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Saunders KRK, McGuinness E, Barnett P, Foye U, Sears J, Carlisle S, Allman F, Tzouvara V, Schlief M, Vera San Juan N, Stuart R, Griffiths J, Appleton R, McCrone P, Rowan Olive R, Nyikavaranda P, Jeynes T, K T, Mitchell L, Simpson A, Johnson S, Trevillion K. A scoping review of trauma informed approaches in acute, crisis, emergency, and residential mental health care. BMC Psychiatry 2023; 23:567. [PMID: 37550650 PMCID: PMC10405430 DOI: 10.1186/s12888-023-05016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023] Open
Abstract
Experiences of trauma in childhood and adulthood are highly prevalent among service users accessing acute, crisis, emergency, and residential mental health services. These settings, and restraint and seclusion practices used, can be extremely traumatic, leading to a growing awareness for the need for trauma informed care (TIC). The aim of TIC is to acknowledge the prevalence and impact of trauma and create a safe environment to prevent re-traumatisation. This scoping review maps the TIC approaches delivered in these settings and reports related service user and staff experiences and attitudes, staff wellbeing, and service use outcomes.We searched seven databases (EMBASE; PsycINFO; MEDLINE; Web of Science; Social Policy and Practice; Maternity and Infant Care Database; Cochrane Library Trials Register) between 24/02/2022-10/03/2022, used backwards and forwards citation tracking, and consulted academic and lived experience experts, identifying 4244 potentially relevant studies. Thirty-one studies were included.Most studies (n = 23) were conducted in the USA and were based in acute mental health services (n = 16). We identified few trials, limiting inferences that can be drawn from the findings. The Six Core Strategies (n = 7) and the Sanctuary Model (n = 6) were the most commonly reported approaches. Rates of restraint and seclusion reportedly decreased. Some service users reported feeling trusted and cared for, while staff reported feeling empathy for service users and having a greater understanding of trauma. Staff reported needing training to deliver TIC effectively.TIC principles should be at the core of all mental health service delivery. Implementing TIC approaches may integrate best practice into mental health care, although significant time and financial resources are required to implement organisational change at scale. Most evidence is preliminary in nature, and confined to acute and residential services, with little evidence on community crisis or emergency services. Clinical and research developments should prioritise lived experience expertise in addressing these gaps.
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Affiliation(s)
- Katherine R K Saunders
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK.
| | - Elizabeth McGuinness
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, & Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Jessica Sears
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sophie Carlisle
- Section of Women's Mental Health, King's College London, London, UK
| | - Felicity Allman
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Vasiliki Tzouvara
- Care for Long Term Conditions Research Division, King's College London, London, UK
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Norha Vera San Juan
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Ruth Stuart
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Jessica Griffiths
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
- School of Health Sciences, University of Greenwich, London, UK
| | - Rachel Rowan Olive
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Tamar Jeynes
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - T K
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Lizzie Mitchell
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Kylee Trevillion
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
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Bahji A, Altomare J, Sapru A, Haze S, Prasad S, Egan R. Predictors of hospital admission for patients presenting with psychiatric emergencies: A retrospective, cohort study. Psychiatry Res 2020; 290:113149. [PMID: 32512355 DOI: 10.1016/j.psychres.2020.113149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Rising psychiatric visits represent a significant and growing burden for emergency departments (EDs) across Canada. For individual psychiatric conditions, there are likely a variety of demographic and social variables that may increase risk of resource intensive hospital admission. METHODS We conducted a retrospective cohort study of all patients admitted into inpatient psychiatric units from two EDs in Kingston, Ontario, Canada from 2015 to 2018. We collected demographic and social variables from an electronic ED information system inclusive of all patients presenting to the ED with a mental health or addictions-related chief complaint. We used multivariate logistic regression models to identify predictors of psychiatric admission. RESULTS A total of 23,814 patients (49.1% male, median age 33) were identified. Admitted patients (n=1838) tended to be older (49 vs. 31 years), have lower Canadian Triage Acuity Scale scores (2.6 vs. 3.0), arrive by ambulance (51% vs. 35%) or police (18% vs. 9%), and have longer lengths of stay (8.4 vs. 4.9 hours). Individuals with mood and psychotic disorders were more likely to require a hospital admission. CONCLUSION A variety of clinical and demographic variables increased the risk of hospital admissions for individuals with a variety of psychiatric disorders.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | | | - Amer Sapru
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Spencer Haze
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Samir Prasad
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Rylan Egan
- Health Quality Programs, Queen's University, Kingston, Ontario, Canada
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Colling C, Khondoker M, Patel R, Fok M, Harland R, Broadbent M, McCrone P, Stewart R. Predicting high-cost care in a mental health setting. BJPsych Open 2020; 6:e10. [PMID: 31950891 PMCID: PMC7001466 DOI: 10.1192/bjo.2019.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/01/2019] [Accepted: 12/04/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The density of information in digital health records offers new potential opportunities for automated prediction of cost-relevant outcomes. AIMS We investigated the extent to which routinely recorded data held in the electronic health record (EHR) predict priority service outcomes and whether natural language processing tools enhance the predictions. We evaluated three high priority outcomes: in-patient duration, readmission following in-patient care and high service cost after first presentation. METHOD We used data obtained from a clinical database derived from the EHR of a large mental healthcare provider within the UK. We combined structured data with text-derived data relating to diagnosis statements, medication and psychiatric symptomatology. Predictors of the three different clinical outcomes were modelled using logistic regression with performance evaluated against a validation set to derive areas under receiver operating characteristic curves. RESULTS In validation samples, the full models (using all available data) achieved areas under receiver operating characteristic curves between 0.59 and 0.85 (in-patient duration 0.63, readmission 0.59, high service use 0.85). Adding natural language processing-derived data to the models increased the variance explained across all clinical scenarios (observed increase in r2 = 12-46%). CONCLUSIONS EHR data offer the potential to improve routine clinical predictions by utilising previously inaccessible data. Of our scenarios, prediction of high service use after initial presentation achieved the highest performance.
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Affiliation(s)
- Craig Colling
- Applied Clinical Informatics Lead, SLaM Biomedical Research Center, South London & Maudsley Foundation NHS Trust, UK
| | - Mizanur Khondoker
- Senior Lecturer in Medical Statistics, University of East Anglia, Norwich Medical School, UK
| | - Rashmi Patel
- MRC UKRI Health Data Research UK Fellow, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London; and South London & Maudsley Foundation NHS Trust, UK
| | - Marcella Fok
- Visiting Researcher, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London; and Central and North West London NHS Foundation Trust, UK
| | - Robert Harland
- Clinical Director of Psychosis, Psychosis CAG, South London & Maudsley Foundation NHS Trust, UK
| | - Matthew Broadbent
- Informatics Lead, SLaM Biomedical Research Center, South London & Maudsley Foundation NHS Trust, UK
| | - Paul McCrone
- Professor of Health Economics, School of Health Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Robert Stewart
- Professor of Psychiatric Epidemiology and Clinical Informatics, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London; and South London & Maudsley Foundation NHS Trust, UK
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Elias ADDS, De Melo Tavares CM, Eleutério Ferreira R. Desafíos provenientes de la experimentación estética para la práctica de la enfermería en el hospital psiquiátrico. REVISTA CUIDARTE 2019. [DOI: 10.15649/cuidarte.v10i3.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Investigamos el potencial del cuerpo de las enfermeras en el cuidado de personas internadas en el hospital psiquiátrico. Partimos del supuesto de que a través de experimentos estéticos con el cuerpo las enfermeras pueden intensificar modos de existencia en el cuidado, vislumbrando nuevas posibilidades de desempeñarse profesionalmente. El objetivo del estudio es analizar los desafíos para la práctica de la enfermería psiquiátrica con base en experimentos creativos con el cuerpo. Materiales y Métodos: Investigación cualitativa, de enfoque socio-poético, realizada en 2017. Los datos se produjeron a través del dispositivo grupo-investigador y del uso de técnicas artísticas, conformado por siete enfermeras de un hospital psiquiátrico del Río de Janeiro, Brasil. Analizados por categorización global según la sociopoética. Resultados: Los datos demostraron un distanciamiento de las enfermeras de las prácticas propias del campo psicosocial, desesperanza en la mejora de la condición de salud del usuario y el potencial de los experimentos estéticos de generar innovación en el cuidado de enfermería. Discusión: Las categorías dialogaron con el referencial teórico de Collière, a saber: 1) el poder reducirse en el cuidado; 2) el poder movilizarse en el cuidado; 3) el poder desenvolverse en el cuidado. Conclusiones: Se concluye que existe una indefinición en cuanto a los quehaceres de la enfermería en el hospital psiquiátrico y la disposición de las enfermeras de cambiar/crear sus prácticas a la luz de una clínica que valore a la persona internada como ciudadano.
Como citar este artículo: Elias AD, Tavares CM, Ferreira RE. Desafios provenientes da experimentação estética para prática de enfermagem no hospital psiquiátrico. Rev Cuid. 2019; 10(3): e629. http://dx.doi.org/10.15649/cuidarte.v10i3.629
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Wykes T, Csipke E, Rose D, Craig T, McCrone P, Williams P, Koeser L, Nash S. Patient involvement in improving the evidence base on mental health inpatient care: the PERCEIVE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundDespite the movement towards care in the community, 40% of the NHS budget on mental health care is still attributed to inpatient services. However, long before the Francis Report highlighted grave shortcomings in inpatient care, there were reports by service user groups on the poor quality of these services in mental health. The programme provides a particular focus on the inclusion of the patient’s perspective in the development and evaluation of evidence.ObjectivesTo understand how changes to inpatient care affect the perceptions of the ward by service users and staff by using stakeholder participatory methods.DesignThe programme consisted of four work packages (WPs). (1) Lasting Improvements for Acute Inpatient SEttings (LIAISE): using participatory methods we developed two new scales [Views On Therapeutic Environment (VOTE) for staff and Views On Inpatient CarE (VOICE) for service users]. (2) Client Services Receipt Inventory – Inpatient (CITRINE): working with nurses and service users we developed a health economic measure of the amount of contact service users have with staff. The self-report measure records interactions with staff as well as the number of therapeutic activities attended. (3) Delivering Opportunities for Recovery (DOORWAYS): a stepped-wedge randomised controlled trial to test if training ward nurses to deliver therapeutic group activities would improve the perception of the ward by service users and staff. A total of 16 wards were progressively randomised and we compared the VOICE, VOTE and CITRINE measures before and after the intervention. A total of 1108 service users and 539 staff participated in this trial. (4) Bringing Emergency TreatmenT to Early Resolution (BETTER PATHWAYS) was an observational study comparing two service systems. The first was a ‘triage’ system in which service users were admitted to the triage ward and then either transferred to their locality wards or discharged back into the community within 7 days. The second system was routine care. We collected data from 454 service users and 284 nurses on their perceptions of the wards.Main outcome measuresThe main outcomes for the DOORWAYS and BETTER project were service user and staff perceptions of the ward (VOICE and VOTE, respectively) and the health economic measure was CITRINE. All were developed in WPs 1 and 2.ResultsWe developed reliable and valid measures of (1) the perceptions of inpatient care from the perspectives of service users and nurses (VOICE and VOTE) and (2) costs of interactions that were valued by service users (CITRINE). In the DOORWAYS project, after adjusting for legal status, we found weak evidence for benefit (standardised effect of –0.18, 95% CI 0.38 improvement to 0.01 deterioration;p = 0.062). There was only a significant benefit for involuntary patients following the staff training (N582, standardised effect of –0.35, 95% CI –0.57 to –0.12;p = 0.002; interactionp-value 0.006). VOTE scores did not change over time (standardised effect size of 0.04, 95% CI –0.09 to 0.18;p = 0.54). We found no evidence of an improvement in cost-effectiveness (estimated effect of £33, 95% CI –£91 to £146;p = 0.602), but resource allocation did change towards patient-perceived meaningful contacts by an average of £12 (95% CI –£76 to £98;p = 0·774). There were no significant differences between the triage and routine models of admission in terms of better perceptions by service users (estimated effect 0.77-point improvement in VOICE score on the triage ward;p = 0.68) or nurses (estimated effect of 1.68-point deterioration in VOTE on the triage ward;p = 0.38) or in terms of the cost of the length of care provided (£391 higher on triage;p = 0.77).Strengths and limitationsWe have developed measures using methods involving both service users and staff from mental health services. The measures were developed specifically for acute inpatient services and, therefore, cannot be assumed to be useful for other services. For instance, extensions of the measures are under construction for use in mother and baby units. The strength of the BETTER PATHWAYS and DOORWAYS projects is the large-scale data collection. However, we were testing specific services based in inner city areas and stretching to inner urban areas. It may be that different effects would be found in more rural communities or in different types of inpatient care.Future workOur database will be used to develop an understanding of the mediating and moderating factors for improving care quality.Trial registrationCurrent Controlled Trials ISRCTN06545047.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Emese Csipke
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Diana Rose
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Thomas Craig
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul McCrone
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paul Williams
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Leonardo Koeser
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Stephen Nash
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Serrano-Blanco A, Rubio-Valera M, Aznar-Lou I, Baladón Higuera L, Gibert K, Gracia Canales A, Kaskens L, Ortiz JM, Salvador-Carulla L. In-patient costs of agitation and containment in a mental health catchment area. BMC Psychiatry 2017; 17:212. [PMID: 28583103 PMCID: PMC5460463 DOI: 10.1186/s12888-017-1373-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. METHODS A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. RESULTS During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. CONCLUSIONS Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.
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Affiliation(s)
- Antoni Serrano-Blanco
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Ignacio Aznar-Lou
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luisa Baladón Higuera
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
| | - Karina Gibert
- Statistics and Operations Research Department, Knowledge Engineering and Machine Learning group, Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain
| | | | | | - José Miguel Ortiz
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Medicine, Biology & Environment, The Australian National University, Canberra, Australia
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