51
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Phillips EA, Himmler S, Schreyögg J. Preferences of psychotherapists for blended care in Germany: a discrete choice experiment. BMC Psychiatry 2022; 22:112. [PMID: 35151294 PMCID: PMC8841060 DOI: 10.1186/s12888-022-03765-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Digital treatment formats are emerging within mental health care. Evidence suggests that mental health care providers and recipients prefer a combination of digital and traditional elements within psychotherapy treatment formats, also called blended care (BC), over standalone digital formats. We examined the attitudes and preferences of licensed psychotherapists in Germany regarding such BC applications. METHODS We fielded a survey among psychotherapists, including questions about attitudes, previous experiences, and expectations regarding BC, as well as a discrete choice experiment. Attributes for the experiment were developed using a stepwise qualitative approach. A Bayesian D-efficient design was used to generate the choice tasks. The choice data were analyzed by applying mixed logit models. RESULTS The survey was completed by 200 psychotherapists. Attitudes towards BC were mainly positive, with strong reported intentions to use BC formats. In the choice experiment, recommendation from a professional society for a BC online component was the most important characteristic. Greater effectiveness and a larger share of face-to-face vs. online time were also desired features, while a financial incentive to use BC was less relevant.
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Affiliation(s)
- Elena A. Phillips
- grid.9026.d0000 0001 2287 2617Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | - Sebastian Himmler
- Erasmus School of Health Policy & Management Health Economics, Burg. Oudlaan 50, 3062 Rotterdam, PA Netherlands
| | - Jonas Schreyögg
- grid.9026.d0000 0001 2287 2617Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
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Aemissegger V, Lopez-Alcalde J, Witt CM, Barth J. Comparability of Patients in Trials of E-Health and Face-To-Face Psychotherapeutic Interventions for Depression: a Meta-Synthesis (Preprint). J Med Internet Res 2022; 24:e36978. [PMID: 36103217 PMCID: PMC9520399 DOI: 10.2196/36978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/16/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vera Aemissegger
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jesus Lopez-Alcalde
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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53
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Lattie EG, Stiles-Shields C, Graham AK. An overview of and recommendations for more accessible digital mental health services. NATURE REVIEWS PSYCHOLOGY 2022; 1:87-100. [PMID: 38515434 PMCID: PMC10956902 DOI: 10.1038/s44159-021-00003-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 03/23/2024]
Abstract
Mental health concerns are common, and various evidence-based interventions for mental health conditions have been developed. However, many people have difficulty accessing appropriate mental health care and this has been exacerbated by the COVID-19 pandemic. Digital mental health services, such as those delivered by mobile phone or web-based platforms, offer the possibility of expanding the reach and accessibility of mental health care. To achieve this goal, digital mental health interventions and plans for their implementation must be designed with the end users in mind. In this Review, we describe the evidence base for digital mental health interventions across various diagnoses and treatment targets. Then, we explain the different formats for digital mental health intervention delivery, and offer considerations for their use across key age groups. We discuss the role that the COVID-19 pandemic has played in emphasizing the value of these interventions, and offer considerations for ensuring equity in access to digital mental health interventions among diverse populations. As healthcare providers continue to embrace the role that technology can play in broadening access to care, the design and implementation of digital mental healthcare solutions must be carefully considered to maximize their effectiveness and accessibility.
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Affiliation(s)
- Emily G. Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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54
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Young CL, Rocks T, Opie RS, Berk M, O'Neil A. Supporting Dietary Change for the Treatment of Mood Disorders in Adults: How Can We Harness Digital Platforms? Psychiatr Ann 2022. [DOI: 10.3928/00485713-20220126-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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55
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Mathiasen K, Andersen TE, Lichtenstein MB, Ehlers LH, Riper H, Kleiboer A, Roessler KK. Clinical Effectiveness of Blended CBT Compared vs Face-to-Face CBT for adult depression: a Randomised Controlled Non-Inferiority Trial (Preprint). J Med Internet Res 2022; 24:e36577. [PMID: 36069798 PMCID: PMC9543221 DOI: 10.2196/36577] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/02/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Internet-based cognitive behavioral therapy (iCBT) has been demonstrated to be cost- and clinically effective. There is a need, however, for increased therapist contact for some patient groups. Combining iCBT with traditional face-to-face (FtF) consultations in a blended format may produce a new treatment format (B-CBT) with multiple benefits from both traditional CBT and iCBT, such as individual adaptation, lower costs than traditional therapy, wide geographical and temporal availability, and possibly lower threshold to implementation. Objective The primary aim of this study is to compare directly the clinical effectiveness of B-CBT with FtF-CBT for adult major depressive disorder. Methods A 2-arm randomized controlled noninferiority trial compared B-CBT for adult depression with treatment as usual (TAU). The trial was researcher blinded (unblinded for participants and clinicians). B-CBT comprised 6 sessions of FtF-CBT alternated with 6-8 web-based CBT self-help modules. TAU comprised 12 sessions of FtF-CBT. All participants were aged 18 or older and met the diagnostic criteria for major depressive disorder and were recruited via a national iCBT clinic. The primary outcome was change in depression severity on the 9-item Patient Health Questionnaire (PHQ-9). Secondary analyses included client satisfaction (8-item Client Satisfaction Questionnaire [CSQ-8]), patient expectancy (Credibility and Expectancy Questionnaire [CEQ]), and working (Working Alliance Inventory [WAI] and Technical Alliance Inventory [TAI]). The primary outcome was analyzed by a mixed effects model including all available data from baseline, weekly measures, 3-, 6, and 12-month follow-up. Results A total of 76 individuals were randomized, with 38 allocated to each treatment group. Age ranged from 18 to 71 years (SD 13.96) with 56 (74%) females. Attrition rate was 20% (n=15), which was less in the FtF-CBT group (n=6, 16%) than in the B-CBT group (n=9, 24%). As many as 53 (70%) completed 9 or more sessions almost equally distributed between the groups (nFtF-CBT=27, 71%; nB-CBT=26, 68%). PHQ-9 reduced 11.38 points in the FtF-CBT group and 8.10 in the B-CBT group. At 6 months, the mean difference was a mere 0.17 points. The primary analyses confirmed large and significant within-group reductions in both groups (FtF-CBT: β=–.03; standard error [SE] 0.00; P<.001 and B-CBT: β=–.02; SE 0.00; P<.001). A small but significant interaction effect was observed between groups (β=.01; SE 0.00; P=.03). Employment status influenced the outcome differently between groups, where the B-CBT group was seen to profit more from not being full-time employed than the FtF group. Conclusions With large within-group effects in both treatment arms, the study demonstrated feasibility of B-CBT in Denmark. At 6 months’ follow-up, there appeared to be no difference between the 2 treatment formats, with a small but nonsignificant difference at 12 months. The study seems to demonstrate that B-CBT is capable of producing treatment effects that are close to FtF-CBT and that completion rates and satisfaction rates were comparable between groups. However, the study was limited by small sample size and should be interpreted with caution. Trial Registration ClinicalTrials.gov NCT02796573; https://clinicaltrials.gov/ct2/show/NCT02796573 International Registered Report Identifier (IRRID) RR2-10.1186/s12888-016-1140-y
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Affiliation(s)
- Kim Mathiasen
- Research Unit for Telepsychiatry and E-Mental Health, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tonny E Andersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mia Beck Lichtenstein
- Research Unit for Telepsychiatry and E-Mental Health, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
- Nordic Institute of Health Economics, Aarhus, Denmark
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Kirsten K Roessler
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Dahlhausen F, Zinner M, Bieske L, Ehlers JP, Boehme P, Fehring L. There's an app for that, but nobody's using it: Insights on improving patient access and adherence to digital therapeutics in Germany. Digit Health 2022; 8:20552076221104672. [PMID: 35811758 PMCID: PMC9260569 DOI: 10.1177/20552076221104672] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Mobile health applications and their subset digital therapeutics—defined as
evidence-based software interventions to prevent, manage, or treat a medical
condition—offer great potential to improve patient care. However, such
solutions often struggle to reach widespread adoption. Objective This study seeks to explore healthcare stakeholders’ roles and potential for
fostering patient access and adherence to evidence-based digital
therapeutics and thereby improve health outcomes from the perspective of
digital therapeutics developers and distributors. Methods Semi-structured qualitative and semiquantitative interviews were conducted
with 19 experts from developers and distributors of digital therapeutics in
Germany to discuss their perceived relevance of different healthcare
stakeholders and strategies in promoting patient access and adherence to
digital therapeutics. Results Healthcare professionals were found to have the greatest potential to promote
both access and patient adherence to digital therapeutics, followed by
health insurers, pharmaceutical companies, and patients themselves. In terms
of patient access, healthcare professionals have potential due to their
ability to prescribe digital therapeutics. Other stakeholders’ potential
stems from their capacity to influence healthcare professionals prescription
decision. In terms of patient adherence, only healthcare professionals are
of high relevance by onboarding patients and monitoring digital therapeutics
use. Most healthcare stakeholders currently do not fully leverage their
potential. Further educating healthcare professionals and simplifying
processes for them, empowering patients to seek treatment with digital
therapeutics, and designing digital therapeutics’ product features for
better adherence can help improve patient access and adherence. Conclusions Established healthcare stakeholders and digital therapeutics developers both
need to take action to improve patient access and adherence to digital
therapeutics. Several macro-level changes can support these efforts,
including broader information dissemination, improved financial incentives,
simplified prescription and activation processes, and a wider adoption of
blended care and pay-for-performance payment models.
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Affiliation(s)
| | | | - Linn Bieske
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Jan P Ehlers
- Didactics and Educational Research in Healthcare, Medical Department, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Philip Boehme
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Leonard Fehring
- Faculty of Health, Witten/Herdecke University, Witten, Germany
- Helios University Hospital Wuppertal, Clinic for Gastroenterology, Hepatology, Endocrinology and Diabetology, Heusnerstr. 40, 42283 Wuppertal, Germany
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57
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Paterson L, Rennick-Egglestone S, Gavan SP, Slade M, Ng F, Llewellyn-Beardsley J, Bond C, Grundy A, Nicholson J, Quadri D, Bailey S, Elliott RA. Development and delivery cost of digital health technologies for mental health: Application to the Narrative Experiences Online Intervention. Front Psychiatry 2022; 13:1028156. [PMID: 36419974 PMCID: PMC9676659 DOI: 10.3389/fpsyt.2022.1028156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The increasing development and use of digital health interventions requires good quality costing information to inform development and commissioning choices about resource allocation decisions. The Narrative Experiences Online (NEON) Intervention is a web-application that delivers recorded mental health recovery narratives to its users. Two randomized controlled trials are testing the NEON Intervention in people with experience of psychosis (NEON) and people experiencing non-psychosis mental health problems (NEON-O). AIM This study describes and estimates the cost components and total cost of developing and delivering the NEON Intervention. MATERIALS AND METHODS Total costs for the NEON Trial (739 participants) and NEON-O Trial (1,024 participants) were estimated by: identifying resource use categories involved in intervention development and delivery; accurate measurement or estimation of resource use; and a valuation of resource use to generate overall costs, using relevant unit costs. Resource use categories were identified through consultation with literature, costing reporting standards and iterative consultation with health researchers involved in NEON Intervention development and delivery. Sensitivity analysis was used to test assumptions made. RESULTS The total cost of developing the NEON Intervention was £182,851. The largest cost components were software development (27%); Lived Experience Advisory Panel workshops (23%); coding the narratives (9%); and researchers' time to source narratives (9%). The total cost of NEON Intervention delivery during the NEON Trial was £118,663 (£349 per NEON Intervention user). In the NEON-O Trial, the total delivery cost of the NEON Intervention was £123,444 (£241 per NEON Intervention user). The largest cost components include updating the narrative collection (50%); advertising (19%); administration (14%); and software maintenance (11%). Uncertainty in the cost of administration had the largest effect on delivery cost estimates. CONCLUSION Our work shows that developing and delivering a digital health intervention requires expertise and time commitment from a range of personnel. Teams developing digital narrative interventions need to allocate substantial resources to curating narrative collections. IMPLICATIONS FOR PRACTICE This study identifies the development and delivery resource use categories of a digital health intervention to promote the consistent reporting of costs and informs future decision-making about the costs of delivering the NEON Intervention at scale. TRIAL REGISTRATION NEON Trial: ISRCTN11152837, registered 13 August 2018, http://www.isrctn.com/ISRCTN11152837. NEON-O Trial: ISRCTN63197153, registered 9 January 2020, http://www.isrctn.com/ISRCTN63197153.
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Affiliation(s)
- Luke Paterson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Sean P Gavan
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,Health and Community Participation Division, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Carmel Bond
- Nottingham University Business School, The University of Nottingham, Nottingham, United Kingdom
| | - Andrew Grundy
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Joe Nicholson
- School of Humanities, The University of Nottingham, Nottingham, United Kingdom
| | - Dania Quadri
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Sylvia Bailey
- Narrative Experiences Online Intervention (NEON) Lived Experience Advisory Panel, Nottingham, United Kingdom
| | - Rachel A Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
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Online therapy: an added value for inpatient routine care? Perspectives from mental health care professionals. Eur Arch Psychiatry Clin Neurosci 2022; 272:107-118. [PMID: 33725165 PMCID: PMC7961170 DOI: 10.1007/s00406-021-01251-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/03/2021] [Indexed: 11/04/2022]
Abstract
Internet-delivered interventions can be effective in treating mental disorders. However, their rate of use in German psychiatric inpatient routine care is low. The current study aimed to investigate the attitude of mental health care professionals working in inpatient care regarding internet-delivered interventions, including presumed benefits, barriers and facilitators. In total, 176 health professionals from ten inpatient psychiatric hospitals throughout Germany were surveyed on site. The professionals' attitude towards internet-delivered interventions in inpatient care was assessed by an adapted version of the 'Attitude toward Telemedicine in Psychiatry and Psychotherapy' (ATTiP) questionnaire. To identify benefits, barriers and facilitators, we developed open-response questions that were based on the 'Unified Theory of Acceptance and Use of Technology' (UTAUT) and analyzed by a qualitative content analysis. Professionals reported little experience or knowledge about internet-delivered interventions. Their attitude towards internet-delivered interventions in psychiatric inpatient care was rather indifferent. The most frequently mentioned potential benefits were an optimised treatment structure and patient empowerment; the most frequently anticipated barriers were too severe symptoms of patients, the feared neglect of face-to-face contacts and insufficient technical equipment; and the most frequently mentioned facilitators were high usability of the internet-based intervention, a sufficient functional level of the patient and further education of staff. For successful implementation in the inpatient sector, internet-delivered interventions must be adapted to the special needs of severely mentally ill patients and to the hospital management systems and workflow. In addition, technical preconditions (internet access, devices) must be met. Last, further education of mental health care professionals is needed.
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59
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Milgrom J, Danaher BG, Seeley JR, Holt CJ, Holt C, Ericksen J, Tyler MS, Gau JM, Gemmill AW. Internet and Face-to-face Cognitive Behavioral Therapy for Postnatal Depression Compared With Treatment as Usual: Randomized Controlled Trial of MumMoodBooster. J Med Internet Res 2021; 23:e17185. [PMID: 34889742 PMCID: PMC8701704 DOI: 10.2196/17185] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/10/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND. OBJECTIVE This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT). METHODS In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up. RESULTS Of the 116 participants, 107 (92.2%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6% and 47.7% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups. CONCLUSIONS In this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683&isReview=true.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Brian G Danaher
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | - John R Seeley
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | | | - Charlene Holt
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia
| | - Jennifer Ericksen
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia
| | - Milagra S Tyler
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | - Jeff M Gau
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | - Alan W Gemmill
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia
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Simon N, Ploszajski M, Lewis C, Smallman K, Roberts NP, Kitchiner NJ, Brookes-Howell L, Bisson JI. Internet-based psychological therapies: A qualitative study of National Health Service commissioners and managers views. Psychol Psychother 2021; 94:994-1014. [PMID: 33788999 DOI: 10.1111/papt.12341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/11/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore in-depth the views on Internet-based psychological therapies and their implementation from the perspective of National Health Service (NHS) commissioners and managers. DESIGN Qualitative interview study. METHOD Ten NHS commissioners and managers participated in a semi-structured, co-produced interview. Each transcribed interview was double-coded and thematically analysed using The Framework Method. RESULTS Interviews generated three main themes. (1) Capacity issues across psychological therapy services create barriers to face-to-face therapies, and Internet-based interventions offer a solution. (2) Despite reservations, there is growing acceptance of Internet-based therapies. Different ways of connecting with patients are required, and Internet-based treatments are accessible and empowering treatment options, with guided self-help (GSH) preferred. Internet-based interventions may however exclude some individuals and be a threat to the therapeutic relationship between patient and practitioner. (3) Successful roll-out of Internet-based interventions would be facilitated by a strong empirical- or practice-based evidence, a national coordinated approach and timely training and supervision. Barriers to the roll-out include digital intervention set-up costs and delays due to NHS inflexibility. CONCLUSIONS The study highlights factors influencing access to Internet-based therapies, important given the rapid evolution of e-therapies, and particularly timely given increasing use of remote therapies due to COVID-19 restrictions. Interviewees were open to Internet-based approaches, particularly GSH interventions, so long as they do not compromise on therapy quality. Interviewees acknowledged implementation may be challenging, and recommendations were offered. PRACTITIONER POINTS There is a shift in practice and increasingly positive views from NHS staff around remote psychological therapies and different ways of connecting with patients, particularly since the COVID-19 pandemic. There is a strong preference for Internet-based psychological interventions that are guided and that include built-in outcome measures co-produced with service users. There is a need to raise awareness of the growing evidence base for Internet-based psychological therapies, including research examining therapeutic alliance across Internet-based and face-to-face therapies. Challenges implementing Internet-based psychological therapies include therapist resistance to changing working practices in general, and inflexibility of the NHS, and national, coordinated implementation efforts are encouraged.
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Affiliation(s)
- Natalie Simon
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
| | - Matt Ploszajski
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
| | - Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
| | - Kim Smallman
- Centre for Trials Research, Cardiff University School of Medicine, Wales, UK
| | - Neil P Roberts
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK.,Psychology and Psychological Therapies Directorate, Cardiff and Vale University Health Board, Wales, UK
| | - Neil J Kitchiner
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK.,Psychology and Psychological Therapies Directorate, Cardiff and Vale University Health Board, Wales, UK
| | - Lucy Brookes-Howell
- Centre for Trials Research, Cardiff University School of Medicine, Wales, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK
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61
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Romijn G, Batelaan N, Koning J, van Balkom A, de Leeuw A, Benning F, Hakkaart van Roijen L, Riper H. Acceptability, effectiveness and cost-effectiveness of blended cognitive-behavioural therapy (bCBT) versus face-to-face CBT (ftfCBT) for anxiety disorders in specialised mental health care: A 15-week randomised controlled trial with 1-year follow-up. PLoS One 2021; 16:e0259493. [PMID: 34767575 PMCID: PMC8589191 DOI: 10.1371/journal.pone.0259493] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 10/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent and cause substantial economic burden. Blended cognitive-behavioural therapy (bCBT), which integrates Internet-based CBT and face-to-face CBT (ftfCBT), is an attractive and potentially cost-saving treatment alternative to conventional CBT for patients with anxiety disorders in specialised mental health care. However, little is known about the effectiveness of bCBT in routine care. We examined the acceptability, effectiveness and cost-effectiveness of bCBT versus ftfCBT in outpatient specialised care to patients with panic disorder, social anxiety disorder and generalised anxiety disorder. METHODS AND FINDINGS Patients with anxiety disorders were randomised to bCBT (n = 52) or ftfCBT (n = 62). Acceptability of bCBT and ftfCBT were evaluated by assessing treatment preference, adherence, satisfaction and therapeutic alliance. Costs and effects were assessed at post-treatment and one-year follow-up. Primary outcome measure was the Beck Anxiety Inventory (BAI). Secondary outcomes were depressive symptoms, general psychopathology, work and social adjustment, quality of life and mastery. Incremental cost-effectiveness ratios (ICERs) were computed from societal and healthcare perspectives by calculating the incremental costs per incremental quality-adjusted life year (QALY). No significant differences between bCBT and ftfCBT were found on acceptability or effectiveness measures at post-treatment (Cohen's d between-group effect size on BAI = 0.15, 95% CI -0.30 to 0.60) or at one-year follow-up (d = -0.38, 95% CI -0.84 to 0.09). The modelled point estimates of societal costs (bCBT €10945, ftfCBT €10937) were higher and modelled point estimates of direct medical costs (bCBT €3748, ftfCBT €3841) were lower in bCBT. The acceptability curves showed that bCBT was expected to be a cost-effective intervention. Results should be carefully interpreted due to the small sample size. CONCLUSIONS bCBT appears an acceptable, clinically effective and potentially cost-saving alternative option for treating patients with anxiety disorders. Trials with larger samples are needed to further investigate cost-effectiveness. TRIAL REGISTRATION Netherlands Trial Register: NTR4912.
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Affiliation(s)
- Geke Romijn
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Specialised Mental Health Institution, GGz Breburg, Tilburg, the Netherlands
- Altrecht Academic Anxiety Centre, Utrecht, Netherlands
| | - Neeltje Batelaan
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jeroen Koning
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Institute for Psychiatry, Vincent van Gogh, Venray, The Netherlands
| | - Anton van Balkom
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Aart de Leeuw
- Altrecht Academic Anxiety Centre, Utrecht, Netherlands
| | - Friederike Benning
- Department of Health Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - Leona Hakkaart van Roijen
- Department of Health Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - Heleen Riper
- Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Centre for Telepsychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
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Haun MW, Hoffmann M, Wildenauer A, Tönnies J, Wensing M, Szecsenyi J, Peters-Klimm F, Krisam R, Kronsteiner D, Hartmann M, Friederich HC. Health providers' experiences with mental health specialist video consultations in primary care: a qualitative study nested within a randomised feasibility trial. BMJ Open 2021; 11:e047829. [PMID: 34753752 PMCID: PMC8578962 DOI: 10.1136/bmjopen-2020-047829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Despite available effective treatments for mental health disorders, few patients in need receive even the most basic care. Integrated telepsychiatry services may be a viable option to increase access to mental healthcare. The aim of this qualitative process evaluation embedded in a randomised controlled feasibility trial was to explore health providers' experiences with a mental healthcare model integrating mental health specialist video consultations (MHSVC) and primary care. METHODS A qualitative process evaluation focusing on MHSVC in primary care was conducted. In 13 semistructured interviews, we assessed the experience of all mental health specialists, primary care physicians and medical assistants who participated in the trial. A thematic analysis, focusing on the implementation, mechanisms of impact and context, was applied to investigate the data. RESULTS Considering (1) the implementation, participants evaluated the consultations as feasible, easy to use and time saving. Concerning (2) the mechanisms of impact, the consultations were regarded as effective for patients. Providers attributed the patients' improvements to two key aspects: the familiarity of the primary care practice and the fast access to specialist mental healthcare. Mental health specialists observed trustful therapeutic alliances emerging and described their experience as comparable to same-room care. However, compared with same-room care, specialists perceived the video consultations as more challenging and sometimes more exhausting due to the additional effort required for establishing therapeutic alliances. Regarding (3) the intervention's context, shorter travel distances for patients positively affected the implementation, while technical failures, that is, poor Internet connectivity, emerged as the main barrier. CONCLUSIONS MHSVCs in primary care are feasible and successful in improving access to mental healthcare for patients. To optimise engagement and comfort of both patients and health providers, future work should focus on empirical determinants for establishing robust therapeutic alliances with patients receiving MHSVC (eg, leveraging non-verbal cues for therapeutic purposes). TRIAL REGISTRATION NUMBER DRKS00015812; Results.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Alina Wildenauer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
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King EL, Spencer CM, Meeks CA. How the COVID-19 Pandemic Can and Must Expand Social Worker e-Interventions for Mental Health, Family Wellness, and Beyond. SOCIAL WORK 2021; 67:swab043. [PMID: 34694398 PMCID: PMC8574323 DOI: 10.1093/sw/swab043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 07/20/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
Both media and academic reports have highlighted COVID-19's negative impacts on mental health and safety in the United States, yet care and service gaps persist. Evidence suggests that a default to in-person service delivery did not meet clients' needs before the pandemic, and that unmet needs have ballooned since COVID-19 spread throughout the United States due to a combination of increased stress, social isolation, and fewer available services during lockdowns. This article reviews literature on online interventions' utility and effectiveness in preventing and treating problems likely exacerbated under pandemic conditions, including mental health conditions, anger, couple dynamics, parenting, and alcohol misuse. The article also describes barriers to evidence-based e-interventions' wider and more consistent use, highlights some vulnerable populations' unique service needs, outlines service gaps that online programs might effectively mitigate, and offers a path by which social workers can lead an interdisciplinary charge in researching, developing, and implementing e-interventions during the current pandemic and beyond.
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Honey A, Waks S, Hines M, Glover H, Hancock N, Hamilton D, Smith-Merry J. COVID-19 and Psychosocial Support Services: Experiences of People Living with Enduring Mental Health Conditions. Community Ment Health J 2021; 57:1255-1266. [PMID: 34235615 PMCID: PMC8262584 DOI: 10.1007/s10597-021-00871-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
This paper uses secondary analysis to understand how COVID-19 shaped people's experiences with psychosocial support services in Australia. Data are drawn from questionnaires (n = 66) and semi-structured interviews (n = 62), conducted for a national service evaluation, with 121 people living with enduring mental health conditions and using psychosocial support services. Data relating to COVID-19 were inductively coded and analysed using constant comparative analysis. Most people's experiences included tele-support. While some people described minimal disruption to their support, many reported reduced engagement. People's wellbeing and engagement were influenced by: their location, living situation and pre-COVID lifestyles; physical health conditions; access to, comfort with, and support worker facilitation of technology; pre-COVID relationships with support workers; and communication from the organisation. The findings can help services prepare for future pandemics, adjust their services for a 'COVID-normal' world, and consider how learnings from COVID-19 could be incorporated into a flexible suite of service delivery options.
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Affiliation(s)
- Anne Honey
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Shifra Waks
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Monique Hines
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Helen Glover
- Enlightened Consultants, Brisbane, QLD, Australia
| | - Nicola Hancock
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Debra Hamilton
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Acceptance of Psycho-Oncological Counseling Formats in a Cancer Counseling Center during the COVID-19 Pandemic: An Exploratory Care Study. ACTA ACUST UNITED AC 2021; 28:3795-3803. [PMID: 34677241 PMCID: PMC8535020 DOI: 10.3390/curroncol28050323] [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: 07/14/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 12/03/2022]
Abstract
Background: The COVID-19 pandemic made it necessary to change established structures of medical counseling services and quickly establish digital counseling formats to ensure continuity of care. In this context, we offered telephone and video-telephonic counseling in addition to traditional face-to-face counseling in the office. Methods: Patients (n = 100) of the Cancer Counseling Center, Tübingen, were asked to complete a questionnaire to assess the acceptance of the counseling format following each counseling session (office, telephone, and video) in the period between July 2020 and February 2021. The questionnaire included the subject areas of patient characterization, assessment of therapeutic contact, therapeutic relationship, and hurdles and was used in this exploratory care study. Results: The satisfaction and acceptance of the three counseling formats (office, telephone, and video) were rated as “good” to “very good” in the three subgroups (range 1–6, office M = 1.2, telephone M = 1.3, video M = 1.4). Likewise, the “therapeutic relationship” achieved high ratings in terms of establishment of a therapeutic relationship in all three subgroups (office M = 5.7, telephone M = 5.0, video M = 5.0). The type of contact (office and video counseling) achieved a significant main effect on the therapeutic relationship for items such as “I believe that counseling is helping me” (F(2,97) = 4.80, p = 0.01) and “I feel that I can rely on the counselor/therapist” (F(2,97) = 3.29, p = 0.04). The “hurdles” were rated as minor and tolerable (office M = 1.3, telephone M = 1.3, video M = 1.4). Predictor analyses showed that there was no effect of age and gender on the acceptance of digital counseling formats in the present sample. Discussion and Conclusion: On the basis of this survey, it can be concluded that digital counseling formats were perceived by patients as a promising addition to the classic face-to-face setting. In addition, it can be stated that the digital formats (telephone and video) were not generally preferred to face-to-face counseling, but that the innovative telecounseling was accepted and perceived with great satisfaction and acceptance. Accordingly, the additional use of digital counseling formats could be an opportunity to enrich and expand the existing presence structures also after the COVID-19 pandemic.
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Romero D, Johansson M, Hermansson U, Lindner P. Impact of Users' Attitudes Toward Anonymous Internet Interventions for Cannabis vs. Alcohol Use: A Secondary Analysis of Data From Two Clinical Trials. Front Psychiatry 2021; 12:730153. [PMID: 34646175 PMCID: PMC8502932 DOI: 10.3389/fpsyt.2021.730153] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Numerous trials have demonstrated the efficacy of internet interventions targeting alcohol or cannabis use, yet a substantial proportion of users do not benefit from the format, warranting further research to identify moderators of treatment effects. Users' initial attitudes toward treatment is a potential moderator, yet no previous study has investigated users' attitudes in the context of internet interventions for addictive disorders. Method: In this secondary analysis on two internet-based trials targeting harmful alcohol use (n = 1,169) and regular cannabis use (n = 303), respectively, we compared user groups' attitudes at the item level; explored within-group heterogeneity by submitting attitude scores to a k-means cluster analysis; and investigated whether latent subgroups in each user group moderated the treatment effects. Outcome models were run using generalized linear models with 10,000 bias-corrected bootstraps accounting for subject-level clustering. Results: While substance groups and latent subgroups converged in enjoying the anonymity provided by the format, their interest toward treatment differed. Outcome analyses revealed a significant and negative time by subgroup effect on grams of cannabis consumed and screening test score (CAST), favoring the subgroup with positive treatment attitudes. There were not any significant effects of subgroup on alcohol consumption. Despite initial treatment reluctance, participants in the neutral subgroup decreased their cannabis use (gram) significantly when receiving the intervention vs. control. Conclusions: This first, exploratory study revealed key differences between substance groups' attitudes, but more importantly that within-group heterogeneity appear to affect cannabis outcomes. Assessing attitudes could be key in patient-treatment matching, yet more research is needed.
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Affiliation(s)
- Danilo Romero
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
| | - Magnus Johansson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
| | - Ulric Hermansson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Region Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Dependency Disorders, Region Stockholm, Stockholm, Sweden
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Gerlinger G, Mangiapane N, Sander J. [Digital health applications (DiGA) in medical and psychotherapeutic care. Opportunities and challenges from the perspective of the healthcare providers]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1213-1219. [PMID: 34550412 DOI: 10.1007/s00103-021-03408-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Abstract
Since 2019, insured persons have a right by law to receive a prescription of digital health applications (DiGA). DiGA can be used in a variety of ways. Most healthcare providers are receptive to the possibilities of integration of DiGA into their treatment. In particular, the promotion of patient empowerment through DiGA is seen as a potential advantage by physicians and psychotherapists.However, from the healthcare provider's view, the preconditions for a successful integration of DiGA into the healthcare system are not yet fulfilled. The most important challenge that remains to be solved is the creation of acceptance and trust in a careful, producer-independent quality inspection of DiGA. Verified evidence on the effectiveness, interoperability, and data security of DiGA, as well as on the additional workload for providers, should be transparently available before they can be prescribed to patients. Furthermore, findings from health services research on the optimal integration of a DiGA into clinical workflow should be generated and integrated into the regulations. In addition, DiGA should be prescribed only if individual circumstances of the patient were considered.
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Affiliation(s)
- Gabriel Gerlinger
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V., Reinhardtstraße 27 B, 10117, Berlin, Deutschland
| | - Nino Mangiapane
- Stabsbereich Strategie, Politik und Kommunikation, Kassenärztliche Bundesvereinigung, Berlin, Deutschland
| | - Julia Sander
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V., Reinhardtstraße 27 B, 10117, Berlin, Deutschland.
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Forman-Hoffman VL, Nelson BW, Ranta K, Nazander A, Hilgert O, de Quevedo J. Significant reduction in depressive symptoms among patients with moderately-severe to severe depressive symptoms after participation in a therapist-supported, evidence-based mobile health program delivered via a smartphone app. Internet Interv 2021; 25:100408. [PMID: 34401367 PMCID: PMC8350582 DOI: 10.1016/j.invent.2021.100408] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023] Open
Abstract
Depression is a debilitating disorder associated with poor health outcomes, including increased comorbidity and early mortality. Despite the advent of new digital health interventions, few have been tested among patients with more severe forms of depression. As such, in an intent-to-treat study we examined whether 218 patients with at least moderately severe depressive symptoms (PHQ-9 ≥ 15) experienced significant reductions in depressive symptoms after participation in a therapist-supported, evidence-based mobile health (mHealth) program, Meru Health Program (MHP). Patients with moderately severe and severe depressive symptoms at pre-program assessment experienced significant decreases in depressive symptoms at end-of treatment (mean [standard deviation] PHQ-9 reduction = 8.30 [5.03], Hedges' g = 1.64, 95% CI [1.44, 1.85]). Also, 34% of patients with at least moderately severe depressive symptoms at baseline and 29.9% of patients with severe depressive symptoms (PHQ-9 ≥ 20) at baseline responded to the intervention at end-of-treatment, defined as experiencing ≥50% reduction in PHQ-9 score and a post-program PHQ-9 score lower than 10. Limitations include use lack of a control group and no clinical diagnostic information. Future randomized trials are warranted to test the MHP as a scalable solution for patients with more severe depressive symptoms.
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Affiliation(s)
| | - Benjamin W. Nelson
- Meru Health Inc., San Mateo, CA, USA
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, NC, USA
| | | | | | | | - Joao de Quevedo
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
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Dederichs M, Weber J, Pischke CR, Angerer P, Apolinário-Hagen J. Exploring medical students' views on digital mental health interventions: A qualitative study. Internet Interv 2021; 25:100398. [PMID: 34026567 PMCID: PMC8122007 DOI: 10.1016/j.invent.2021.100398] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Medical students show a relatively high prevalence for common mental disorders. Only few of those in need for treatment seek professional help. Therefore, easily accessible interventions are required. While several evidence-based internet- and mobile-based interventions (IMIs) have been proposed, little is known about medical students' attitudes towards using them. OBJECTIVE We aimed to explore the views of medical students on IMIs as well as facilitators and barriers to use them and gain first insights into their preferences for tailored IMIs. METHODS We conducted four focus groups with 26 medical students enrolled at a German medical school in March 2020. Focus groups were audio-recorded, transcribed and analyzed following established approaches for qualitative content analysis. RESULTS Medical students valued IMIs for their low-threshold and flexible access, their potential to bridge waiting times and as a first step towards face-to-face-therapy. However, medical students preferred face-to-face interventions in case of severe mental health problems. The main disadvantages named by students included difficulties to find or decide on suitable IMIs based on clear quality criteria, fear of a misdiagnosis and lack of personalisation and human interaction. Some students also questioned the effectiveness of IMIs. Easy handling, flexible use, data safety and easily understandable terms of use were believed to facilitate the uptake of IMIs, whereas technical problems, frequent notifications, required internet access, need to register, lack of anonymity, high time expenditure and costs were reported to hinder their use. Most students did not prefer IMIs tailored to medical students but rather wanted to use IMIs suitable for students of all disciplines. CONCLUSION Our results suggest overall positive views regarding IMIs for mental health promotion but concerns regarding their use for severe mental disorders and acute crises. Our findings indicate that IMIs may represent promising tools for stress prevention and early interventions for medical students. Students explicitly stated to prefer quality-approved IMIs recommended and provided by their university.
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Affiliation(s)
- Melina Dederichs
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, North Rhine-Westphalia, Germany
| | - Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, North Rhine-Westphalia, Germany
| | - Claudia R. Pischke
- Institute of Medical Sociology, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, North Rhine-Westphalia, Germany
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, North Rhine-Westphalia, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, North Rhine-Westphalia, Germany
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Teles S, Ferreira A, Paúl C. Assessing attitudes towards online psychoeducational interventions: Psychometric properties of a Brief Attitudes Scale. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e1-e10. [PMID: 33170537 DOI: 10.1111/hsc.13227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/20/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
Participant attitudes are an explanatory factor for attrition in online health-related interventions. However, its assessment prior to interventions start is uncommon, partly because proper measures are missing. This study presents the psychometric properties of a new scale measuring attitudes towards online psychoeducational interventions (OPIs). Structural validity, reliability and screening performance of the Online Psychoeducational Intervention - Brief Attitudes Scale (OPI-BAS) were studied in a sample of 157 dementia caregivers. Scale cut-off scores were derived to categorise the participants into 'OPIs sympathisers' or 'non-sympathisers'. Groups were compared across sociodemographic and internet use variables. A parsimonious five-item version of OPI-BAS demonstrated good structural validity, with one factor explaining 63.3% of variance. Internal consistency of the scale was high (α = 0.85). OPI-BAS showed good screening performance in identifying individuals with either a preference to use conventional face-to-face or online psychoeducational interventions (area under the curve = 0.84). An optimal cut-off score of 20 was suggested by the receiver operating characteristic graph, providing good sensitivity (74%) and specificity (84%). No significant differences were found between groups on sociodemographic and internet use variables. Attitudes towards OPIs were overall positive, but face-to-face interventions were preferred. This study offers preliminary support to the psychometric quality of OPI-BAS. This short scale has practical applications for research and intervention.
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Affiliation(s)
- Soraia Teles
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Behavioral Sciences, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Porto, Portugal
| | - Ana Ferreira
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Behavioral Sciences, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Porto, Portugal
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Ribeiro NS, Colugnati FAB, Kazantzis N, Sartes LMA. Observing the Working Alliance in Videoconferencing Psychotherapy for Alcohol Addiction: Reliability and Validity of the Working Alliance Inventory Short Revised Observer. Front Psychol 2021; 12:647814. [PMID: 34531780 PMCID: PMC8438131 DOI: 10.3389/fpsyg.2021.647814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/26/2021] [Indexed: 01/02/2023] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has affected the mental health and alcohol consumption of individuals. Videoconferencing psychotherapy has become a fundamental mode of treatment for people with alcohol use disorders. However, there are still doubts about its effectiveness and the therapeutic relationship. The working alliance is considered a foundation of effective practice in cognitive behavioral therapy (CBT). Observer measurements of the working alliance have demonstrated reliability and meaningful associations with the reduction of symptoms. However, translations of instruments to evaluate the working alliance and examine its construct have not previously been conducted for online psychotherapy for alcohol addiction. This study aimed for the cross-cultural adaptation of the Working Alliance Inventory-Short Form-Observer (WAI-SR-O) for Brazil and the evaluation of its reliability and evidence of its validity in videoconferencing psychotherapy for alcoholism. The WAI-SR-O was applied by pairs of observers for the evaluation of the working alliance in 19 recorded sessions of videoconferencing psychotherapy of 10 clients with a diagnosis of alcohol addiction. The sessions were also evaluated by the therapist (WAI-T) and client (WAI-C). The WAI-SR-O shows a moderate inter-rater intraclass correlation coefficient (ICC = 0.67) for the general scale, higher ICC for the goals and bond subscales, and a moderate value for the task subscale. The internal consistency was good (a = 0.86). The results show low but significant correlations among the goals and bond subscales of the WAI-SR-O and the general, goals, and bond scales of the WAI-T. No correlations were found with the WAI-C. As the literature points out, the client, therapist, and observer versions of the WAI evaluated the alliance differently, requiring further study. The WAI-SR-O proved to be a reliable and valid measurement for the evaluation of the working alliance in videoconferencing psychotherapy for alcohol addiction, becoming an important tool for the study of the working alliance in telepsychotherapy.
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Affiliation(s)
- Nathálya Soares Ribeiro
- Human Sciences Institute, Psychology Department, Center for Research, Intervention, and Evaluation for Alcohol and Drugs, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Fernando Antonio Basile Colugnati
- Human Sciences Institute, Psychology Department, Center for Research, Intervention, and Evaluation for Alcohol and Drugs, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit, Institute for Social Neuroscience, Melbourne, VIC, Australia
- Beck Institute for Cognitive Behavior Therapy and Research, Philadelphia, PA, United States
| | - Laisa Marcorela Andreoli Sartes
- Human Sciences Institute, Psychology Department, Center for Research, Intervention, and Evaluation for Alcohol and Drugs, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Gericke F, Ebert DD, Breet E, Auerbach RP, Bantjes J. A qualitative study of university students' experience of Internet‐based CBT for depression. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Franco Gericke
- Institute for Life Course Health Research Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
| | - David D. Ebert
- Psychology & Digital Mental Health Care, Department of Sport and Health Sciences Technical University Munich Munich Germany
| | - Elsie Breet
- Institute for Life Course Health Research Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
| | | | - Jason Bantjes
- Institute for Life Course Health Research Department of Global Health Faculty of Medicine and Health Sciences Stellenbosch University Stellenbosch South Africa
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73
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Jacobi C, Waldherr K, Klesges LM, Dorner TE, Taylor CB. Introduction to the EJPH supplement 'E-mental health: exploring the evidence base and stakeholders' perspectives on Internet-based interventions for the prevention of mental health conditions'. Eur J Public Health 2021; 31:i1-i2. [PMID: 34240151 PMCID: PMC8266529 DOI: 10.1093/eurpub/ckz087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Corinna Jacobi
- Technische Universität Dresden, Faculty of Psychology, Chair of Clinical Psychology and E-Mental Health, Dresden, Germany
| | - Karin Waldherr
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| | - Lisa M Klesges
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Thomas Ernst Dorner
- Department of Social and Preventive Medicine, Medical University of Vienna, Centre for Public Health, Vienna, Austria
| | - C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
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74
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Kuso S, Nitsch M, Zeiler M, Simek M, Adamcik T, Dey M, Berger T, Krieger T, Weisel KK, Zarski AC, Ebert DD, Schaub MP, Moser CT, Botella C, Baños R, Herrero R, Etchemendy E, Nacke B, Beintner I, Vollert B, Schmidt-Hantke J, Hütter K, Jacobi C, Waldherr K. Stakeholders' views on online interventions to prevent common mental health disorders in adults implemented into existing healthcare systems in Europe. Eur J Public Health 2021; 31:i55-i63. [PMID: 34240157 PMCID: PMC8495679 DOI: 10.1093/eurpub/ckab043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Online preventive interventions can help to reduce the incidence of mental disorders. Whereas knowledge on stakeholders' attitudes and factors relevant for successfully integrating online treatment into existing healthcare systems is available, knowledge is scarce for online prevention. METHODS Stakeholders from Germany, Switzerland, Austria and Spain were surveyed. Potential facilitators/delivery staff (e.g. psychologists, psychotherapists) completed an online questionnaire (n = 183), policy makers (i.e. from the governing sector or health insurance providers) participated in semi-structured interviews (n = 16) and target groups/potential users of mental illness prevention (n = 49) participated in ten focus groups. Thematic analysis was used to identify their experiences with and attitudes and needs regarding online programmes to prevent mental disorders. Additionally, it was examined which groups they consider underserved and which factors they consider as fostering and hindering for reach, adoption, implementation and maintenance (cf. RE-AIM model) when integrating online prevention into existing healthcare systems. RESULTS Main advantages of online mental illness prevention are perceived in low structural and psychological barriers. Lack of personal contact, security, privacy and trust concerns were discussed as disadvantages. Relevant needs are high usability and target group appropriateness, evidence for effectiveness and the use of motivational tools. CONCLUSIONS Positive attitudes among stakeholders are the key for successful integration of online mental illness prevention into existing healthcare systems. Potential facilitators/delivery staff must receive training and support to implement these programmes; the programmes must be attractive and continuously evaluated, updated and promoted to ensure ongoing reach; and existing infrastructure and contextual factors must be considered.
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Affiliation(s)
- Stefanie Kuso
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Martina Nitsch
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Michael Zeiler
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
| | - Monika Simek
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
| | - Tanja Adamcik
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Michelle Dey
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David D Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Christian T Moser
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christina Botella
- Jaume I University, Castellón, Spain.,CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
| | - Rosa Baños
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Rocio Herrero
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Ernestina Etchemendy
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Barbara Nacke
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Ina Beintner
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Bianka Vollert
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | | | - Kristian Hütter
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Karin Waldherr
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
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Irish M, Kuso S, Simek M, Zeiler M, Potterton R, Musiat P, Nitsch M, Wagner G, Karwautz A, Bolinski F, Karyotaki E, Rovira CS, Etchemendy E, Herrero R, Mira A, Cormo G, Baños R, Garcia-Palacios A, Ebert DD, Franke M, Zarski AC, Weisel K, Berger T, Dey M, Schaub MP, Jacobi C, Botella C, Oliver E, Gordon G, Spencer L, Waldherr K, Schmidt U. Online prevention programmes for university students: stakeholder perspectives from six European countries. Eur J Public Health 2021; 31:i64-i70. [PMID: 34240152 PMCID: PMC8495721 DOI: 10.1093/eurpub/ckab040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Students beginning university are at a heightened risk for developing mental
health disorders. Online prevention and early intervention programmes
targeting mental health have the potential to reduce this risk, however,
previous research has shown uptake to be rather poor. Understanding
university stakeholders’ (e.g. governing level and delivery staff
[DS] and students) views and attitudes towards such online prevention
programmes could help with their development, implementation and
dissemination within university settings. Methods Semi-structured interviews, focus groups and online surveys were completed
with staff at a governing level, university students and DS (i.e. student
health or teaching staff) from six European countries. They were asked about
their experiences with, and needs and attitudes towards, online prevention
programmes, as well as the factors that influence the translation of these
programmes into real-world settings. Results were analyzed using thematic
analysis. Results Participating stakeholders knew little about online prevention programmes for
university settings; however, they viewed them as acceptable. The main
themes to emerge were the basic conditions and content of the programmes,
the awareness and engagement, the resources needed, the usability and the
responsibility and ongoing efforts to increase reach. Conclusions Overall, although these stakeholders had little knowledge about online
prevention programmes, they were open to the idea of introducing them. They
could see the potential benefits that these programmes might bring to a
university setting as a whole and the individual students and staff
members.
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Affiliation(s)
- Madeleine Irish
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Stefanie Kuso
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| | - Monika Simek
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Michael Zeiler
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Rachel Potterton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Peter Musiat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Martina Nitsch
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| | - Gudrun Wagner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Andreas Karwautz
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Felix Bolinski
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Ernestina Etchemendy
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Rocio Herrero
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | | | - Giulia Cormo
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Rosa Baños
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | | | - David D Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marvin Franke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Kiona Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, Universität Bern, Bern, Switzerland
| | - Michelle Dey
- Universität Zürich, Schweizer Institut für Sucht- und Gesundheitsforschung, Zurich, Switzerland
| | - Michael P Schaub
- Universität Zürich, Schweizer Institut für Sucht- und Gesundheitsforschung, Zurich, Switzerland
| | - Corinna Jacobi
- Department of Psychology, Technische Universität Dresden, School of Science, Chair of Clinical Psychology and E-Mental-Health, Dresden, Germany
| | | | | | - Gemma Gordon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Lucy Spencer
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Karin Waldherr
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Scholl J, Kohls E, Görges F, Steinbrecher M, Baldofski S, Moessner M, Rummel-Kluge C. Acceptability and Feasibility of the Transfer of Face-to-Face Group Therapy to Online Group Chats in a Psychiatric Outpatient Setting During the COVID-19 Pandemic: Longitudinal Observational Study. JMIR Form Res 2021; 5:e27865. [PMID: 34161252 PMCID: PMC8315157 DOI: 10.2196/27865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND At the height of the COVID-19 pandemic, several mental health care providers were obliged to shut down outpatient services, including group therapy and psychoeducational sessions. The lockdown in many countries is a serious threat to people's mental well-being, especially for individuals with severe mental illnesses. Discontinued outpatient treatments and disruption of daily routines are considered to be risk factors for destabilization of patients with mental illness. OBJECTIVE The aim of this study was to evaluate the acceptability, usability, and feasibility of a group chat program to replace cancelled face-to-face group sessions in an outpatient psychiatric department. METHODS Participants (N=33) were recruited in the outpatient department of a large university medical center in Leipzig, Germany. Former face-to-face group participants were invited to take part in a therapist-guided group-chat for 4 weeks (8 sessions) and were asked to evaluate the program via self-administered standardized questionnaires at baseline (T0, preintervention), after every chat session (T1), and posttreatment (T2, after 4-6 weeks). The chat groups were specific to the following mental disorder diagnoses and based on the same therapeutic principles and techniques as the former face-to-face groups: anxiety, depression, obsessive-compulsive disorder, and adult attention-deficit/hyperactivity disorder (ADHD). Sociodemographic measures, attitudes toward the COVID-19 pandemic, depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), treatment credibility/expectancy (Credibility Expectancy Questionnaire), and participants' satisfaction (Client Satisfaction Questionnaire-8 [ZUF-8]) were measured. RESULTS Participants joined an average of 5 out of 8 offered chat sessions. Participation rates in the respective groups were highest in the ADHD group (8.6/11, 78%) and lowest in the anxiety group (3.7/9, 41%). The overall preintervention level of depressive symptoms was moderate and showed a slight, nonsignificant improvement at posttreatment (T0: mean 10.7, SD 5.5; T2: mean 10.2, SD 5.5). A similar result was observed regarding quality of life (T0: median 41.7-68.8; T2: median 50-70.3). Treatment credibility and expectancy scores were medium-high (T0: meancredibility 18.1, SD 3.8; meanexpectancy 11.2, SD 5.1; T2: meancredibility 17.1, SD 4.8; meanexpectancy 10.3, SD 5.8). Further, significant correlations were detected between posttreatment expectancy score and posttreatment PHQ-9 score (r=-0.41, P=.02), posttreatment physical quality of life (r=0.54, P=.001), and posttreatment psychological quality of life (r=0.53, P=.002). Overall, participants' satisfaction with the program was very high, both after chat sessions and at posttreatment (ZUF-8: mean score 20.6, SD 1.0). Of all participants, a majority (27/31, 87%) rated the program as excellent/good and indicated they would recommend the group chat program to a friend in need of similar help (23/31, 74%). CONCLUSIONS A therapist-guided group chat program to substitute outpatient group setting treatment during the COVID-19 lockdown was shown to be feasible, usable, and highly acceptable for participants. Web-based programs such as this one provide an easy-to-implement tool to successfully stabilize participants during a difficult time, such as the COVID-19 pandemic. TRIAL REGISTRATION German Clinical Trials Register DRKS00021527; https://tinyurl.com/3btyxc2r.
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Affiliation(s)
- Julia Scholl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Frauke Görges
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Marc Steinbrecher
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Leipzig, Germany
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77
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Békés V, Aafjes-van Doorn K, Luo X, Prout TA, Hoffman L. Psychotherapists' Challenges With Online Therapy During COVID-19: Concerns About Connectedness Predict Therapists' Negative View of Online Therapy and Its Perceived Efficacy Over Time. Front Psychol 2021; 12:705699. [PMID: 34367030 PMCID: PMC8339462 DOI: 10.3389/fpsyg.2021.705699] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Therapists' forced transition to provide psychotherapy remotely during the COVID-19 pandemic offers a unique opportunity to examine therapists' views and challenges with online therapy. This study aimed to investigate the main challenges experienced by therapists during the transition from in-person to online therapy at the beginning of the pandemic and 3 months later, and the association between these challenges and therapists' perception of the quality of the relationship with their online patients, and therapists' attitudes and views about online therapy and its efficacy at these two timepoints. As part of a large-scale international longitudinal survey, we collected data from 1,257 therapists at two timepoints: at the start of COVID-19, when many therapists switched from providing in-person therapy to online therapy, as well as 3 months later, when they had had the opportunity to adjust to the online therapy format. At both timepoints, therapists reported on perceived challenges, quality of working alliance and real relationship, attitudes toward online therapy, and their views on online therapy's efficacy compared to in-person therapy. Factor analysis of individual survey items at both timepoints identified four different types of challenges among this therapist sample: Emotional connection (feeling connected with patients, reading emotions, express or feel empathy), Distraction during sessions (therapist or patient), Patients' privacy (private space, confidentiality), and Therapists' boundaries (professional space, boundary setting). Older and more experienced therapists perceived fewer challenges in their online sessions. At baseline, all four types of challenges were associated with lower perceived quality of the therapeutic relationship (working alliance and real relationship), and more negative attitudes toward online therapy and its efficacy. After 3 months, perceived challenges with three domains - Emotional connection, Patients' privacy, and Therapists' boundaries significantly decreased - whereas challenges in the fourth domain - Distraction - increased. In our study, therapists' concerns about being able to connect with patients online appeared to be the most impactful, in that it predicted negative attitudes toward online therapy and its perceived efficacy 3 months later, above and beyond the effect of therapists' age and clinical experience. Clinical and training implications are discussed.
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Affiliation(s)
- Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States
| | | | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, United States
| | - Tracy A. Prout
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States
| | - Leon Hoffman
- New York Psychoanalytic Society & Institute, New York, NY, United States
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78
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Tönnies J, Oeljeklaus L, Wensing M, Hartmann M, Friederich HC, Haun MW. Health policy experts' perspectives on implementing mental health specialist video consultations in routine primary care - a qualitative interview study. BMC Health Serv Res 2021; 21:713. [PMID: 34284786 PMCID: PMC8293503 DOI: 10.1186/s12913-021-06676-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/22/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many patients with mental disorders are treated by their general practitioner (GP). Innovative technology-based integrated care models (e.g., mental health specialist video consultations) have been proposed to facilitate access to specialist services in primary care settings. While perspectives of patients and providers have been examined, there is little insight into the perspectives of health policy experts on such models. The purpose of this study was to examine the perspectives of health policy experts on (1) current challenges for continuity of care, (2) anticipated benefits and barriers for implementation of mental health specialist video consultations along with (3) practical and regulative preconditions for sustained implementation in primary care. METHODS In a cross-sectional qualitative study, we conducted 15 semi-structured interviews with health policy experts representing various stakeholders in the German health care system: health insurances, governmental bodies, clinicians' professional associations, and patient representatives. Following a critical realism approach, we applied a qualitative inductive content analysis to derive key themes from the material. RESULTS Health policy experts saw long waiting times for patients and a lack of collaboration between in- and outpatient mental health services as well as mental health specialists and GPs as main barriers for current continuity of care. Health policy experts also felt that video consultations bear great potential to foster coordinated care between GPs and specialists and ensure timely referral for severely burdened patients. Increased workload for the general practice staff to facilitate video consultations and difficulties in establishing reliable therapeutic alliances between patients and specialists via remote treatment were considered as major barriers. Health policy experts varied significantly in their level of knowledge concerning legal frameworks and regulations pertaining to video consultations. However, the implementation of appropriate reimbursement schemes and sufficient data protection were regarded as the major regulative challenges. CONCLUSIONS Health policy experts mostly consider mental health specialist video consultations as a promising way to overcome current challenges for the management of patients with mental disorders at the interface between primary and specialist care. To ensure sustained implementation, a multi-stakeholder approach accounting for the perspective of health policy experts, patients, and providers should be followed. TRIAL REGISTRATION German Clinical Trials Register DRKS00012487.
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Affiliation(s)
- Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lydia Oeljeklaus
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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79
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Nitsch M, Waldherr K, Zeiler M, Klesges L, Jacobi C. Stakeholder consultation to facilitate implementation of interventions for prevention and promotion in mental health in Europe: introducing the design of the ICare Stakeholder Survey. Eur J Public Health 2021; 31:i48-i54. [PMID: 34240158 PMCID: PMC8266536 DOI: 10.1093/eurpub/ckab045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Online interventions to prevent mental health problems have proven to be effective. However, knowledge about their implementation in real-world practice as well as for dissemination to the target groups in different settings is scarce. The goal of the 'ICare' network is to establish a comprehensive model of eMental-health service delivery in and across different European countries. Since implementation and dissemination are influenced by many contextual factors, in the first phase of ICare a stakeholder survey was conducted. The survey aim was to explore stakeholders' experiences, needs and attitudes regarding Internet-based prevention of mental health problems and hindering and fostering factors for implementation and dissemination. This article is part of a supplement and describes the design of the stakeholder survey. Survey results are published in separate articles in the same supplement. METHODS Based on a literature review and the individual characteristics of the ICare interventions, stakeholder groups were identified in different settings across six European countries. The RE-AIM framework guided the development of the research questions and survey instruments. A concurrent mixed methods design was applied comprising focus groups with the intended target groups of ICare interventions, an online questionnaire with potential facilitators/delivery staff and semi-structured interviews with policy makers. CONCLUSION The challenge was to develop a design that allowed flexibility but at the same did not jeopardize the validity of the study. Implications drawn from this survey are not restricted to specific preventive interventions but will provide general information on how online mental illness prevention can be best implemented in various settings.
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Affiliation(s)
- Martina Nitsch
- Ferdinand Porsche FernFH—Distance-Learning University of Applied Sciences, Vienna, Austria
| | - Karin Waldherr
- Ferdinand Porsche FernFH—Distance-Learning University of Applied Sciences, Vienna, Austria
| | - Michael Zeiler
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Lisa Klesges
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Corinna Jacobi
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany
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80
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Hanf M, Hirt J, van den Akker M. Primary care professionals' attitudes towards digital health interventions for common mental disorders: study protocol for a mixed methods systematic review. BMJ Open 2021; 11:e045657. [PMID: 34127490 PMCID: PMC8204153 DOI: 10.1136/bmjopen-2020-045657] [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: 12/04/2022] Open
Abstract
INTRODUCTION Mental disorders such as depression are common, and an estimated 264 million people are affected by them throughout the world. In recent years, studies on digital health interventions to treat mental disorders have shown evidence of their efficacy, and interest in using them has increased as a result. In the primary care setting, depression and anxiety are the two most frequently diagnosed and treated mental disorders. When they do not refer them to specialists, primary care professionals such as general practitioners treat patients with mental disorders themselves but have insufficient time to treat them adequately. Furthermore, there is a shortage of psychotherapists and those that exist have long waiting lists for an appointment. The purpose of this mixed methods systematic review is to explore the attitudes of primary care professionals towards the use of digital health interventions in the treatment of patients with mental disorders. Their attitudes will provide an indication whether digital mental health interventions can effectively complement standard care in the primary care setting. METHODS AND ANALYSIS We searched for qualitative, quantitative and mixed methods studies published in English, German, Spanish, Russian, French and Dutch after January 2010 for inclusion in the review. The included studies must involve digital mental health interventions conducted via computer and/or mobile devices in the primary care setting. The search was conducted in July 2020 in the following electronic bibliographic databases: MEDLINE, Embase, CINAHL, PsycINFO and Web of Science Core Collection. Two reviewers will independently screen titles, abstracts and full texts and extract data. We will use the 'Integrated methodology' framework to combine both quantitative and qualitative data. ETHICS AND DISSEMINATION Ethical approval is not required. We will disseminate the results of the mixed methods systematic review in a peer-reviewed journal and scientific conferences. PROSPERO REGISTRATION NUMBER CRD42020188879.
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Affiliation(s)
- Maria Hanf
- Institute of General Practice, University of Frankfurt, Frankfurt am Main, Germany
| | - Julian Hirt
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, University of Applied Sciences of Eastern Switzerland, St Gallen, Switzerland
- International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Marjan van den Akker
- Institute of General Practice, University of Frankfurt, Frankfurt am Main, Germany
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Academic Centre for General Practice, Leuven, Belgium
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81
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Schouten MJE, Dekker JJM, de Bruijn TQ, Ebert DD, Koomen LM, Kosterman SLA, Riper H, Schaub MP, Goudriaan AE, Blankers M. Effectiveness of a digital alcohol moderation intervention as an add-on to depression treatment for young adults: study protocol of a multicentre pragmatic randomized controlled trial. BMC Psychiatry 2021; 21:265. [PMID: 34022840 PMCID: PMC8140318 DOI: 10.1186/s12888-021-03222-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depressive disorders and problematic drinking often co-occur, also among young adults. These co-occurring conditions are associated with various negative health outcomes compared to both conditions alone. Early intervention by addressing alcohol use and depressive symptoms simultaneously in the same treatment might improve both conditions. However, evidence on the (cost-) effectiveness of digital combined depression and alcohol interventions for young adults is currently insufficient. We therefore developed an add-on digital alcohol moderation adherence-focussed guided intervention to complement treatment as usual (TAU) for depressive disorders. The digital intervention is a web-app, including 6 modules based on motivational interviewing and cognitive behavioural therapy. This study aims to evaluate the (cost-)effectiveness of a digital alcohol moderation intervention + TAU compared to TAU on alcohol and depression outcomes among young adults with co-occurring depressive disorders and problematic alcohol use. METHODS One hundred fifty-six participants, aged 18-35 years, with problematic alcohol use and a diagnosed depressive disorder will participate in a pragmatic multicentre two-arm randomized controlled trial. Problematic alcohol use is operationalised as scoring ≥5 for women and ≥ 8 for men on the Alcohol Use Disorder Identification Test (AUDIT). Participants will be randomized to either the experimental group (digital alcohol intervention + TAU) or control group (TAU only). Participants will be recruited at three Dutch mental health care centres and through social media. Assessments take place at baseline and after 3, 6 and 12 months post-randomization. The primary outcome is treatment response at 6-month follow-up, operationalized as a composite score that combines alcohol use and depression measures and indicates whether treatment has been successful or not. Secondary outcomes are depressive symptoms and alcohol use (i.e. number of weekly standard drinks and AUDIT score). An economic evaluation will be conducted alongside the trial. DISCUSSION This study evaluates the (cost-) effectiveness of an add-on digital alcohol moderation intervention for young adults who are in treatment for depressive disorders. If proven effective, the digital intervention could be implemented in mental health care and improve treatment for people with co-occurring depressive disorders and problematic alcohol use. TRIAL REGISTRATION Pre-registered on October 29, 2019 in The Netherlands Trial Register ( NL8122 ).
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Affiliation(s)
- Maria J E Schouten
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Tamara Q de Bruijn
- Department of Prevention, Jellinek, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - David D Ebert
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisanne M Koomen
- Arkin BasisGGZ, Arkin Mental Health Care, Roetersstraat 210, Amsterdam, The Netherlands
| | - Sjoerd L A Kosterman
- Department of Outpatient Treatment of Common Mental Health Disorders, PuntP, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Research Unit for Telepsychiatry and e-Mental Health, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Anna E Goudriaan
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Addiction Research and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Addiction Research and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Trimbos Institute-The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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82
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Barth J, Canella C, Oehler M, Witt CM. Digital Consultations During COVID-19: A Multiperspective Mixed-Methods Study in an Integrative Medicine Setting in Switzerland. J Altern Complement Med 2021; 27:569-578. [PMID: 33960805 DOI: 10.1089/acm.2020.0539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: We evaluated digital consultations at a University Hospital in Switzerland within an integrative medicine outpatient setting. Patients' and treatment providers' (physicians and therapists) evaluated digital conversation-based consultations as well as the digital delivery of practical exercises. Methods: Digital consultations between March 15, 2020 and April 30, 2020 were identified. Between June and July 2020, patients and treatment providers completed online questionnaires addressing challenges and advantages of their digital consultations. Both groups documented their satisfaction and working alliance (Working Alliance Inventory). In addition, semistructured qualitative interviews with treatment providers were conducted. Findings: A total of 82 online surveys (response rate 47%) about the digital consultations were available for analyses, with 60 patients correctly identifying at least one treatment provider, and 9 interviews were performed. Patients and treatment providers overall evaluated the new setting of digital consultation as feasible and an efficient consultation format. Interestingly, the working alliance was rated as good. Technical problems were mentioned as the main challenge and the delivery of practical exercises in digital consultations was seen more challenging than having digital conversation-based consultations. Conclusion: Digital consultations were established with overall positive evaluations and with a good working alliance between patients and providers. For the delivery of practical exercises it might be required to develop more innovative digital settings to overcome shortcomings of the digital format. Hybrid settings that combine the best of both settings could be a good option for future in postpandemic times.
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Affiliation(s)
- Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Claudia Canella
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Manuela Oehler
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany.,Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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83
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Breil B, Dederichs M, Kremer L, Richter D, Angerer P, Apolinário-Hagen J. [Awareness and Use of Digital Health Services in Germany: A Cross-sectional Study Representative of the Population]. DAS GESUNDHEITSWESEN 2021; 83:1019-1028. [PMID: 33862648 DOI: 10.1055/a-1335-4245] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES In light of the current efforts of health policy to implement eHealth, the question arises which sections of the population already use online self-help in order to tailor them to users' needs. The present study aims to determine the differences in the use of health information and psychological online counseling based on socio-demographic variables, health status and previous illnesses. METHODS The basis for the cross-sectional data analyses using logistic regression analysis was the innovation sample of the German socio-economic panel. Data were collected from September 2016 to February 2017, with 4802 participants aged between 17-95 years. RESULTS Fifty-five percent of the sample searched for health information on the Internet, while 1.1% had experience with online counseling. Logistic regression analyses showed that online search for information was significantly determined by age (Odds Ratio (OR)=0.96; 95-%-CI=0.96-0.97), gender (OR=1.20; 95-%-CI=1.05-1.36), awareness of Internet therapy (OR=2.57; 95-%-CI=2.20-3.00), experience with psychotherapy (OR=1.40; 95-%-CI=1.16-1.69) and the diagnosis of asthma (OR=1.14; 95-%-CI=1.01-1.29) or stroke (OR=0.66; 95-%-CI=0.52-0.84). Regarding the use of online counseling, awareness of Internet therapy and experience with face-to-face psychotherapy proved to be significant determinants. CONCLUSION For the first time, a reliable picture has become available of the determinants of the awareness of internet therapy and online self-help utilization among the German public that should enable target-group-specific strategies to improve the care situation.
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Affiliation(s)
- Bernhard Breil
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Krefeld, Deutschland
| | - Melina Dederichs
- Medizinische Fakultät, Institut für Arbeits-, Sozial- und Umweltmedizin, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Lisanne Kremer
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Krefeld, Deutschland
| | - David Richter
- DIW, Deutsches Institut für Wirtschaftsforschung eV, Berlin, Düsseldorf, Deutschland.,Fachbereich Erziehungswissenschaft und Psychologie, Freie Universität Berlin, Berlin, Düsseldorf, Deutschland
| | - Peter Angerer
- Medizinische Fakultät, Institut für Arbeits-, Sozial- und Umweltmedizin, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Jennifer Apolinário-Hagen
- Medizinische Fakultät, Institut für Arbeits-, Sozial- und Umweltmedizin, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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84
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Mitchell LM, Joshi U, Patel V, Lu C, Naslund JA. Economic Evaluations of Internet-Based Psychological Interventions for Anxiety Disorders and Depression: A Systematic Review. J Affect Disord 2021; 284:157-182. [PMID: 33601245 PMCID: PMC8008508 DOI: 10.1016/j.jad.2021.01.092] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Internet-based interventions show clinical effectiveness for treating anxiety disorders and depression and could make mental healthcare more affordable. METHODS We searched databases including PubMed; EMBASE; Cochrane Central; PsychINFO; CINAHL; EconLit; and Web of Science from January 1, 2000 to August 21, 2020. Inclusion criteria were: 1) pertained to the treatment or prevention of anxiety disorders or depression; 2) evaluated the use of an internet-delivered psychological intervention; 3) recruited participants; and 4) reported costs or cost-effectiveness. RESULTS Of the 6,069 articles identified, 33 targeted anxiety (N=13) and depression (n=20) and met final inclusion criteria. All studies were from high-income countries. The control conditions and cost components included were heterogeneous. Only eight studies reported costs of developing the intervention. Of 27 studies that made a conclusion about cost-effectiveness, 81% of interventions were cost-effective. The quality of studies included was high based on a quality assessment checklist of economic evaluations, although many studies did not include definitions of cost components or differentiate between patient-side and system-level costs. LIMITATIONS Studies varied in methodology, making conclusions about cost-effectiveness difficult. The generalizability of these results is unclear as studies were clustered in a small number of high-income countries and costs vary over time and between regions. CONCLUSIONS Internet-delivered interventions appeared to be cost-effective although control conditions and cost component reporting were variable. We propose a checklist of cost components for future cost analyses to better compare intervention costs. More research is needed to describe development costs, cost-effectiveness in low-resource settings, and cost-effectiveness of newer technologies.
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Affiliation(s)
- Lauren M Mitchell
- Department of Internal Medicine, New York Presbyterian Hospital - Weill Cornell, New York, NY, USA.
| | | | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA,Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA,Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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85
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Bentham C, Driver K, Stark D. Wellbeing of CAMHS staff and changes in working practices during the COVID-19 pandemic. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 34:225-235. [PMID: 33738882 PMCID: PMC8250400 DOI: 10.1111/jcap.12311] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/19/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022]
Abstract
Introduction The coronavirus disease 2019 pandemic has necessitated significant changes in working practices across healthcare services. The current study aimed to assess the wellbeing of health professionals and quantify the adaptations to working practices in a Child and Adolescent Mental Health Service (CAMHS) during the pandemic. Method The study was conducted in a UK CAMH team six weeks into lockdown measures. All clinicians were invited to complete a survey eliciting their experiences of working practices during the pandemic, degree of worry about the virus and mental wellbeing. Results Clinicians had significantly lower levels of mental wellbeing during the pandemic than population normative data, to the extent that some clinicians were classified as at heightened risk of depression. A significant shift to remote working, reduction in face‐to‐face appointments, and decrease in clinicians' perceived ability to undertake clinical tasks was observed. Themes emerging from clinicians' experiences of working during the pandemic include being supported within the team, providing a service, working adaptations, and working as a team. A further theme highlights the needs of clinicians to complete their clinical role effectively. Conclusion CAMHS clinicians require additional support, training, and guidance during a pandemic to promote mental wellbeing and effectiveness in completing clinical tasks.
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Affiliation(s)
| | - Katie Driver
- Sheffield Child and Adolescent Mental Health Service, Sheffield Children's Hospital Foundation Trust, Sheffield, UK
| | - Daniel Stark
- Sheffield Child and Adolescent Mental Health Service, Sheffield Children's Hospital Foundation Trust, Sheffield, UK
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86
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Domhardt M, Cuijpers P, Ebert DD, Baumeister H. More Light? Opportunities and Pitfalls in Digitalized Psychotherapy Process Research. Front Psychol 2021; 12:544129. [PMID: 33815184 PMCID: PMC8017120 DOI: 10.3389/fpsyg.2021.544129] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 02/27/2021] [Indexed: 12/23/2022] Open
Abstract
While the evidence on the effectiveness of different psychotherapies is often strong, it is not settled whereby and how these therapies work. Knowledge on the causal factors and change mechanisms is of high clinical and public relevance, as it contributes to the empirically informed advancement of psychotherapeutic interventions. Here, digitalized research approaches might possess the potential to generate new insights into human behavior change, contributing to augmented interventions and mental healthcare practices with better treatment outcomes. In this perspective article, we describe recent findings of research into change mechanisms that were only feasible with digital tools and outline important future directions for this rather novel branch of research. Furthermore, we indicate several challenges and pitfalls that are to be solved, in order to advance digitalized psychotherapy process research, both methodologically and technologically.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David Daniel Ebert
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
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87
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Sklar M, Reeder K, Carandang K, Ehrhart MG, Aarons GA. An observational study of the impact of COVID-19 and the rapid implementation of telehealth on community mental health center providers. Implement Sci Commun 2021; 2:29. [PMID: 33706815 PMCID: PMC7948664 DOI: 10.1186/s43058-021-00123-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/01/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has remarkably altered community mental health service delivery through the rapid implementation of telehealth. This study reports provider perspectives on the impact that COVID-19 and the transition to telehealth had on their work and their ability to deliver evidence-based practices (EBPs). METHODS Providers (n = 93) completed online surveys with quantitative measures and open-ended items exploring their reactions to COVID-19 and to the transition to providing services via telehealth. RESULTS Perceptions of personal risk and rumination around COVID-19 were low, while telehealth was viewed positively by providers. Three major themes emerged regarding the major impacts of COVID-19 on work: (1) the altered nature of interactions between patient/client and provider due to telehealth implementation, (2) changes in provider expectations regarding productivity, and (3) challenges maintaining work-life balance. In regard to the major impacts of COVID-19 on EBP delivery, three themes emerged: (1) increased difficulty delivering certain therapies via telehealth, (2) potential limitations to session confidentiality, and (3) challenge of engaging children in telehealth. CONCLUSIONS In the context of the COVID-19 pandemic, community mental health providers continued to engage with clients and deliver EBPs while navigating a number of changes related to the rapid transition to and implementation of telehealth. This study highlights the need for further work on what supports providers need to effectively engage with clients and deliver EBPs via telehealth, and has implications for how telehealth is sustained or de-implemented post-COVID-19.
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Affiliation(s)
- Marisa Sklar
- University of California San Diego Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
- UC San Diego Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, San Diego, USA
| | - Kendal Reeder
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
- University of California Los Angeles Department of Psychology, Psychology Building 1285, Box 951563, Los Angeles, CA 90095-1563 USA
| | - Kristine Carandang
- University of California San Diego Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
| | - Mark G. Ehrhart
- University of Central Florida Department of Psychology, P.O. Box 161390, Orlando, FL 32816-1390 USA
| | - Gregory A. Aarons
- University of California San Diego Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
- UC San Diego Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, San Diego, USA
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Mellentin AI, Behrendt S, Bilberg R, Blankers M, Folker MP, Tarp K, Uffelmann J, Nielsen AS. BLEND-A: blending internet treatment into conventional face-to-face treatment for alcohol use disorder - a study protocol. BMC Psychiatry 2021; 21:131. [PMID: 33676429 PMCID: PMC7937233 DOI: 10.1186/s12888-021-03122-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A major challenge to psychological treatment for alcohol use disorder (AUD) is patient non-compliance. A promising new treatment approach that is hypothesized to increase patient compliance is blended treatment, consisting of face-to-face contact with a therapist combined with modules delivered over the internet within the same protocol. While this treatment concept has been developed and proven effective for a variety of mental disorders, it has not yet been examined for AUD. AIMS The study described in this protocol aims to examine and evaluate patient compliance with blended AUD treatment as well as the clinical and cost effectiveness of such treatment compared to face-to-face treatment only. METHODS The study design is a pragmatic, stepped-wedge cluster randomized controlled trial. The included outpatient institutions (planned number of patients: n = 1800) will be randomized in clusters to implement either blended AUD treatment or face-to-face treatment only, i.e. treatment as usual (TAU). Both treatment approaches consist of motivational interviewing and cognitive behavioral therapy. Data on sociodemographics, treatment (e.g. intensity, duration), type of treatment conclusion (compliance vs. dropout), alcohol consumption, addiction severity, consequences of drinking, and quality of life, will be collected at treatment entry, at treatment conclusion, and 6 months after treatment conclusion. The primary outcome is compliance at treatment conclusion, and the secondary outcomes include alcohol consumption and quality of life at six-months follow-up. Data will be analyzed with an Intention-to-treat approach by means of generalized linear mixed models with a random effect for cluster and fixed effect for each step. Also, analyses evaluating cost-effectiveness will be conducted. DISCUSSION Blended treatment may increase treatment compliance and thus improve treatment outcomes due to increased flexibility of the treatment course. Since this study is conducted within an implementation framework it can easily be scaled up, and when successful, blended treatment has the potential to become an alternative offer in many outpatient clinics nationwide and internationally. TRIAL REGISTRATION Clinicaltrials.gov .: NCT04535258 , retrospectively registered 01.09.20.
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Affiliation(s)
- Angelina Isabella Mellentin
- Department of Clinical Research, Unit of Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark. .,Psychiatric University Hospital, University Function, Region of Southern Denmark, Odense, Denmark. .,Research Unit for Telepsychiatry and E-mental Health, Centre for Telepsychiatry in the Mental Health Services in the Region of Southern Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Department of Clinical Research, I BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark.
| | - Silke Behrendt
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, Unit of Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Institute for Psychology, University of Southern Denmark, Odense, Denmark
| | - Randi Bilberg
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, Unit of Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark ,Psychiatric University Hospital, University Function, Region of Southern Denmark Odense, Denmark
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands ,grid.416017.50000 0001 0835 8259Trimbos Institute – The Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Marie Paldam Folker
- grid.10825.3e0000 0001 0728 0170Research Unit for Telepsychiatry and E-mental Health, Centre for Telepsychiatry in the Mental Health Services in the Region of Southern Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristine Tarp
- grid.10825.3e0000 0001 0728 0170Research Unit for Telepsychiatry and E-mental Health, Centre for Telepsychiatry in the Mental Health Services in the Region of Southern Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Anette Søgaard Nielsen
- grid.10825.3e0000 0001 0728 0170Department of Clinical Research, Unit of Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark ,Psychiatric University Hospital, University Function, Region of Southern Denmark Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, I BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark ,grid.7143.10000 0004 0512 5013OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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Phillips EA, Himmler SF, Schreyögg J. Preferences for e-Mental Health Interventions in Germany: A Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:421-430. [PMID: 33641777 DOI: 10.1016/j.jval.2020.09.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/11/2020] [Accepted: 09/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Recent evidence suggests that e-mental health interventions can be effective at improving mental health but that there is still a notable hesitation among patients to use them. Previous research has revealed that they are perceived by patients as being less helpful than face-to-face psychotherapy. The reasons for this unfavorable perception are, however, not yet well understood. The aim of our study was to address this question by eliciting preferences for individual components of e-mental health interventions in a discrete choice experiment. METHODS Using a stepwise qualitative approach, we developed the following 5 attributes of eMHIs: introductory training, human contact, peer support, proven effectiveness, content delivery, and price. Additionally, we asked questions about respondents' demographics, attitudes, and previous experience of traditional psychotherapy, as well as their distress level. RESULTS A total of 1984 respondents completed the survey. Using mixed logit models, we found that personal contact with a psychotherapist in blended care, proven effectiveness, and low price were highly valued by participants. Participants were indifferent toward the mode of content delivery but showed a slight preference for introductory training via phone, as well as for peer support via online forum alongside coach-led group meetings on site. DISCUSSION Our results suggest a clear preference for blended care that includes face-to-face contact with a psychotherapist. This preference remained stable irrespective of sociodemographics, previous experience of psychotherapy, distress level, and the 2 context scenarios used in our discrete choice experiment. Further investigations looking at the potential benefits and risks of blended care are needed.
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Affiliation(s)
- Elena A Phillips
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany.
| | - Sebastian F Himmler
- Erasmus School of Health Policy & Management Health Economics, Rotterdam, The Netherlands
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
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90
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Ganapathy A, Clough BA, Casey LM. Organizational and Policy Barriers to the Use of Digital Mental Health by Mental Health Professionals. Telemed J E Health 2021; 27:1332-1343. [PMID: 33646057 DOI: 10.1089/tmj.2020.0455] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Digital mental health (DMH) provides effective methods of overcoming issues of time constraints, accessibility, and availability of mental health care. They can provide a valuable means to deliver mental health care in the present pandemic. However, adoption of these methods has been slow. Mental health professional (MHP) concerns at the organizational and policy level that influence this slow adoption need to be examined. Materials and Methods: A narrative review was conducted to identify the barriers. Searches using the databases Scopus, Embase, and PubMed were conducted to identify research focused on barriers reported by MHPs to use DMH. Results: The search resulted in 356 unique citations, and 21 papers met the inclusion and exclusion criteria. Forward and backward sampling resulted in identifying an additional 19 relevant papers. Discussion: Unmet needs for information, training, and infrastructure, challenges to the workflow and excessive workloads, and ambiguous policies serve as barriers to DMH use. This article recommends strategies for researchers, organizations, DMH designers, and governmental institutions to ensure efficient utilization of DMH. Conclusion: Concerted efforts at individual, organizational, and governmental levels are essential to ensure efficient utilization of DMH.
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Affiliation(s)
- Aarthi Ganapathy
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Bonnie A Clough
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
| | - Leanne M Casey
- School of Applied Psychology, Griffith University, Brisbane, Australia.,Menzies Health Institute, Mount Gravatt, Australia
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91
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Ghaneirad E, Groba S, Bleich S, Szycik GR. [Use of outpatient psychotherapy via video consultation]. PSYCHOTHERAPEUT 2021; 66:240-246. [PMID: 33642699 PMCID: PMC7898015 DOI: 10.1007/s00278-021-00497-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Aufgrund der Hygienemaßnahmen während der Coronapandemie Anfang 2020 war Präsenzpsychotherapie vielerorts in Deutschland nicht mehr oder nur eingeschränkt möglich. Psychotherapie via Videokonferenz trat als alternative Versorgungsmöglichkeit an diese Stelle. Fragestellung Die vorliegende Studie beschäftigt sich mit der Frage der tatsächlichen Nutzung dieser Art von Psychotherapie während des Lockdowns. Material und Methode Durch Befragung von Behandlern in der psychotherapeutischen Ausbildungsambulanz der Medizinischen Hochschule Hannover bezüglich ihrer Erfahrung sowie Erfahrung ihrer Patienten mit der Nutzung der Videosprechstunde während laufender Richtlinienpsychotherapie konnten Daten von 338 Patienten erhoben werden. Die Daten enthalten Angaben u. a. zur Annahme oder zur Ablehnung des Angebots der Videosprechstunde, zu Gründen der Ablehnung oder zu technischen Problemen bei der Durchführung. Ergebnisse Die präsentierten Daten zeigen, dass 35 % der Patienten von der Videosprechstunde nicht erreicht werden konnten. Circa die Hälfte der Patienten aus dieser Gruppe konnte aufgrund mangelnder technischer Ausstattung diese Therapieform nicht nutzen. Die andere Hälfte wünschte keine Therapie mithilfe der Videosprechstunde, obwohl die technischen Voraussetzungen dazu vorhanden waren. In der Gruppe der Nutzer der Videosprechstunde wurden in 31 % der Fälle die Sitzungen durch technische Störungen beeinträchtigt, und in weiteren 10 % der Fälle führten die Störungen sogar zur vorzeitigen Beendigung der Sitzung. Die vorgestellten Daten machen deutlich, dass mit steigendem Alter und sinkendem Bildungsniveau die Nutzung der Therapie über Videosprechstunde signifikant abnimmt. Schlussfolgerung Die Ergebnisse der vorliegenden Studie zeigen, dass trotz der Verbreitung der Videosprechstunde ein beträchtlicher Anteil der Patienten durch das Angebot nicht erreicht wird und somit im Fall weiterer Lockdowns Spezialangebote für diese Gruppe erwogen werden sollten. Die Autoren empfehlen Unterstützung durch Krankenkassen für Patienten, die über keine technischen Voraussetzungen verfügen. Patienten, die sich auf diese Form der Behandlung nicht einlassen wollten, brauchen therapeutisch motivierende Unterstützung. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00278-021-00497-3) enthält folgendes Zusatzmaterial: Fragebogen zur Nutzung der Videosprechstunde in der ambulanten Psychotherapie. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.
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Affiliation(s)
- Erfan Ghaneirad
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stefanie Groba
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stefan Bleich
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Gregor R Szycik
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Deutschland.,Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Zentrum für Seelische Gesundheit, Carl-Neuberg-Str. 1, 30625 Hannover, Deutschland
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Transition to Multidisciplinary Pediatric Telerehabilitation during the COVID-19 Pandemic: Strategy Development and Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041484. [PMID: 33557395 PMCID: PMC7914913 DOI: 10.3390/ijerph18041484] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 02/01/2023]
Abstract
Telerehabilitation offers a unique solution for continuity of care in pediatric rehabilitation under physical distancing. The major aims of this study were to: (1) describe the development of telerehabilitation usage guidelines in a large hospital in Israel, and to (2) evaluate the implementation of telerehabilitation from the perspectives of healthcare practitioners and families. An expert focus group developed guidelines which were disseminated to multidisciplinary clinicians. Following sessions, clinicians filled The Clinician Evaluation of Telerehabilitation Service (CETS), a custom-built feedback questionnaire on telerehabilitation, and parents completed the client version of the Therapist Presence Inventory (TPI-C) and were asked to rate the effectiveness of sessions on an ordinal scale. Four goals of telerehabilitation sessions were defined: (1) maintenance of therapeutic alliance, (2) provision of parental coping strategies, (3) assistance in maintaining routine, and (4) preventing functional deterioration. Principal Components Analysis was used for the CETS questionnaire and the relationships of CETS and TPI-C with child’s age and the type of session were evaluated using Spearman’s correlations and the Kruskal–Wallis H test. In total, sixty-seven telerehabilitation sessions, with clients aged 11.31 ± 4.8 years, were documented by clinicians. Three components (child, session, parent) explained 71.3% of the variance in CETS. According to therapists, their ability to maintain the therapeutic alliance was generally higher than their ability to achieve other predefined goals (p < 0.01). With younger children, the ability to provide feedback to the child, grade treatment difficulty and provide coping strategies to the parents were diminished. Families perceived the therapist as being highly present in therapy regardless of treatment type. These results demonstrate a potential framework for the dissemination of telerehabilitation services in pediatric rehabilitation.
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93
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Pascoal PM, Carvalho J, Raposo CF, Almeida J, Beato AF. The Impact of COVID-19 on Sexual Health: A Preliminary Framework Based on a Qualitative Study With Clinical Sexologists. Sex Med 2021; 9:100299. [PMID: 33482611 PMCID: PMC7837091 DOI: 10.1016/j.esxm.2020.100299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION In recent months, some attempts were made to understand the impact of COVID-19 on sexual health. Despite recent research that suggests COVID-19 and lockdown measures may eventually impact sexual response and sexually related behaviors, we are missing clinical sexologists' perspectives on the impact of COVID-19 in sexual health. Such perspectives could inform a preliminary framework aimed at guiding future research and clinical approaches in the context of COVID-19. AIM To explore the perspectives of clinical sexologists about the impact of COVID-19 on their patients' sexual health, as well as the professional challenges they have faced during the current pandemic. Findings are expected to inform a preliminary framework aimed at understanding the impact of COVID-19 on sexual health. METHODS We conducted an online qualitative exploratory survey with 4 open-ended questions with 39 clinical sexologists aged between 32 and 73 years old. The survey was advertised among professional associations' newsletters. We performed a Thematic Analysis using an inductive, semantic, and (critical) realist approach, leading to a final thematic map. MAIN OUTCOME MEASURES The outcome is the thematic map and the corresponding table that aggregates the main themes, subthemes, and codes derived from participants' answers and that can serve as a preliminary framework to understand the impact of COVID-19 on sexual health. RESULTS The final thematic map, expected to serve as a preliminary framework on the impact of COVID-19 in sexual health, revealed 3 main themes: Clinical Focus, Remapping Relationships, and Reframing Technology Use. These themes aggregate important interrelated issues, such as worsening of sexual problems and dysfunctions, mental health, relationship management, the rise of conservatism, and the use of new technology that influences sexuality and sexual health-related services. CONCLUSION The current study allowed us to develop a preliminary framework to understand the impact of COVID-19 on sexual health. This framework highlights the role of mental health, as well as the contextual nature of sexual problems, and subsequently, their relational nature. Also, it demonstrates that the current pandemic has brought into light the debate of e-Health delivery within clinical sexology. Pascoal PM, Carvalho J, Raposo CF, et al. The Impact of COVID-19 on Sexual Health: A Preliminary Framework Based on a Qualitative Study With Clinical Sexologist. Sex Med 2021;9:100299.
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Affiliation(s)
- Patrícia M Pascoal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal; Sociedade Portuguesa de Sexologia Clínica, Lisboa, Portugal; Universidade Lusófona, HEI-Lab, Lisboa, Portugal; CPUP, Faculdade de Psicologia e Ciências da Educação, Universidade do Porto, Porto, Portugal.
| | - Joana Carvalho
- CPUP, Faculdade de Psicologia e Ciências da Educação, Universidade do Porto, Porto, Portugal
| | - Catarina F Raposo
- CPUP, Faculdade de Psicologia e Ciências da Educação, Universidade do Porto, Porto, Portugal
| | - Joana Almeida
- Sociedade Portuguesa de Sexologia Clínica, Lisboa, Portugal
| | - Ana Filipa Beato
- Sociedade Portuguesa de Sexologia Clínica, Lisboa, Portugal; Universidade Lusófona, HEI-Lab, Lisboa, Portugal
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94
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Khan MI, Saleem HAR, Anwar MF, Chang YC. Novel Coronavirus and Emerging Mental Health Issues—A Timely Analysis of Potential Consequences and Legal Policies Perspective. FUDAN JOURNAL OF THE HUMANITIES AND SOCIAL SCIENCES 2021; 14. [PMCID: PMC7841381 DOI: 10.1007/s40647-020-00313-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The present outbreak of coronavirus disease 2019 (COVID-19) has swiftly crossed borders, and inflicted the global mental health issues. It is also affecting peoples’ daily behaviours, economics, prevention strategies and decision-making among policymakers, healthcare organisations and medical centres that may unintentionally weaken COVID-19 control strategies and lead to increased morbidity, as well as mental health care needs globally. Ultimately, this outbreak is leading to further health complications worldwide, such as stress, fear of the unknown, anger, anxiety, denial, depression symptoms, and insomnia. Notwithstanding all the resources used to counter the spread of the virus, further universal strategies are desirable to address the associated mental health problems. The present study uses the qualitative means to investigate the potential impact of COVID-19, the consequences and legal aspects, then recommend policy implications, in an attempt to cover any apparent loopholes. It presents a unique analysis of its kind on the policy and legal aspects of the ongoing pandemic, as regards mental health. It concludes that there is an acute need to prioritising the health care and curative issues, strengthen awareness and address the psychological syndromes or similar complications afflicting members of the general public during this pandemic.
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Affiliation(s)
- Mehran Idris Khan
- School of Law, Dalian Maritime University, Dalian, 116026 Liaoning Province China
- Business Administration Department, Faculty of Management Sciences, ILMA University, Karachi, 75190 Sindh Province Pakistan
| | | | - Muhammad Fahad Anwar
- Department of Law, University of Sahiwal, Sahiwal, 57000 Punjab Province, Pakistan
| | - Yen-Chiang Chang
- School of Law, Dalian Maritime University, Dalian, 116026 Liaoning Province China
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95
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Levine DT, Morton J, O'Reilly M. Child safety, protection, and safeguarding in the time of COVID-19 in Great Britain: Proposing a conceptual framework. CHILD ABUSE & NEGLECT 2020; 110:104668. [PMID: 32828561 PMCID: PMC7425676 DOI: 10.1016/j.chiabu.2020.104668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Great Britain has the highest coronavirus death rate in Europe. While the pandemic clearly poses a risk to the lives and wellbeing of vulnerable groups, necessary public health measures taken to delay or limit the spread of the virus have led to distinctive challenges for prevention, family support, court processes, placement and alternative care. The pandemic has also come about at a time when statutory changes to partnerships have led to a reduction in the importance of educational professional representation in the new formulation in England and Wales. OBJECTIVES In this discussion paper, we propose a novel and pragmatic conceptual framework during this challenging time. PARTICIPANTS We consulted with 8 education professionals and 4 field-based student social workers. SETTING Bodies responsible for safeguarding have been working quickly to develop new approaches to fulfilling their responsibilities, for example through online home visits and case conferences. However, some communities have been highlighted as experiencing particular challenges because of the pandemic and its impacts. Protection of vulnerable children is increasingly dependent on individualised - and often pathologising - practice with a lack of emphasis on the importance of the social. Holistic consideration of the child is side-lined. RESULTS Our framework comprises two phases: pandemic and aspirational. CONCLUSION The framework illuminates the importance of interconnected sectors and multi-agency working, the need for resilient and adaptable support systems, and the need to promote the importance of children's rights and voices to be heard above the noise of the pandemic.
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Affiliation(s)
| | - Julie Morton
- The University of Salford, The Crescent, Salford, M5 4WT, United Kingdom.
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96
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Størksen HT, Haga SM, Slinning K, Drozd F. Health Personnel's Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study. JMIR Ment Health 2020; 7:e15149. [PMID: 33206058 PMCID: PMC7710450 DOI: 10.2196/15149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 06/09/2020] [Accepted: 10/28/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Approximately 10%-15% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel's attitudes to perceived usefulness of internet-based interventions. OBJECTIVE The purpose of this study was to examine health professionals' perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful. METHODS Between May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: "How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?" The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often). RESULTS The participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006). CONCLUSIONS Internet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support.
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Affiliation(s)
- Hege Therese Størksen
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Silje Marie Haga
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Kari Slinning
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Filip Drozd
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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97
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Social Skills Training for Autism Spectrum Disorder: a Meta-analysis of In-person and Technological Interventions. ACTA ACUST UNITED AC 2020; 6:166-180. [PMID: 33225056 PMCID: PMC7670840 DOI: 10.1007/s41347-020-00177-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
Social skills training (SST) for autism spectrum disorder (ASD) has traditionally focused on face-to-face (F2F-SST) interventions. Recently, Behavioral Intervention Technologies (BITs-SST) have been utilized to target social skills deficits using computer-based programs, avatars, and therapeutic robots. The present meta-analysis reviews recent evidence and compares the efficacy of 14 F2F-SST and four identified BITs-SST intervention trials for youth with ASD. These preliminary analyses did not indicate significant differences between F2F-SST and BITs-SST, with effect sizes consistently in the medium to high range (g = 0.81 and g = 0.93, respectively). These findings provide initial support for the continued investigation of BITs for providing SST to youth with ASD.
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98
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Graham AK, Lattie EG, Powell BJ, Lyon AR, Smith JD, Schueller SM, Stadnick NA, Brown CH, Mohr DC. Implementation strategies for digital mental health interventions in health care settings. ACTA ACUST UNITED AC 2020; 75:1080-1092. [PMID: 33252946 DOI: 10.1037/amp0000686] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
U.S. health care systems are tasked with alleviating the burden of mental health, but are frequently underprepared and lack workforce and resource capacity to deliver services to all in need. Digital mental health interventions (DMHIs) can increase access to evidence-based mental health care. However, DMHIs commonly do not fit into the day-to-day activities of the people who engage with them, resulting in a research-to-practice gap for DMHI implementation. For health care settings, differences between digital and traditional mental health services make alignment and integration challenging. Specialized attention is needed to improve the implementation of DMHIs in health care settings so that these services yield high uptake, engagement, and sustainment. The purpose of this article is to enhance efforts to integrate DMHIs in health care settings by proposing implementation strategies, selected and operationalized based on the discrete strategies established in the Expert Recommendations for Implementing Change project, that align to DMHI-specific barriers in these settings. Guidance is offered in how these strategies can be applied to DMHI implementation across four phases commonly distinguished in implementation science using the Exploration, Preparation, Implementation, Sustainment Framework. Next steps to advance research in this area and improve the research-to-practice gap for implementing DMHIs are recommended. Applying implementation strategies to DMHI implementation will enable psychologists to systematically evaluate this process, which can yield an enhanced understanding of the factors that facilitate implementation success and improve the translation of DMHIs from controlled trials to real-world settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University
| | | | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Justin D Smith
- Center for Prevention Implementation Methodology, Northwestern University
| | | | | | - C Hendricks Brown
- Center for Prevention Implementation Methodology, Northwestern University
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University
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99
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Dores AR, Geraldo A, Carvalho IP, Barbosa F. The Use of New Digital Information and Communication Technologies in Psychological Counseling during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207663. [PMID: 33096650 PMCID: PMC7589044 DOI: 10.3390/ijerph17207663] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022]
Abstract
The use of digital information and communication technologies (ICTs) has enabled many professionals to continue to provide their services during the COVID-19 pandemic. However, little is known about the adoption of ICTs by psychologists and the impact of such technologies on their practice. This study aimed to explore psychologists’ practices related with the use of ICTs before and during the COVID-19 lockdown, to identify the main changes that the pandemic has brought and the impact that such changes have had on their practice with clients, and also identify the factors that potentially have affected such changes. The Portuguese Psychologists Association announced the study, and 108 psychologists responded to an online survey during the mandatory lockdown. The results showed that these professionals continued to provide their services due to having adopted ICTs. Comparing with face-to-face interventions, psychologists recognized that additional precautions/knowledge were needed to use such technologies. Despite the challenges identified, they described the experience with the use of ICTs as positive, meeting clients’ adherence, and yielding positive results. Psychologists with the most years of professional experience maintained their services the most, but those with average experience showed the most favorable attitudes toward the use of technologies and web-based interventions.
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Affiliation(s)
- Artemisa R. Dores
- Center for Rehabilitation Research, School of Health, Polytechnic Institute of Porto, 4200-072 Porto, Portugal
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences of University of Porto, 4200-135 Porto, Portugal; (A.G.); (F.B.)
- Correspondence:
| | - Andreia Geraldo
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences of University of Porto, 4200-135 Porto, Portugal; (A.G.); (F.B.)
| | - Irene P. Carvalho
- CINTESIS and Department of Clinical Neurosciences and Mental Health, School of Medicine, University of Porto (FMUP), 4200-319 Porto, Portugal;
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences of University of Porto, 4200-135 Porto, Portugal; (A.G.); (F.B.)
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van Dijk SDM, Bouman R, Folmer EH, den Held RC, Warringa JE, Marijnissen RM, Voshaar RCO. (Vi)-rushed Into Online Group Schema Therapy Based Day-Treatment for Older Adults by the COVID-19 Outbreak in the Netherlands. Am J Geriatr Psychiatry 2020; 28:983-988. [PMID: 32622730 PMCID: PMC7274959 DOI: 10.1016/j.jagp.2020.05.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/24/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Societal measures in context of the COVID-19 outbreak forced us to transform our schema therapy based day-treatment for older adults with chronic affective disorders and personality problems into an online program. The objective of this paper is to present first impressions of this transformation. METHODS Using over-the-phone instructions initially, all patients were able to participate with the online therapy program. To reduce screen-time for patients, the nonverbal therapies were shortened. Four patients, aged 64-70 years, started our online program. RESULTS Therapists were positive about the online capabilities and resilience of patients to adapt to the new situation. Prejudices on limited effectiveness of online psychotherapy were counteracted. Sending homework by email and mail seems to facilitate therapy adherence. Nonverbal therapy could be important to stimulate the online group process. CONCLUSION We were positively surprised by the online capabilities of our geriatric mental healthcare patients and encourage further formal effectiveness studies.
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Affiliation(s)
- Silvia Dian Maria van Dijk
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen (SDMVD, RB, EHF, RCDH, JEW, RMM, and RCOV), Groningen, the Netherlands.
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