set as outcomes. A systematic review and meta-analysis were performed. A total of 1675 articles were included and the screening identified a total of 17 articles. Results indicated that telemonitoring systems have a beneficial effect on depression [standardized mean difference for depression questionnaire score -0.78 (P = 0.07), -0.55 (P < 0.001), for with and without involving a psychological intervention, respectively]. Results on PC or cell phone-based psychosocial education and training have also a beneficial influence on depression [standardized mean difference for depression questionnaire score -0.49 (P = 0.009)]. Conclusion Telemonitoring systems for heart failure and PC/cell phone-based psychosocial education and training for patients with heart failure or coronary heart disease had a beneficial effect especially on depression. Regarding telemonitoring for heart failure, this effect was reached even without incorporating a specific psychological intervention. These results illustrate the future potential of DHIs for mental health in cardiology.
Collapse
Affiliation(s)
- Toshiki Kaihara
- Corresponding author. Tel: +32 11 268 111, Fax: +32 11 268 199,
| | - Martijn Scherrenberg
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences/Human-Computer Interaction and eHealth, Diepenbeek, Belgium
- Faculty of Medicine and Health Sciences, UAntwerp, Antwerp, Belgium
| | | | - Maarten Falter
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences/Human-Computer Interaction and eHealth, Diepenbeek, Belgium
- Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Hanne Kindermans
- UHasselt, Faculty of Medicine and Life Sciences/Human-Computer Interaction and eHealth, Diepenbeek, Belgium
| | - Ines Frederix
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences/Human-Computer Interaction and eHealth, Diepenbeek, Belgium
- Faculty of Medicine and Health Sciences, UAntwerp, Antwerp, Belgium
- Faculty of Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Paul Dendale
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences/Human-Computer Interaction and eHealth, Diepenbeek, Belgium
| |
Collapse
|
46
|
E Stubbe D. Through the Lens: Telepsychotherapy and the Working Alliance. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:309-312. [PMID: 37205018 PMCID: PMC10172521 DOI: 10.1176/appi.focus.20220051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Dorothy E Stubbe
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
47
|
Ramos G, Montoya AK, Hammons HR, Smith D, Chavira DA, Rith-Najarian LR. Digital Intervention Barriers Scale–7 (DIBS-7): Development, Evaluation, and Preliminary Validation (Preprint). JMIR Form Res 2022; 7:e40509. [PMID: 37023417 PMCID: PMC10131680 DOI: 10.2196/40509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The translation of mental health services into digital formats, deemed digital mental health interventions (DMHIs), has the potential to address long-standing obstacles to accessing care. However, DMHIs have barriers of their own that impact enrollment, adherence, and attrition in these programs. Unlike in traditional face-to-face therapy, there is a paucity of standardized and validated measures of barriers in DMHIs. OBJECTIVE In this study, we describe the preliminary development and evaluation of such a scale, the Digital Intervention Barriers Scale-7 (DIBS-7). METHODS Following an iterative QUAN → QUAL mixed methods approach, item generation was guided by qualitative analysis of feedback from participants (n=259) who completed a DMHI trial for anxiety and depression and identified barriers related to self-motivation, ease of use, acceptability, and comprehension of tasks. Item refinement was achieved through DMHI expert review. A final item pool was administered to 559 treatment completers (mean age 23.02 years; 438/559, 78.4% female; 374/559, 69.9% racially or ethnically minoritized). Exploratory factor analyses and confirmatory factor analyses were estimated to determine the psychometric properties of the measure. Finally, criterion-related validity was examined by estimating partial correlations between the DIBS-7 mean score and constructs related to treatment engagement in DMHIs. RESULTS Statistical analyses estimated a 7-item unidimensional scale with high internal consistency (α=.82, ω=0.89). Preliminary criterion-related validity was supported by significant partial correlations between the DIBS-7 mean score and treatment expectations (pr=-0.25), number of modules with activity (pr=-0.55), number of weekly check-ins (pr=-0.28), and treatment satisfaction (pr=-0.71). CONCLUSIONS Overall, these results provide preliminary support for the use of the DIBS-7 as a potentially useful short scale for clinicians and researchers interested in measuring an important variable often associated with treatment adherence and outcomes in DMHIs.
Collapse
Affiliation(s)
- Giovanni Ramos
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Amanda Kay Montoya
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hayley Renee Hammons
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Danielle Smith
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Denise April Chavira
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | | |
Collapse
|
48
|
Maher M, Reilly K, Smith E, Coyne E, Murphy S, Wilson C. Receiving teletherapy in Ireland: The experiences of service users in the public mental health system. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Michael Maher
- School of Psychology, Trinity College Dublin The University of Dublin Dublin 2 Ireland
| | - Katie Reilly
- School of Psychology, Trinity College Dublin The University of Dublin Dublin 2 Ireland
| | - Elaine Smith
- HSE Adult Mental Health Service Dublin South Kildare West Wicklow Community Healthcare Kildare Ireland
| | - Elaine Coyne
- HSE Adult Mental Health Service, Co. Kildare Ireland
| | - Síle Murphy
- HSE Adult Mental Health Service, Co. Kildare Ireland
| | - Charlotte Wilson
- School of Psychology, Trinity College Dublin The University of Dublin Dublin 2 Ireland
| |
Collapse
|
49
|
Adams L, Adamo N, Hollocks MJ, Valmaggia L, Brewster A, Watson J, Krisson M, Simonoff E. Examining clinicians' concerns delivering telemental health interventions directly to autistic individuals during COVID-19. RESEARCH IN AUTISM SPECTRUM DISORDERS 2022; 94:101956. [PMID: 35369648 PMCID: PMC8963796 DOI: 10.1016/j.rasd.2022.101956] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 05/04/2023]
Abstract
Background The COVID-19 pandemic necessitated the adoption of telemental health (TMH). Pre-pandemic, clinicians had voiced many TMH concerns, but these had not been investigated with respect to autism spectrum disorder (ASD) even with it being known that there are distinct ASD-associated challenges for in-person mental health interventions. Method A convenience sample of (n = 55) clinicians completed an online survey regarding their perspectives of adopting TMH interventions in ASD, with closed- and open-answered questions. Quantitative and qualitative data were analysed descriptively/inferentially and via Content Analysis, respectively. Results Multiple clinicians endorsed each TMH challenges/barrier previously identified as concerns in the non-ASD literature. However, overall levels of concern over challenges/barriers were low, and challenges were more likely to be predicted than experienced and considered to be case/presentation specific. Challenges that were considered ASD-specific included the exacerbation of those associated with in-person delivery in ASD, alongside difficulties with trust and appropriate remote social behaviour. On average, clinicians indicated a preference for 50% TMH interventions post-pandemic. Clinicians' perceived technological competence and extent of professional experience with ASD were not significantly associated with levels of concern, nor number of experienced challenges, with TMH interventions in ASD. Conclusion In support of the existing TMH literature, challenges/barriers were more likely to be predicted than experienced and were considered to be case/presentation-specific, though this may be more variable in ASD owing to the well-established marked heterogeneity in this population. Remote provision of interventions exacerbated in-person ASD-associated challenges, as predicted, but clinician-level factors appeared not to impact TMH perceptions.
Collapse
Affiliation(s)
- Lucy Adams
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Nicoletta Adamo
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Matthew J Hollocks
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Aylana Brewster
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Jennifer Watson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Maisie Krisson
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Emily Simonoff
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| |
Collapse
|
50
|
Johnson DA, Stone A, Marsh S. Structural, Construct, and Concurrent Score Validity Evidence for the State-Interpersonal Reactivity Index in Telemental Health Care Sessions. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2022. [DOI: 10.1080/07481756.2022.2066545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Sarah Marsh
- Wake Forest University, Winston Salem, NC, USA
| |
Collapse
|