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Gutierrez G, Stephenson C, Eadie J, Asadpour K, Alavi N. Examining the role of AI technology in online mental healthcare: opportunities, challenges, and implications, a mixed-methods review. Front Psychiatry 2024; 15:1356773. [PMID: 38774435 PMCID: PMC11106393 DOI: 10.3389/fpsyt.2024.1356773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Online mental healthcare has gained significant attention due to its effectiveness, accessibility, and scalability in the management of mental health symptoms. Despite these advantages over traditional in-person formats, including higher availability and accessibility, issues with low treatment adherence and high dropout rates persist. Artificial intelligence (AI) technologies could help address these issues, through powerful predictive models, language analysis, and intelligent dialogue with users, however the study of these applications remains underexplored. The following mixed methods review aimed to supplement this gap by synthesizing the available evidence on the applications of AI in online mental healthcare. Method We searched the following databases: MEDLINE, CINAHL, PsycINFO, EMBASE, and Cochrane. This review included peer-reviewed randomized controlled trials, observational studies, non-randomized experimental studies, and case studies that were selected using the PRISMA guidelines. Data regarding pre and post-intervention outcomes and AI applications were extracted and analyzed. A mixed-methods approach encompassing meta-analysis and network meta-analysis was used to analyze pre and post-intervention outcomes, including main effects, depression, anxiety, and study dropouts. We applied the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the quality of the evidence. Results Twenty-nine studies were included revealing a variety of AI applications including triage, psychotherapy delivery, treatment monitoring, therapy engagement support, identification of effective therapy features, and prediction of treatment response, dropout, and adherence. AI-delivered self-guided interventions demonstrated medium to large effects on managing mental health symptoms, with dropout rates comparable to non-AI interventions. The quality of the data was low to very low. Discussion The review supported the use of AI in enhancing treatment response, adherence, and improvements in online mental healthcare. Nevertheless, given the low quality of the available evidence, this study highlighted the need for additional robust and high-powered studies in this emerging field. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=443575, identifier CRD42023443575.
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Affiliation(s)
- Gilmar Gutierrez
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Jazmin Eadie
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
- Faculty of Education, Queen’s University, Kingston, ON, Canada
- Department of Psychology, Faculty of Arts and Sciences, Queen’s University, Kingston, ON, Canada
| | - Kimia Asadpour
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
- OPTT Inc., Toronto, ON, Canada
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Gutierrez G, Gizzarelli T, Moghimi E, Vazquez G, Alavi N. Online cognitive behavioral therapy (eCBT) for the management of depression symptoms in unipolar and bipolar spectrum disorders, a systematic review and network meta-analysis. J Affect Disord 2023; 341:379-392. [PMID: 37683940 DOI: 10.1016/j.jad.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 07/30/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Face-to-face cognitive behavioral therapy (CBT) is effective in the management of depression symptoms in unipolar and bipolar spectrum disorders. Though, compared to electronic adaptations of CBT (eCBT), it carries several accessibility limitations. Furthermore, unlike eCBT for depression symptoms (eCBTg), eCBT specific for bipolar depression (eCBT-Bipol) remains largely understudied. Thus, supplementing this gap, this systematic review and network meta-analysis (NMA) synthesized the available literature on eCBT for the treatment of unipolar and bipolar depression symptoms. METHOD MEDLINE, CINAHL, PsycINFO, EMBASE, and Cochrane were searched for relevant randomized controlled trials (RCTs) on eCBTg and eCBT-Bipol The review followed PRISMA guidelines and used the Cochrane risk of bias tool and GRADE criteria for quality assessment. Effect sizes were summarized using standardized mean differences (SMDs) and risk ratios (RRs). RESULTS eCBT-Bipol was comparable to eCBTg (SMD: 0.05, 95 % CI: -0.18; 0.28) and other psychotherapeutic interventions (SMD: 0.14, 95 % CI: -0.07; 0.35) for the management of mild to moderate depression symptoms. eCBT-Bipol was significantly more effective than attention controls (SMD: 0.35, 95 % CI: 0.11; 0.59), treatment as usual (SMD: 0.55, 95 % CI: 0.21; 0.90) and no intervention controls (SMD: 0.66, 95 % CI: 0.40; 0.93) in mitigating symptoms. LIMITATIONS The scarcity of eCBT-Bipol studies impacted the quality of the evidence in terms of risk of bias and imprecision. CONCLUSIONS The findings of this systematic review suggest that eCBT-Bipol has comparable effectiveness to eCBTg in managing depressive symptoms of unipolar and bipolar spectrum disorder. Though, they also highlighted the need for more studies on eCBT-Bipol.
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Affiliation(s)
- Gilmar Gutierrez
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Tessa Gizzarelli
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Elnaz Moghimi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Gustavo Vazquez
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada; Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada; OPTT Inc., Toronto, Ontario, Canada
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Kim KH, Lee SM, Hong M, Han KM, Paik JW. Trends in telemedicine utilization for mental illness during the COVID-19 pandemic: an analysis of a nationwide database in Korea. BMC Psychiatry 2023; 23:777. [PMID: 37875854 PMCID: PMC10598914 DOI: 10.1186/s12888-023-05258-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has worsened mental health and reduced access to mental health services. During the pandemic, the demand for telemedicine has increased and related laws have been enacted. This study aimed to investigate telemedicine use for cases of major mental illnesses during the COVID-19 pandemic and to compare the characteristics of patients who received telemedicine service with those of patients who received in-person care. METHODS This population-based, cross-sectional, observational study was based on health insurance claims data, and included 2,749,872 patients who received outpatient treatment for mental illness from February 24, 2020 to June 30, 2022. Logistic regression was performed to assess the relationships between patient characteristics and telemedicine service use. Patients who received telemedicine services were analyzed in subgroups of each mental illness. RESULTS During the study period, 80,157 patients (2.9%), with an average age of 63 years, received at least one telemedicine treatment. There was a predominance of women and medical aid recipients. The lowest proportion of telemedicine treatments was for depression (2.1%), and the highest was for dementia (6.7%). The proportion of patients receiving telemedicine in long-term care hospitals was high (22.6%), with the highest odds ratio (OR) (5.84), compared with that in tertiary or general hospitals, followed by that in psychiatric hospitals and clinics. The proportions were high in the departments of internal medicine, neurology, and psychiatry. Patients aged > 80 years received most telemedicine treatment (OR: 1.23) across all diagnoses. Cases of dementia and other mental disorders had higher ORs (2.60 and 2.36, respectively) compared with cases of depression. Except for dementia and behavioral/emotional disorders, hospitalization increased the probability of telemedicine treatment. Comorbidities were positively associated with telemedicine treatment. CONCLUSIONS Older people and people with other physical illnesses were more likely to use telemedicine treatments temporarily provided during the pandemic. Telemedicine maintained continuity of treatment for patients with dementia and severe mental illnesses. Telemedicine can be useful for filling the medical gaps for vulnerable populations other than those with mild mental illnesses. This aspect should be considered for the future establishment of telemedicine systems.
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Affiliation(s)
- Kyoung Hoon Kim
- Department of Health Administration, College of Nursing and Health, Kongju National University, Gongju, Republic of Korea
| | - Sang Min Lee
- Department of Psychiatry, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- UNC Neuroscience Center, University of North Carolina, Chapel Hill, NC, USA
| | - Minha Hong
- UNC Neuroscience Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
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Cavallo M, Pedroli E, Cantoia M, McGrath B, Cecchetti S. Attitudes of Mental Health Professionals towards Telepsychology during the Pandemic: A Pilot Study. Healthcare (Basel) 2023; 11:healthcare11111542. [PMID: 37297682 DOI: 10.3390/healthcare11111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE This pilot study investigated mental health professionals' attitudes towards remote psychological consultations and internet-based interventions. METHODS An online survey in Italian and English was administered to a sample of 191 psychologists and psychotherapists to collect detailed information about their professional experience providing online psychological interventions a year and a half after the beginning of the SARS-CoV-2 pandemic. RESULTS The results did not reveal a statistically significant association between the participants' theoretical approaches and the number of patients treated via the online modality. Overall, most of the participants found advantages to the online setting but also noted critical issues regarding privacy and the ease of integrating new technology into their clinical practice. CONCLUSIONS According to the participants, despite the challenges that must be addressed, telehealth is a viable psychological therapeutic option that is destined to grow in importance in the near future.
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Affiliation(s)
- Marco Cavallo
- Faculty of Psychology, eCampus University, 22060 Novedrate, CO, Italy
- Clinical Psychology Service, Saint George Foundation, 12030 Cavallermaggiore, CN, Italy
| | - Elisa Pedroli
- Faculty of Psychology, eCampus University, 22060 Novedrate, CO, Italy
- Applied Technology for Neuropsychology Lab, IRCCS Istituto Auxologico Italiano, 20135 Milan, MI, Italy
| | - Manuela Cantoia
- Faculty of Psychology, eCampus University, 22060 Novedrate, CO, Italy
| | - Breeda McGrath
- The Chicago School of Professional Psychology, Chicago, IL 60601, USA
| | - Sonja Cecchetti
- Faculty of Psychology, eCampus University, 22060 Novedrate, CO, Italy
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Duricy E, Durisko C, Dickey MW, Fiez JA. Comparing the Reliability of Virtual and In-Person Post-Stroke Neuropsychological Assessment with Language Tasks. Arch Clin Neuropsychol 2023; 38:557-569. [PMID: 36537281 PMCID: PMC10202548 DOI: 10.1093/arclin/acac100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE Neuropsychological testing is essential for both clinical and basic stroke research; however, the in-person nature of this testing is a limitation. Virtual testing overcomes the hurdles of geographic location, mobility issues and permits social distancing, yet its validity has received relatively little investigation, particularly in comparison with in-person testing. METHOD We expand on our prior findings of virtual testing feasibility by assessing virtual versus in-person administration of language and communication tasks with 48 left-hemisphere stroke patients (21 F, 27 M; mean age = 63.4 ± 12; mean years of education = 15.3 ± 3.5) in a quasi-test-retest paradigm. Each participant completed two testing sessions: one in their home and one in the research lab. Participants were assigned to one of the eight groups, with the testing condition (fully in-person, partially virtual), order of home session (first, second) and technology (iPad, Windows tablet) varied across groups. RESULTS Across six speech-language tasks that utilized varying response modalities and interfaces, we found no significant difference in performance between virtual and in-person testing. However, our results reveal key considerations for successful virtual administration of neuropsychological tests, including technology complications and disparities in internet access. CONCLUSIONS Virtual administration of neuropsychological assessments demonstrates comparable reliability with in-person data collection involving stroke survivors, though technology issues must be taken into account.
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Affiliation(s)
- Erin Duricy
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA 15213, USA
| | - Corrine Durisko
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Michael Walsh Dickey
- Center for the Neural Basis of Cognition, Pittsburgh, PA 15213, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
| | - Julie A Fiez
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA 15213, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA 15260, USA
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Gutierrez G, Stephenson C, Eadie J, Moghimi E, Omrani M, Groll D, Soares C, Milev R, Vazquez G, Yang M, Alavi N. Evaluating the efficacy of Web-Based Cognitive Behavioural Therapy for the treatment of patients with Bipolar II Disorder and residual depressive symptoms: Protocol for a randomized controlled trial. JMIR Res Protoc 2023; 12:e46157. [PMID: 37140460 DOI: 10.2196/46157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a highly prevalent psychiatric condition that can significantly impact every aspect of a person's life if left untreated. A subtype of BD, Bipolar disorder II (BD-II) is characterized by long depressive episodes and residual depression symptoms, with short-lived hypomanic episodes. Medication and psychotherapy, such as cognitive behavioral therapy (CBT), are the main treatment options for BD-II. CBT specific for BD-II involves the recognition of warning signs, potentially triggering stimuli, and the development of coping skills to increase euthymic periods and improve global functioning. However, access to in-person CBT may be limited by several barriers including low availability, high costs and geographical limitations. Thus, online adaptations of CBT (e-CBT) have become a promising solution to address these treatment barriers Nevertheless, e-CBT for the treatment of BD-II remains understudied. OBJECTIVE The proposed study aims to establish the first e-CBT program specific for the treatment of BD-II with residual depressive symptoms. The primary objective of this study will be to determine the effect of e-CBT in managing BD symptomatology. The secondary objective will be to assess the effects of this e-CBT program on quality of life, and resilience. The tertiary objective will involve gathering user feedback using a post-treatment survey to support the continuous improvement and optimization of the proposed program. METHODS Adult participants (n = 170) with a confirmed diagnosis of BD-II experiencing residual depressive symptoms will be randomly assigned to either the e-CBT plus TAU (n = 85) group or the TAU (n = 85) control group. Participants in the control group will be able to participate in the online program after the first 13 weeks. The e-CBT program will consist of 13 weekly online modules designed following a validated CBT framework. Participants will complete module-related homework and receive asynchronous personalized feedback from a therapist. TAU will consist of standard treatment services conducted outside of the current research study. Depression and manic symptoms quality of life and resiliency will be assessed using clinically validated symptomatology questionnaires at baseline, week 6, and week 13. RESULTS The study received ethics approval in March 2020 and participant recruitment is expected to begin in February 2023 through targeted advertisements and physician referrals. Data collection and analysis are expected to conclude by December 2024. Linear and binomial regression (continuous and categorical outcomes respectively) will be conducted along with qualitative interpretive methods. CONCLUSIONS The findings will be the first on the effectiveness of delivering e-CBT for patients with BD-II with residual depressive symptoms. This approach can provide an innovative method to address barriers to in-person psychotherapy by increasing accessibility and decreasing costs. CLINICALTRIAL clinicaltrials.gov (NCT04664257); clinicaltrials.gov/ct2/show/NCT04664257.
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Affiliation(s)
- Gilmar Gutierrez
- Department of Psychiatry, Queen's University, 15 Arch Street, Kingston, CA
| | - Callum Stephenson
- Department of Psychiatry, Queen's University, 15 Arch Street, Kingston, CA
| | - Jazmin Eadie
- Department of Psychiatry, Queen's University, 15 Arch Street, Kingston, CA
- Department of Psychology, Queen's University, Kingston, CA
- Department of Education, Queen's University, Kingston, CA
| | - Elnaz Moghimi
- Department of Psychiatry, Queen's University, 15 Arch Street, Kingston, CA
| | - Mohsen Omrani
- Department of Psychiatry, Queen's University, 15 Arch Street, Kingston, CA
| | - Dianne Groll
- Department of Psychiatry, Queen's University, 15 Arch Street, Kingston, CA
| | - Claudio Soares
- Department of Psychiatry, Queen's University, 15 Arch Street, Kingston, CA
- Centre for Neuroscience Studies, Queen's University, Kingston, CA
| | - Roumen Milev
- Department of Psychiatry, Queen's University, 15 Arch Street, Kingston, CA
- Centre for Neuroscience Studies, Queen's University, Kingston, CA
| | - Gustavo Vazquez
- Department of Psychiatry, Queen's University, 15 Arch Street, Kingston, CA
- Centre for Neuroscience Studies, Queen's University, Kingston, CA
| | - Megan Yang
- Department of Psychiatry, Queen's University, 15 Arch Street, Kingston, CA
| | - Nazanin Alavi
- Department of Psychiatry, Queen's University, 166 Brock street, Kingston, CA
- Centre for Neuroscience Studies, Queen's University, Kingston, CA
- OPTT Inc., Toronto, CA
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Pourat N, Padilla-Frausto DI, Chen X, Lim D, Osterweil D, Batra RA. The Impact of a Primary Care Telepsychiatry Program on Outcomes of Managed Care Older Adults. J Am Med Dir Assoc 2023; 24:119-124.e4. [PMID: 36356654 DOI: 10.1016/j.jamda.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The goal of this study was to assess the outcomes of a primary-based telepsychiatry intervention program for older managed care enrollees with depression/anxiety and with limited access to in-person psychiatric care. DESIGN A pre-post design was used to examine service use (n = 218) and severity of depression (n = 204). Enrollment, claims, and depression and anxiety score data were obtained from the medical group. The implementation process and self-reported outcomes were examined. SETTING AND PARTICIPANTS The program was funded by the Senior Care Action Network (SCAN) group and implemented by a large medical group serving older adults who were identified as needing outpatient psychiatric care, including those with psychiatric hospitalizations, depression/anxiety disorders, comorbid substance use disorders, or other multiple comorbidities. METHODS Poisson regressions were used to examine changes in predicted rates of outpatient services, emergency department visits, and hospitalizations up to 24 months prior and 24 months following the first telepsychiatry visit. Changes in predicted severity of depression up to 2 quarters prior and 3 quarters following the first telepsychiatry visit were examined. RESULTS The number of outpatient services declined significantly by 0.24 per patient per 6-month time frame following the first telepsychiatry visit. The number of emergency department visits and hospitalizations also declined after the first visit (0.07 and 0.03 per patient per 6-month time frame, respectively). Depression severity scores also declined in the quarters following the first visit (1.52). The medical group reported improvements in both wait time for appointments and no-show rates with the integration of telepsychiatry in primary care. CONCLUSIONS AND IMPLICATIONS The telepsychiatry program lowered service use, depression severity, and increased better access to psychiatry care. The findings highlight the potential benefits of sustaining and expanding the telepsychiatry program by SCAN and other plans facing a limited supply of psychiatrists.
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Affiliation(s)
- Nadereh Pourat
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Xiao Chen
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA
| | - Dominic Lim
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
| | - Dan Osterweil
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA; Division of Geriatric Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Romilla A Batra
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
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Li F, Cui Y, Li Y, Guo L, Ke X, Liu J, Luo X, Zheng Y, Leckman JF. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals. J Child Psychol Psychiatry 2022; 63:34-46. [PMID: 34019305 DOI: 10.1111/jcpp.13445] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND To date, no national-scale psychiatric epidemiological survey for children and adolescents has been conducted in China. In order to inform government officials and policymakers and to develop a comprehensive plan for service providers, there was a clear need to conduct an up-to-date systematic nationwide psychiatric epidemiological survey. METHODS We conducted a two-stage large-scale psychiatric point prevalence survey. Multistage cluster stratified random sampling was used as the sampling strategy. Five provinces were selected by comprehensively considering geographical partition, economic development, and rural/urban factors. In Stage 1, the Child Behavior Checklist was used as the screening tool. In Stage 2, Mini-International Neuropsychiatric Interview for Children and Adolescents and a diagnostic process based on the Diagnostic and Statistical Manual were used to make the diagnoses. Sampling weights and poststratification weights were employed to match the population distributions. Exploratory analyses were also performed using socio-demographic factors. Prevalence in socio-demographic factor subgroups and overall were estimated. Rao-Scott adjusted chi-square tests were utilized to determine if between-group differences were present. Factor interactions were checked by logistic regression analyses. RESULTS A total of 73,992 participants aged 6-16 years of age were selected in Stage 1. In Stage 2, 17,524 individuals were screened and diagnosed. The weighted prevalence of any disorder was 17.5% (95% CI: 17.2-18.0). Statistically significant differences in prevalence of any psychiatric disorder were observed between sexes [χ2 (1, N = 71,929) = 223.0, p < .001], age groups [χ2 (1, N = 71,929) = 18.6, p < .001] and developed vs. developing areas [χ2 (1, N = 71,929) = 2,129.6, p < .001], while no difference was found between rural and urban areas [χ2 (1, N = 71,929) = 1.4, p = .239]. Male, younger individuals, children, and adolescents from developed areas had higher prevalence of any psychiatric disorder. The prevalence of any psychiatric disorder was found to decrease with the age in the male group, while the female group increased with the age. Individuals diagnosed with attention-deficit hyperactivity disorder, oppositional defiant disorder, a tic disorder, conduct disorder, and major depression disorder had the highest rates of comorbidity. CONCLUSIONS The prevalence of any psychiatric disorder we found is the highest ever reported in China. These results urgently need to be addressed by public mental health service providers and policymakers in order to provide access to the necessary treatments and to reduce the long-term negative impact of these conditions on families and the society as a whole.
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Affiliation(s)
- Fenghua Li
- Key Lab of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yonghua Cui
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Li
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lanting Guo
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, China
| | | | - Jing Liu
- Sixth hospital, Peking University, Beijing, China
| | - Xuerong Luo
- Mental Health Institute, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Yi Zheng
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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Bagchi AD, Damas K, Salazar de Noguera N, Melamed B, Menifield C, Baveja A, Weber P, Swaminathan S. Comfort With Telehealth Among Residents of an Underserved Urban Area. J Prim Care Community Health 2022; 13:21501319221119692. [PMID: 36039812 PMCID: PMC9434674 DOI: 10.1177/21501319221119692] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Deployment of telehealth has been touted as a means of reducing health
disparities in underserved groups. However, efforts to reduce regulatory
barriers have not been associated with greater telehealth uptake. The goal
of this study was to examine engagement with technology among low-income
people of color living in Newark, New Jersey. Methods: Using surveys and focus groups, we examined study participants’ daily use of
technology (eg, Internet) and comfort with telehealth services (eg, use of
teleconferencing for medication refills) before and after COVID-related
social distancing mandates went into effect. Results: Use of technology was significantly lower in the pre-COVID period. However,
prior months’ use of technology had a weak but significant correlation with
comfort with telehealth (r = .243,
P = .005) in bivariate analyses and was the only
significant predictor in multivariate analyses. Analyses of focus group
discussions confirmed that lack of experience with technology and distrust
of the security and privacy of digital systems were the most important
barriers to comfort with telehealth in our sample. Conclusion: Our study found that approximately 20% of people in this under-resourced
community lacked access to basic technologies necessary for successful
deployment of telehealth services. The study’s timing provided an unexpected
opportunity to compare experiences and attitudes relating to telehealth in 2
regulatory environments. Although uptake of telehealth services increased
with the Federal governments’ relaxation of regulatory barriers, there was
not a similar increase in comfort with telehealth use. Investments in
broadband access and equipment should be accompanied by educational programs
to increase day-to-day use of and comfort with associated technologies which
would improve consumer confidence in telehealth.
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Affiliation(s)
- Ann D Bagchi
- Rutgers Business School, Department of Supply Chain Management, Rutgers - The State University of New Jersey, Piscataway, NJ, USA
| | - Kasny Damas
- School of Public Affairs and Administration, Rutgers - The State University of New Jersey, Newark, NJ, USA
| | | | - Benjamin Melamed
- Rutgers Business School, Department of Supply Chain Management, Rutgers - The State University of New Jersey, Piscataway, NJ, USA
| | - Charles Menifield
- School of Public Affairs and Administration, Rutgers - The State University of New Jersey, Newark, NJ, USA
| | - Alok Baveja
- Rutgers Business School, Department of Supply Chain Management, Rutgers - The State University of New Jersey, Piscataway, NJ, USA
| | - Paul Weber
- Center for Continuing and Outreach Education, Rutgers Robert Wood Johnson Medical School and New Jersey Medical School, Piscataway, NJ, USA
| | - Shobha Swaminathan
- Department of Medicine, New Jersey Medical School, Rutgers - The State University of New Jersey, Newark, NJ, USA
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10
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Traube D, Gozalians S, Duan L. Transitions to virtual early childhood home visitation during COVID-19. Infant Ment Health J 2021; 43:69-81. [PMID: 34953079 PMCID: PMC9015548 DOI: 10.1002/imhj.21957] [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: 04/07/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022]
Abstract
COVID-19 has disrupted many of the preventive service sectors designed to promote infant mental health. The purpose of this study is to examine provider and supervisor transition strategies as well as maternal-child outcomes during the transition from in-person to virtual early childhood home visitation services in Los Angeles County. Los Angeles County is one of the largest home visitation sectors in the U.S. and disproportionately impacted by the COVID-19 pandemic. Transitioning from in-person to virtual home visitation was an important step in ensuring the continuity of infant mental health services. Home visitors reported relative ease in transitioning to virtual services themselves but noted that families encountered greater difficulty. The most helpful strategies to support this transition included training, ongoing reflective supervision, and provision of technology. Family level analysis revealed that positive screening rates for anxiety and depression decreased during the pandemic as did referrals for most support services. These findings likely highlight challenges in delivering virtual home visitation. Understanding how transitions in a key infant serving sector were managed serves an important role in forecasting for the future and preparing for future public heath emergencies.
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Affiliation(s)
- Dorian Traube
- USC Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Sharlene Gozalians
- Los Angeles Best Babies Network at Dignity Health California Hospital Medical Center, Los Angeles, California, USA
| | - Lei Duan
- USC Dworak-Peck School of Social Work, Los Angeles, California, USA
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11
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Abraham A, Jithesh A, Doraiswamy S, Al-Khawaga N, Mamtani R, Cheema S. Telemental Health Use in the COVID-19 Pandemic: A Scoping Review and Evidence Gap Mapping. Front Psychiatry 2021; 12:748069. [PMID: 34819885 PMCID: PMC8606591 DOI: 10.3389/fpsyt.2021.748069] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/15/2021] [Indexed: 01/07/2023] Open
Abstract
Background: The COVID-19 pandemic has highlighted telemedicine use for mental illness (telemental health). Objective: In the scoping review, we describe the scope and domains of telemental health during the COVID-19 pandemic from the published literature and discuss associated challenges. Methods: PubMed, EMBASE, and the World Health Organization's Global COVID-19 Database were searched up to August 23, 2020 with no restrictions on study design, language, or geographical, following an a priori protocol (https://osf.io/4dxms/). Data were synthesized using descriptive statistics from the peer-reviewed literature and the National Quality Forum's (NQF) framework for telemental health. Sentiment analysis was also used to gauge patient and healthcare provider opinion toward telemental health. Results: After screening, we identified 196 articles, predominantly from high-income countries (36.22%). Most articles were classified as commentaries (51.53%) and discussed telemental health from a management standpoint (86.22%). Conditions commonly treated with telemental health were depression, anxiety, and eating disorders. Where data were available, most articles described telemental health in a home-based setting (use of telemental health at home by patients). Overall sentiment was neutral-to-positive for the individual domains of the NQF framework. Conclusions: Our findings suggest that there was a marked growth in the uptake of telemental health during the pandemic and that telemental health is effective, safe, and will remain in use for the foreseeable future. However, more needs to be done to better understand these findings. Greater investment into human and financial resources, and research should be made by governments, global funding agencies, academia, and other stakeholders, especially in low- and middle- income countries. Uniform guidelines for licensing and credentialing, payment and insurance, and standards of care need to be developed to ensure safe and optimal telemental health delivery. Telemental health education should be incorporated into health professions curricula globally. With rapidly advancing technology and increasing acceptance of interactive online platforms amongst patients and healthcare providers, telemental health can provide sustainable mental healthcare across patient populations. Systematic Review Registration: https://osf.io/4dxms/.
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Affiliation(s)
- Amit Abraham
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Anupama Jithesh
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | | | | | - Ravinder Mamtani
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Sohaila Cheema
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
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12
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Bierbooms J, Feijt MA, IJsselsteijn WA, Bongers IMB. Design of a Game-Based Training Environment to Enhance Mental Healthcare Professionals’ Skills in Using eMental Health: a User Requirements Analysis (Preprint). JMIR Serious Games 2021; 10:e34700. [PMID: 35896032 PMCID: PMC9377428 DOI: 10.2196/34700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/24/2022] [Accepted: 05/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background A major factor hampering the adoption of technology in mental health care is a lack of knowledge and skills. Serious gaming offers a potentially effective strategy to enhance the skills needed through experiencing and learning-by-doing in a playful way. However, serious gaming solutions are not widely available for mental health care. Therefore, the development of a game-based training environment in mental health care was pursued in a design project. The first step in such a design project is to identify user requirements that should be met. Objective This study aims to deliver user requirements that inform the design of a game-based training environment for mental health care professionals. This environment aims to support mental health care professionals’ knowledge and skill enhancement regarding the use of e–mental health (eMH); for example, video calling, mobile apps, web-based treatment modules, and techniques such as virtual or augmented reality. Methods We used an exploratory multiple methods design consisting of a web-based questionnaire, co-design sessions, and interviews. To ensure a good representation of the target user group, professionals from various disciplines within mental health care were included in the research. The multiple methods design facilitates a broad view of user needs and in-depth knowledge of specific design requirements. We describe the protocol for this research project in a protocol paper published in the JMIR Research Protocols in February 2021. Results The user requirements analysis revealed three types of users for the envisioned game-based training environment: mental health care professionals who want to learn about the basic possibilities of eMH, mental health care professionals who want to develop their eMH skills to the next level, and mental health care professionals who want to experiment with new technologies. This reflects the diversity of needs that were identified, as well as the need to develop a diversity of suitable scenarios in the environment. User requirements analysis shows that the focus of a training environment should be on increasing knowledge about the possibilities of eMH, focusing on experiencing the benefits in particular situations, and building confidence in using eMH in a therapeutic setting. This requires careful consideration of the suitable game characteristics. Conclusions Improvement of mental health care professionals’ skills in eMH requires an environment that is user driven and flexible, and simultaneously incorporates contextual factors that are relevant for its implementation in practice. This user requirements analysis contributes to the understanding of the issues that should be considered in the development of a game-based training environment. This shows that there are multiple and diverse learning needs among mental health care professionals. Various client populations, services, and situations demand various options for training. International Registered Report Identifier (IRRID) RR2-10.2196/18815
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Affiliation(s)
- Joyce Bierbooms
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Milou A Feijt
- Human-Technology Interaction, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Wijnand A IJsselsteijn
- Human-Technology Interaction, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Inge M B Bongers
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
- GGz Eindhoven en de Kempen, Eindhoven, Netherlands
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13
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Zhong C, Freeman RE, Boggs KM, Zachrison KS, Gao J, Espinola JA, Camargo CA. Receipt of Telepsychiatry and Emergency Department Visit Outcomes in New York State. Psychiatr Q 2021; 92:1109-1127. [PMID: 33587257 PMCID: PMC7882855 DOI: 10.1007/s11126-021-09886-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/04/2022]
Abstract
Telepsychiatry has made psychiatric care more accessible to emergency department (ED) patients. To date, most telepsychiatry studies have focused on specific populations or small groups of EDs. This study sought to examine the potential role of telepsychiatry across a wider range of EDs by comparing visit dispositions for psychiatric visits in EDs that did (versus did not) receive telepsychiatry services. ED telepsychiatry service status was identified from the 2016 National ED Inventory-USA and then linked to psychiatric visits from the 2016 New York State Emergency Department Databases/State Inpatient Databases. Unadjusted analyses and multivariable logistic regression models were used to evaluate associations between an ED's telepsychiatry service status and two clinical outcomes: use of observation services and ED visit disposition. Across all psychiatric ED visits, 712,236 were in EDs without telepsychiatry while 101,025 were in EDs with telepsychiatry. Most (99.8%) visits were in urban EDs. In multivariable logistic regression models, psychiatric visits in EDs with telepsychiatry services had lower odds (adjusted odds ratio 0.30) of using observation services compared to visits in EDs without telepsychiatry. The receipt of ED telepsychiatry is associated with lower usage of observation services for psychiatric visits, likely reducing the amount of time spent in the ED and mitigating the ongoing problem of ED crowding. An overwhelming majority of visits in EDs with telepsychiatry services were in urban hospitals with existing psychiatric services. Factors affecting the delivery and effectiveness of telepsychiatry services to hospitals lacking in psychiatric resources merit further investigation.
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Affiliation(s)
- Cordelia Zhong
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 920, Boston, MA, 02114-1101, USA
| | - Rain E Freeman
- Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 920, Boston, MA, 02114-1101, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 920, Boston, MA, 02114-1101, USA
| | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 920, Boston, MA, 02114-1101, USA
| | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 920, Boston, MA, 02114-1101, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 920, Boston, MA, 02114-1101, USA.
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14
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Bock MJ, Kakavand K, Careaga D, Gozalians S. Shifting from in-person to virtual home visiting in Los Angeles County: Impact on programmatic outcomes. Matern Child Health J 2021; 25:1025-1030. [PMID: 33982171 PMCID: PMC8116195 DOI: 10.1007/s10995-021-03169-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 12/02/2022]
Abstract
Purpose This paper describes the effect that the COVID-19 pandemic, and subsequent shift from in-person to virtual (video-based) home visiting, had on the Los Angeles County Welcome Baby Home Visiting Program. Description The Welcome Baby (WB) Program is a voluntary, universal home visiting program for expectant women and women with infants in Los Angeles County implemented in 14 hospitals in Los Angeles County. Oversight of the program is managed by LA Best Babies Network (LABBN) and funded by First 5 LA. The COVID-19 pandemic forced Welcome Baby Home visitors to shift from in-person home visits to virtual visits, which had an impact on programmatic outcomes. Assessment LABBN manages a database utilized by WB sites. In assessing data trends before and during the pandemic, shifting to virtual visits resulted in an increase in both missed visits and completed visits, and a decrease in overall visit length. Completion of required assessments and overall client program completion were not affected by the COVID-19 pandemic. Conclusion The Welcome Baby sites across Los Angeles County were able to successfully migrate in-person visits to a virtual platform, proving that virtual visits are possible and do provide some programmatic benefits. However, the long-term efficacy of virtual visits remains to be seen, and further research is warranted.
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Affiliation(s)
- Martha J Bock
- Technical Assistance and Training Team, LA Best Babies Network, 1401 S Grand Ave, Los Angeles, CA, 90015, USA.
| | - Kayla Kakavand
- Technical Assistance and Training Team, LA Best Babies Network, 1401 S Grand Ave, Los Angeles, CA, 90015, USA
| | | | - Sharlene Gozalians
- Technical Assistance and Training Team, LA Best Babies Network, 1401 S Grand Ave, Los Angeles, CA, 90015, USA
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15
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Classen B, Tudor K, du Preez E, Day E, Ioane J, Rodgers B. An Integrative Review of Contemporary Perspectives on Videoconference-Based Therapy-Prioritising Indigenous and Ethnic Minority Populations in the Global South. ACTA ACUST UNITED AC 2021; 6:545-558. [PMID: 33898737 PMCID: PMC8058578 DOI: 10.1007/s41347-021-00209-3] [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: 12/09/2020] [Revised: 03/14/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
An integrative literature review was undertaken as a means of drawing together contemporary perspectives on the outcomes and affordances of videoconference-based therapy. This review was conducted in a way which placed emphasis on the need for mental healthcare strategies which are mindful of the cultural and social needs of indigenous and ethnic minority populations, particularly those situated in the Global South. The review was undertaken using an inverse funnelling approach which sought to prioritise literature on videoconference-based therapy literature which specifically focused on indigenous and ethnic minority populations. A series of general and population specific searches across relevant health databases were supplemented by a simultaneous search of Google Scholar. The PICOS search tool was used in developing the search terms, and data was processed using an inductive approach to thematic analysis. A final dataset of 43 articles were included in the review. This body of literature encompassed an international range of studies and included perspectives informed by quantitative, qualitative and mixed methods research. Four key themes were identified across the reviewed literature: indigenous and ethnic minority populations, therapeutic relationships, clinical outcomes and technical and logistical considerations. Based on our findings, there is reason to believe that videoconference-based therapy can be made to be just as effective as offline, face-to-face modes of delivery. However, research into the efficacy, impact and cultural implications of this technology in relation to indigenous and ethnic minority populations represents a significant gap within contemporary literature.
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Affiliation(s)
- Ben Classen
- Auckland University of Technology, Auckland, New Zealand
| | - Keith Tudor
- Auckland University of Technology, Auckland, New Zealand
| | | | - Elizabeth Day
- Auckland University of Technology, Auckland, New Zealand
| | - Julia Ioane
- Auckland University of Technology, Auckland, New Zealand
| | - Brian Rodgers
- Auckland University of Technology, Auckland, New Zealand
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16
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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: 7] [Impact Index Per Article: 2.3] [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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17
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Naslund JA, Mitchell LM, Joshi U, Nagda D, Lu C. Economic evaluation and costs of telepsychiatry programmes: A systematic review. J Telemed Telecare 2020; 28:311-330. [PMID: 32746762 DOI: 10.1177/1357633x20938919] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Telepsychiatry involves use of telecommunications technology to deliver psychiatric care and offers promise to reduce costs and increase access to mental health services. This systematic review examined cost reporting of telepsychiatry programmes for mental healthcare. METHODS We systematically searched electronic databases for studies reporting costs, including economic evaluations such as cost-effectiveness analyses, or costs of developing telepsychiatry programmes for clinical care of mental disorders. Included studies enrolled participants with mental disorders and involved telepsychiatry for depression, anxiety disorders, serious mental illnesses including schizophrenia spectrum disorders and bipolar disorder, post-traumatic stress disorder, dementia or epilepsy. RESULTS Twenty-six unique studies met inclusion criteria (17,967 participants), with most targeting depression (n = 7; 27%), general mental disorders and screening (n = 7; 27%), child mental health (n = 4; 15%) and geriatric mental health (n = 4; 15%). Nearly all studies (n = 25; 96%) compared telepsychiatry programme costs with either standard in-person consultation or usual care, with 15 (60%) reporting that telepsychiatry programmes were less expensive, and 8 (32%) showing telepsychiatry programmes were more expensive. Three studies reported cost-effectiveness analyses, favouring telepsychiatry programmes, but at highly elevated cost-effectiveness thresholds. Few studies reported costs of developing or delivering telepsychiatry programmes. CONCLUSION Costs of telepsychiatry programmes varied widely, with substantial heterogeneity in how costs were defined and reported. Some programmes cost less than in-person services while others cost more. Therefore, rigorous cost-effectiveness studies following established standards in economic evaluation are needed to inform implementation and sustainability of these programmes in health systems.
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Affiliation(s)
- John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | | | | | | | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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18
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Maeng D, Richman JH, Lee HB, Hasselberg MJ. Impact of integrating psychiatric assessment officers via telepsychiatry on rural hospitals' emergency revisit rates. J Psychosom Res 2020; 133:109997. [PMID: 32220648 DOI: 10.1016/j.jpsychores.2020.109997] [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: 12/05/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the impact of integrating Psychiatric Assessment Officers (PAO) and telepsychiatry in rural hospitals on their all-cause emergency department (ED) revisit rates. As a pilot project, a full-time PAO was embedded in each of three rural hospitals in New York State and was augmented by telepsychiatry. METHOD A retrospective data analysis using ED census data obtained from the hospitals. The intervention group, defined as those patients treated by PAOs, was compared via a difference-in-difference method against a contemporaneous comparison group defined as those who visited the same EDs and had PAO-qualifying behavioral health diagnoses but were not seen by PAOs. RESULTS The intervention group was associated with an approximately 36% lower all-cause ED revisit rate during the first 90-day period (i.e. 1-90 days) following the initial PAO treatment (p = .003). A reduction of the similar magnitude (44%) persisted into the subsequent 90-day period (i.e., 91-180 days since the initial PAO treatment; p < .001). CONCLUSION The PAO telepsychiatry pilot program suggests a potential way to provide relief for overburdened EDs in rural communities that lack resources to treat patients with severe behavioral health symptoms.
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Affiliation(s)
- Daniel Maeng
- University of Rochester Medical Center, 300 Crittenden Boulevard Box PSYCH, Rochester, NY 14642, United States of America.
| | - Jennifer H Richman
- University of Rochester Medical Center, 300 Crittenden Boulevard Box PSYCH, Rochester, NY 14642, United States of America.
| | - H Benjamin Lee
- University of Rochester Medical Center, 300 Crittenden Boulevard Box PSYCH, Rochester, NY 14642, United States of America.
| | - Michael J Hasselberg
- University of Rochester Medical Center, 300 Crittenden Boulevard Box PSYCH, Rochester, NY 14642, United States of America.
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19
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Kemp J, Zhang T, Inglis F, Wiljer D, Sockalingam S, Crawford A, Lo B, Charow R, Munnery M, Singh Takhar S, Strudwick G. Delivery of Compassionate Mental Health Care in a Digital Technology-Driven Age: Scoping Review. J Med Internet Res 2020; 22:e16263. [PMID: 32141833 PMCID: PMC7084292 DOI: 10.2196/16263] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/19/2019] [Accepted: 12/14/2019] [Indexed: 12/17/2022] Open
Abstract
Background Compassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood. Objective This scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care. Methods We conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019. Results Of the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues. Conclusions Implementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care.
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Affiliation(s)
- Jessica Kemp
- Faculty of Science, University of Waterloo, Waterloo, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Timothy Zhang
- Faculty of Science, University of Waterloo, Waterloo, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fiona Inglis
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Education Technology and Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Brian Lo
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rebecca Charow
- Education Technology and Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mikayla Munnery
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Shuranjeet Singh Takhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
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20
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McClellan SR, Sirkin JT, Pfefferle S, Hunt M, Olsho LEW. Acceptance of New Clients by Mental Health Clinicians in Massachusetts: Findings From a Representative Survey. Psychiatr Serv 2020; 71:158-164. [PMID: 31551040 DOI: 10.1176/appi.ps.201900072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective was to assess the number of new clients accepted by licensed mental health clinicians in Massachusetts and clinician characteristics associated with new clients accepted. METHODS Surveys about client access to outpatient mental health care were sent to a stratified random sample of 2,250 licensed mental health clinicians (psychiatrists, psychologists, licensed certified social workers, licensed independent clinical social workers, licensed mental health counselors, and licensed marriage and family therapists) practicing in Massachusetts. The survey was administered from September 2016 to March 2017 by using a mail survey with a push-to-Web design and telephone follow-up. The final adjusted response rate was 28% (N=413). Results were weighted to reflect the sampling design and for nonresponse and are representative of all licensed mental health clinicians in Massachusetts. RESULTS On average, clinicians accepted seven new clients per month. Although most clinicians reported accepting one or more new clients per month, half reported accepting four or fewer new clients per month. After adjustment for other factors, the analysis showed that clinicians in practices owned by hospitals or health systems reported accepting eight more new clients per month, on average, than clinicians in solo private practices (p<0.05). Clinicians in private group practices reported accepting two more new clients per month on average than clinicians in solo private practices (p<0.05). Working fewer than 30 hours per week and tenure of more than 1 year in one's current position were negatively associated with acceptance of new clients. CONCLUSIONS New client acceptance varied by practice setting but not by type of clinician. These findings can inform mental health system and workforce planning to improve access to mental health services.
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Affiliation(s)
- Sean R McClellan
- Abt Associates, Cambridge, Massachusetts (McClellan, Hunt), and Seattle (Olsho); NORC at the University of Chicago, Boston (Sirkin); Mercy College School of Health and Natural Sciences, Dobbs Ferry, New York (Pfefferle)
| | - Jenna T Sirkin
- Abt Associates, Cambridge, Massachusetts (McClellan, Hunt), and Seattle (Olsho); NORC at the University of Chicago, Boston (Sirkin); Mercy College School of Health and Natural Sciences, Dobbs Ferry, New York (Pfefferle)
| | - Sue Pfefferle
- Abt Associates, Cambridge, Massachusetts (McClellan, Hunt), and Seattle (Olsho); NORC at the University of Chicago, Boston (Sirkin); Mercy College School of Health and Natural Sciences, Dobbs Ferry, New York (Pfefferle)
| | - Meaghan Hunt
- Abt Associates, Cambridge, Massachusetts (McClellan, Hunt), and Seattle (Olsho); NORC at the University of Chicago, Boston (Sirkin); Mercy College School of Health and Natural Sciences, Dobbs Ferry, New York (Pfefferle)
| | - Lauren E W Olsho
- Abt Associates, Cambridge, Massachusetts (McClellan, Hunt), and Seattle (Olsho); NORC at the University of Chicago, Boston (Sirkin); Mercy College School of Health and Natural Sciences, Dobbs Ferry, New York (Pfefferle)
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21
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Ferrazzi P, Krupa T. Remoteness and its impact on the potential for mental health initiatives in criminal courts in Nunavut, Canada. Int J Circumpolar Health 2019; 77:1541700. [PMID: 30384817 PMCID: PMC6225482 DOI: 10.1080/22423982.2018.1541700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Remoteness in the isolated communities of Nunavut, Canada adversely affects access to mental health services. Mental health initiatives in criminal courts exist in many cities to offer healthcare alternatives to regular criminal court processing for people affected by mental illness. These initiatives do not exist in Nunavut. A qualitative multiple-case study in 3 Nunavut communities involving 55 semi-structured interviews and 3 focus groups explored perceptions by health, justice and community stakeholders of the potential for criminal court mental health initiatives in the territory. Findings suggest remoteness is perceived to hinder mental healthcare support for court responses to people affected by mental illness, creating delay in psychiatric assessments and treatment. While communication technologies, such as tele-mental health, are considered an effective solution by most health professionals, many justice-sector participants are sceptical because of perceived limits to accessibility, reliability and therapeutic value. These perceptions suggest remoteness is a significant hurdle facing future criminal court mental health initiatives in Nunavut. Additionally, remoteness is viewed as affecting decisions by lawyers to bypass legislated mental health avenues, possibly resulting in more people with mental illness facing criminal justice sanctions without assessment and treatment.
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Affiliation(s)
- Priscilla Ferrazzi
- a Faculty of Health Sciences , School of Rehabilitation Therapy, Queen's University , Kingston , Canada
| | - Terry Krupa
- a Faculty of Health Sciences , School of Rehabilitation Therapy, Queen's University , Kingston , Canada
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Bice-Urbach B, Kratochwill T, Fischer AJ. Teleconsultation: Application to Provision of Consultation Services for School Consultants. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2017. [DOI: 10.1080/10474412.2017.1389651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mobile Health Technology in Late-Life Mental Illness: A Focused Literature Review. Am J Geriatr Psychiatry 2017; 25:865-872. [PMID: 28495467 DOI: 10.1016/j.jagp.2017.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE In an era of rising geriatric mental health care needs worldwide, technological advances can help address care needs in a cost-effective fashion. Our objective in this review was to assess whether mobile health technology, such as tablets and smartphones, are feasible to use in patients with late-life mental and cognitive disorders, as well as whether they were generally reliable modes of mental health/cognitive assessment. METHODS We performed a focused literature review of MEDLINE, PsychInfo, and Embase databases, including papers specifically assessing the implementation of mobile health technologies: electronic tablets (e.g., iPad), smartphones, and other mobile computerized equipment in older adults (age ≥65 years) diagnosed with or at risk of a mental and/or cognitive disorder. RESULTS A total of 2,079 records were assessed, of which 7 papers were of direct relevance. Studies investigated a broad variety of mobile health technologies. Almost all examined samples with dementia/cognitive dysfunction or at risk for those disorders. All studies exclusively examined the use of mobile health technologies for the assessment of cognitive and or mental illness symptoms or disorders. None of the studies reported participants having any difficulties using the mobile health technology assessments and overall reliability was similar to paper-and-pencil modes of assessment. CONCLUSION Overall, mobile health technologies were found to be feasible by patients and had promising reliability for the assessment of cognitive and mental illness domains in older adults. Future clinical trials will be necessary to assess whether portable communication interventions (e.g., symptom tracking) can improve geriatric mental health outcomes.
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Nestor BA, Cheek SM, Liu RT. Ethnic and racial differences in mental health service utilization for suicidal ideation and behavior in a nationally representative sample of adolescents. J Affect Disord 2016; 202:197-202. [PMID: 27262642 PMCID: PMC4947425 DOI: 10.1016/j.jad.2016.05.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 04/22/2016] [Accepted: 05/13/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study examined racial/ethnic differences in mental health treatment utilization for suicidal ideation and behavior in a nationally representative sample of adolescents. METHOD Data were drawn from the National Survey on Drug Use and Health. Participants included 4176 depressed adolescents with suicidal ideation and behavior in the previous year. Weighted logistic regressions were estimated to examine whether adolescent racial/ethnic minorities had lower rates of past-year treatment for suicidal ideation and behavior in inpatient or outpatient settings, while adjusting for age, depressive symptom severity, family income, and health insurance status. RESULTS Among adolescents with any suicidal ideation and behavior, and suicide attempts specifically, non-Hispanic blacks and Native Americans were less likely than whites to receive outpatient treatment, and multiracial adolescents were less likely to be admitted to inpatient facilities. Apart from Hispanics, racial/ethnic minorities were generally less likely to receive mental health care for suicidal ideation, particularly within psychiatric outpatient settings. A pattern emerged with racial/ethnic differences in treatment receipt being greatest for adolescents with the least severe suicidal ideation and behavior. LIMITATIONS The cross-sectional data limits our ability to form causal inferences. CONCLUSION Strikingly low rates of treatment utilization for suicidal ideation and behavior were observed across all racial/ethnic groups. Certain racial/ethnic minorities may be less likely to seek treatment for suicidal ideation and behavior when symptoms are less severe, with this gap in treatment use narrowing as symptom severity increases. Native Americans were among the racial/ethnic groups with lowest treatment utilization, but also among the highest for rates of suicide attempts, highlighting the pressing need for strategies to increase mental health service use in this particularly vulnerable population.
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Affiliation(s)
- Bridget A Nestor
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA.
| | - Shayna M Cheek
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
| | - Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA.
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Bice-Urbach BJ, Kratochwill TR. Teleconsultation: The use of technology to improve evidence-based practices in rural communities. J Sch Psychol 2016; 56:27-43. [DOI: 10.1016/j.jsp.2016.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 09/27/2015] [Accepted: 02/17/2016] [Indexed: 12/31/2022]
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Hidalgo-Mazzei D, Mateu A, Reinares M, Matic A, Vieta E, Colom F. Internet-based psychological interventions for bipolar disorder: Review of the present and insights into the future. J Affect Disord 2015; 188:1-13. [PMID: 26342885 DOI: 10.1016/j.jad.2015.08.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/12/2015] [Accepted: 08/05/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the last decade, there has been an increasing advent of innovative concepts in psychological interventions aimed at empowering bipolar patients by means of technological advancements and taking advantage of the proliferation of the Internet. Since the adoption of these technologies for behavioral monitoring and intervention is not trivial in clinical practice, the main objective of this review is to provide an overview and to discuss the several initiatives published so far in the literature related to the Internet-based technologies aimed to deliver evidence-based psychological interventions for bipolar disorder patients. METHODS We conducted a comprehensive systematic review of the literature from multiple technological, psychiatric and psychological domains. The search was conducted by applying the Boolean algorithm "BIPOLAR AND DISORDER AND (treatment OR intervention) AND (online OR Internet OR web-based OR smartphone OR mobile)" at MEDLINE, SCOPUS, EMBASE, ClinicalTrials, ISI Web of Science and Google Scholar. RESULTS We identified over 251 potential entries matching the search criteria and after a thorough manual review, 29 publications pertaining to 12 different projects, specifically focusing on psychological interventions for bipolar patients through diverse Internet-based methods, were selected. LIMITATIONS Taking into consideration the diversity of the initiatives and the inconclusive main outcome results of the studies, there is still limited evidence available to draw firm conclusions about the efficacy of interventions using Internet-based technologies for bipolar disorder. CONCLUSIONS However, considering the high rates of retention and compliance reported, they represent a potential highly feasible and acceptable method of delivering this kind of interventions to bipolar patients.
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Affiliation(s)
- Diego Hidalgo-Mazzei
- Bipolar Disorder Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Ainoa Mateu
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - María Reinares
- Bipolar Disorder Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | | | - Eduard Vieta
- Bipolar Disorder Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Francesc Colom
- Bipolar Disorder Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
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Abstract
This article reviews the organization, infrastructure basics, applications, effectiveness, outreach, and implementation barriers related to telepsychiatry. We highlight the tremendous potential and promise that this technology holds and also discuss the importance that telepsychiatry may play in the field of psychodynamic psychiatry. Given the growing effectiveness evidence base for therapy delivered over the Internet, telepsychiatry holds a large unexplored territory to help psychodynamically minded patients connect with psychodynamically oriented psychiatrists. This economically advantageous medium can be utilized to deliver psychodynamically guided approaches to the patient, alone or in combination with pharmacological and other psychosocial interventions. We hope, this article will help psychodynamically trained psychiatrists to consider bridging the gap with the remotely located, chronically mentally ill population which oftentimes has scarcity of resources.
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Affiliation(s)
- Sy Atezaz Saeed
- Professor and Chairman, Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University
| | - Vivek Anand
- Clinical Assistant Professor, Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University
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Shealy KM, Davidson TM, Jones AM, Lopez CM, de Arellano MA. Delivering an Evidence-Based Mental Health Treatment to Underserved Populations Using Telemedicine: The Case of a Trauma-Affected Adolescent in a Rural Setting. COGNITIVE AND BEHAVIORAL PRACTICE 2015. [DOI: 10.1016/j.cbpra.2014.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Deslich SA, Thistlethwaite T, Coustasse A. Telepsychiatry in correctional facilities: using technology to improve access and decrease costs of mental health care in underserved populations. Perm J 2014; 17:80-6. [PMID: 24355894 DOI: 10.7812/tpp/12-123] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE It is unclear if telepsychiatry, a subset of telemedicine, increases access to mental health care for inmates in correctional facilities or decreases costs for clinicians or facility administrators. The purpose of this investigation was to determine how utilization of telepsychiatry affected access to care and costs of providing mental health care in correctional facilities. METHODS A literature review complemented by a semistructured interview with a telepsychiatry practitioner. Five electronic databases, the National Bureau of Justice, and the American Psychiatric Association Web sites were searched for this research, and 49 sources were referenced. The literature review examined implementation of telepsychiatry in correctional facilities in Arizona, California, Georgia, Kansas, Ohio, Texas, and West Virginia to determine the effect of telepsychiatry on inmate access to mental health services and the costs of providing mental health care in correctional facilities. RESULTS Telepsychiatry provided improved access to mental health services for inmates, and this increase in access is through the continuum of mental health care, which has been instrumental in increasing quality of care for inmates. Use of telepsychiatry saved correctional facilities from $12,000 to more than $1 million. The semistructured interview with the telepsychiatry practitioner supported utilization of telepsychiatry to increase access and lower costs of providing mental health care in correctional facilities. CONCLUSIONS Increasing access to mental health care for this underserved group through telepsychiatry may improve living conditions and safety inside correctional facilities. Providers, facilities, and state and federal governments can expect increased savings with utilization of telepsychiatry.
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Affiliation(s)
- Stacie Anne Deslich
- Master of Science in Healthcare Administration, Graduate School of Business at Marshall University in South Charleston, West Virginia. E-mail:
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Ye X, Bapuji SB, Winters S, Metge C, Raynard M. Quality and Methodological Challenges in Internet-Based Mental Health Trials. Telemed J E Health 2014; 20:744-7. [DOI: 10.1089/tmj.2013.0298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Xibiao Ye
- Research and Evaluation Unit, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Shannon Winters
- Research and Evaluation Unit, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Colleen Metge
- Research and Evaluation Unit, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mellissa Raynard
- Concordia Hospital Library, University of Manitoba, Winnipeg, Manitoba, Canada
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Turchik JA, Rafie S, Rosen CS, Kimerling R. Preferences for Gender-Targeted Health Information. Am J Mens Health 2013; 8:240-8. [DOI: 10.1177/1557988313508304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
No prior research has examined men’s opinions or preferences regarding receiving health education materials related to sexual violence. The objective of the current study was to investigate whether male veteran patients who have experienced military sexual trauma (MST) prefer gender-targeted versus gender-neutral printed health information and whether receipt of this information increased utilization of outpatient mental health services in the following 6-month period. In-person 45-minute interviews were conducted with 20 male veterans receiving health care services at a large Veterans Health Administration facility to evaluate opinions on a gender-targeted and a gender-neutral brochure about MST. An additional 153 veterans received psychoeducational materials through the mail and participated in the completion of a survey as part of a psychoeducational intervention. Our results demonstrate that male veterans prefer gender-targeted information about sexual trauma compared to gender-neutral information. Whereas veterans in the study had clear preferences for gender-targeted materials, receipt of information about MST (whether gender-targeted or gender-neutral) did not increase utilization of mental health care in the 6 months following receipt of these materials. These results demonstrated that materials about sexual trauma are acceptable to men and should be gender-targeted. Further research is needed to examine strategies to increase access to mental health care among male Veterans who have experienced MST.
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Affiliation(s)
- Jessica A. Turchik
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Samantha Rafie
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Palo Alto University, Palo Alto, CA, USA
| | - Craig S. Rosen
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Rachel Kimerling
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
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Blanco C, Rafful C, Olfson M. The use of clinical trials in comparative effectiveness research on mental health. J Clin Epidemiol 2013; 66:S29-36. [PMID: 23849150 DOI: 10.1016/j.jclinepi.2013.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 01/03/2013] [Accepted: 02/03/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES A large body of comparative effectiveness research (CER) focuses on the use of observational and quasi-experimental approaches. We sought to examine the use of clinical trials as a tool for CER, particularly in mental health. STUDY DESIGN AND SETTING Examination of three ongoing randomized clinical trials in psychiatry addressing issues that would pose difficulties for nonexperimental CER methods. RESULTS Existing statistical approaches to nonexperimental data appear insufficient to compensate for biases that may arise when the pattern of missing data cannot be properly modeled such as when there are no standards for treatment, when affected populations have limited access to treatment, or when there are high rates of treatment dropout. CONCLUSION Clinical trials should retain an important role in CER, particularly in cases of high disorder prevalence, large expected effect sizes, difficult-to-reach populations, or when examining sequential treatments or stepped-care algorithms. Progress in CER on mental health will require careful consideration of appropriate selection between clinical trials and nonexperimental designs and on allocation of research resources to optimally inform key treatment decisions for each patient.
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Affiliation(s)
- Carlos Blanco
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
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Abstract
BACKGROUND The use of telemedicine for the care of mental health problems has developed significantly over the last decade thanks to the emergence of a number of stable telepsychiatry programs in many countries. Parallel to this development, this care modality has also targeted specific populations with higher difficulty in gaining access to mental health services such as the elderly. Telepsychogeriatrics is expected to have an increasing role in providing care to geographically isolated rural communities, with a particular focus on long-term care facilities, in light of the high prevalence of psychiatric disorders in these centers and the lack of available specialized care. METHODS A thorough search of the literature was conducted using Medline, Web of Science, and PsychINFO databases in order to gather available evidence on the applicability of telepsychiatry, specifically the use of videoconferencing for remote consultation, in the elderly population with mental disorders. A succinct description of the selected studies is given along with a general reflection on the state-of-the-art in the field of psychogeriatric clinical practice and research. RESULTS Research on the use of telemedicine in this age group has taken into account their special characteristics, and has focused on demonstrating its applicability, the acceptance and satisfaction of elderly users and their healthcare providers, the possibility of carrying out cognitive and diagnostic assessments, and the efficiency of these programs. CONCLUSIONS Despite limited experience, telepsychogeriatrics appears to be a viable option, well accepted by patients, including those having dementia. More systematized studies are needed in this new field based on larger sample sizes, including comparison with traditional consultations and assessment of the clinical outcomes.
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Johnson K, Isham A, Shah DV, Gustafson DH. Potential roles for new communication technologies in treatment of addiction. Curr Psychiatry Rep 2011; 13:390-7. [PMID: 21739171 PMCID: PMC3179375 DOI: 10.1007/s11920-011-0218-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Information and communication technologies offer clinicians the opportunity to work with patients to manage chronic conditions, including addiction. The early research on the efficacy of electronic treatment and support tools is promising. Sensors have recently received increased attention as key components of electronic treatment and recovery management systems. Although results of the research are very promising, concerns at the clinical and policy level must be addressed before widespread adoption of these technologies can become practical. First, clinicians must adapt their practices to incorporate a continuing flow of patient information. Second, payment and regulatory systems must make adjustments far beyond what telemedicine and electronic medical records have required. This paper examines potential roles of information and communication technologies as well as process and regulatory challenges.
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Affiliation(s)
- Kimberly Johnson
- NIATx/Center for Health Enhancement Systems Studies (CHESS), University of Wisconsin-Madison College of Engineering, 4155 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA
| | - Andrew Isham
- Center for Health Enhancement Systems Studies (CHESS), University of Wisconsin-Madison College of Engineering, 4155 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA
| | - Dhavan V. Shah
- University of Wisconsin-Madison College of Letters and Science, 5162 Vilas Communication Hall, 821 University Avenue, Madison, WI 53706, USA
| | - David H. Gustafson
- Center for Health Enhancement Systems Studies (CHESS), University of Wisconsin-Madison College of Engineering, 4109 Mechanical Engineering Building, 1513 University Avenue, Madison, WI 53706, USA
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Drost LM, Cuijpers P, Schippers GM. Developing an interactive website for adolescents with a mentally ill family member. Clin Child Psychol Psychiatry 2011; 16:351-64. [PMID: 20980365 DOI: 10.1177/1359104510366281] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescents with a mentally ill parent are at high risk for developing a disorder themselves. It is widely recommended that these adolescents be provided with preventive interventions designed especially for them, but their avoidance of professional help is a common problem. Because most teenagers in Western societies use the World Wide Web as a means of social interaction, use of the Internet for reaching these young people would appear to be a promising option. In this article, the authors describe the development of Survivalkid.nl, an interactive, Internet-delivered, preventive intervention for supporting adolescents with a mentally ill family member. Usage statistics with regard to frequency and duration of visits and amount of activity during visits suggest that: (a) the target group has been better served than before the site was launched; and (b) we have accomplished our goal of expanding the range of support.
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Affiliation(s)
- Louisa M Drost
- Indigo/GGZ Drenthe, Community Mental Health Centre; University of Groningen, the Netherlands.
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Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2009; 16:323-338. [PMID: 20161010 PMCID: PMC2758653 DOI: 10.1111/j.1468-2850.2009.01170.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
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Affiliation(s)
| | | | - Anouk L. Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
| | - Leonard Egede
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
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Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY : A PUBLICATION OF THE DIVISION OF CLINICAL PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION 2009. [PMID: 20161010 DOI: 10.1111/j.1468‐2850.2009.01170.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
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Self-Brown S, Whitaker DJ. Parent-focused child maltreatment prevention: improving assessment, intervention, and dissemination with technology. CHILD MALTREATMENT 2008; 13:400-16. [PMID: 18567847 DOI: 10.1177/1077559508320059] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The goal of this article is to examine how technology has been and can be utilized to enhance parent-focused child maltreatment (CM) prevention efforts. The authors begin with a brief discussion of the current state of the CM prevention field. In the sections that follow, they review studies that have examined the use of technology across three facets of prevention: identification of CM, administration/augmentation of CM prevention programs, and broad dissemination and implementation of evidenced-based CM prevention programs. They conclude with a discussion of limitations and problems related to the use of technology as a tool to enhance CM prevention and future directions.
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Feil EG, Baggett KM, Davis B, Sheeber L, Landry S, Carta JJ, Buzhardt J. Expanding the reach of preventive interventions: development of an Internet-based training for parents of infants. CHILD MALTREATMENT 2008; 13:334-46. [PMID: 18843143 PMCID: PMC2744504 DOI: 10.1177/1077559508322446] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
There are major obstacles to the effective delivery of mental health services to poor families, particularly for those families in rural areas. The rise of Internet use, however, has created potentially new avenues for service delivery, which, when paired with the many recent advances in computer networking and multimedia technology, is fueling a demand for Internet delivery of mental health services. The authors report on the adaptation of a parenting program for delivery via the Internet, enhanced with participant-created videos of parent-infant interactions and weekly staff contact, which enable distal treatment providers to give feedback and make decisions informed by direct behavioral assessment. This Internet-based, parent-education intervention has the potential to promote healthy and protective parent-infant interactions in families who might not otherwise receive needed mental health services.
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Affiliation(s)
- Edward G Feil
- Oregon Research Institute, Eugene, OR 97403-1983, USA.
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