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Hartch CE, Dietrich MS, Lancaster BJ, Stolldorf DP, Mulvaney SA. Effects of a medication adherence app among medically underserved adults with chronic illness: a randomized controlled trial. J Behav Med 2024; 47:389-404. [PMID: 38127174 PMCID: PMC11026187 DOI: 10.1007/s10865-023-00446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023]
Abstract
For individuals living with a chronic illness who require use of long-term medications, adherence is a vital aspect of successful symptom management and outcomes. This study investigated the effect of a smartphone app on adherence, self-efficacy, knowledge, and medication social support in a medically underserved adult population with various chronic illnesses. Participants were randomized to a group who used the app for one month or a control group provided with a printed medication list. Compared to the control group, participants receiving the intervention had significantly greater medication adherence (Cohen's d = -0.52, p = .014) and medication self-efficacy (Cohen's d = 0.43, p = .035). No significant effects were observed related to knowledge or social support. The findings suggest use of the app could positively impact chronic disease management in a medically underserved population in the United States.
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Affiliation(s)
- Christa E Hartch
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA.
- School of Nursing and Health Sciences, Manhattanville College, 2900 Purchase Street, Purchase, NY, 10577, USA.
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1100, Nashville, TN, 37203, USA
| | - B Jeanette Lancaster
- Sadie Heath Cabiness Professor and Dean Emerita, School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
| | - Deonni P Stolldorf
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
| | - Shelagh A Mulvaney
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN, 37240, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, #1475, Nashville, TN, 37203, USA
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Singla DR, Fernandes L, Savel K, Shah A, Agrawal R, Bhan A, Nadkarni A, Sharma A, Khan A, Lahiri A, Tugnawat D, Lesh N, Naslund J, Patel V. Scaling up the task-sharing of psychological therapies: A formative study of the PEERS smartphone application for supervision and quality assurance in rural India. Glob Ment Health (Camb) 2024; 11:e20. [PMID: 38572256 PMCID: PMC10988170 DOI: 10.1017/gmh.2024.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/28/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024] Open
Abstract
Measurement-based peer supervision is one strategy to assure the quality of psychological treatments delivered by non-mental health specialist providers. In this formative study, we aimed to 1) describe the development and 2) examine the acceptability and feasibility of PEERS (Promoting Effective mental healthcare through peER Supervision)-a novel smartphone app that aims to facilitate registering and scheduling patients, collecting patient outcomes, rating therapy quality and assessing supervision quality-among frontline treatment providers delivering behavioral activation treatment for depression. The PEERS prototype was developed and tested in 2021, and version 1 was launched in 2022. To date, 215 treatment providers (98% female; ages 30-35) in Madhya Pradesh and Goa, India, have been trained to use PEERS and 65.58% have completed the supplemental, virtual PEERS course. Focus group discussions with 98 providers were examined according to four themes-training and education, app effectiveness, user experience and adherence and data privacy and safety. This yielded commonly endorsed facilitators (e.g., collaborative learning through group supervision, the convenience of consolidated patient data), barriers (e.g., difficulties with new technologies) and suggested changes (e.g., esthetic improvements, suicide risk assessment prompt). The PEERS app has the potential to scale measurement-based peer supervision to facilitate quality assurance of psychological treatments across contexts.
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Affiliation(s)
- Daisy R. Singla
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | | | - Katarina Savel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | | | - Ravindra Agrawal
- Addictions and Related Research Group, Sangath, Goa, India
- Sangath Bhopal Hub, Bhopal, India
- Antarman Centre for Psychosocial Wellbeing, Panjim, Goa, India
- Manipal Hospital, Panaji, Goa, India
| | | | - Abhijit Nadkarni
- Addictions and Related Research Group, Sangath, Goa, India
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - John Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard Chan School of Public Health, Boston, MA, USA
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Stern E, Micoulaud Franchi JA, Dumas G, Moreira J, Mouchabac S, Maruani J, Philip P, Lejoyeux M, Geoffroy PA. How Can Digital Mental Health Enhance Psychiatry? Neuroscientist 2023; 29:681-693. [PMID: 35658666 DOI: 10.1177/10738584221098603] [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] [Indexed: 11/17/2022]
Abstract
The use of digital technologies is constantly growing around the world. The wider-spread adoption of digital technologies and solutions in the daily clinical practice in psychiatry seems to be a question of when, not if. We propose a synthesis of the scientific literature on digital technologies in psychiatry and discuss the main aspects of its possible uses and interests in psychiatry according to three domains of influence that appeared to us: 1) assist and improve current care: digital psychiatry allows for more people to have access to care by simply being more accessible but also by being less stigmatized and more convenient; 2) develop new treatments: digital psychiatry allows for new treatments to be distributed via apps, and practical guidelines can reduce ethical challenges and increase the efficacy of digital tools; and 3) produce scientific and medical knowledge: digital technologies offer larger and more objective data collection, allowing for more detection and prevention of symptoms. Finally, ethical and efficacy issues remain, and some guidelines have been put forth on how to safely use these solutions and prepare for the future.
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Affiliation(s)
- Emilie Stern
- GHU Paris-Psychiatrie & Neurosciences, Paris, France
| | - Jean-Arthur Micoulaud Franchi
- University of Bordeaux, SANPSY, USR 3413, F-33000, Bordeaux, France
- CNRS, SANPSY, USR 3413, F-33000, Bordeaux, France
- CHU Bordeaux, Service Universitaire de Médecine Du sommeil, F-33000, Bordeaux, France
| | - Guillaume Dumas
- CHU Sainte-Justine Research Center, Department of Psychiatry, University of Montreal, Quebec, Canada
- Mila-Quebec Artificial Intelligence Institute, University of Montreal, Quebec, Canada
| | | | - Stephane Mouchabac
- Department of Psychiatry, Department of Psychiatry Hôpital Saint Antoine-APHP, Sorbonne University, Paris, France
- Infrastructure of Clinical Research in Neurosciences-Psychiatry, Brain and Spine Institute (ICM), Inserm, Sorbonne University, Paris, France
| | - Julia Maruani
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
- Université de Paris, NeuroDiderot, Inserm U1141, F-75019, Paris, France
| | - Pierre Philip
- University of Bordeaux, SANPSY, USR 3413, F-33000, Bordeaux, France
- CNRS, SANPSY, USR 3413, F-33000, Bordeaux, France
- CHU Bordeaux, Service Universitaire de Médecine Du sommeil, F-33000, Bordeaux, France
| | - Michel Lejoyeux
- GHU Paris-Psychiatrie & Neurosciences, Paris, France
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
- Université de Paris, NeuroDiderot, Inserm U1141, F-75019, Paris, France
| | - Pierre A Geoffroy
- GHU Paris-Psychiatrie & Neurosciences, Paris, France
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
- Université de Paris, NeuroDiderot, Inserm U1141, F-75019, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
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Shin HD, Zaheer J, Torous J, Strudwick G. Designing Implementation Strategies for a Digital Suicide Safety Planning Intervention in a Psychiatric Emergency Department: Protocol for a Multimethod Research Project. JMIR Res Protoc 2023; 12:e50643. [PMID: 37943582 PMCID: PMC10667981 DOI: 10.2196/50643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/27/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization. OBJECTIVE The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians' perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2). METHODS We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1. RESULTS This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway. CONCLUSIONS Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians' behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50643.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Ontario, Canada, Toronto, ON, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Gillian Strudwick
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Lagera PGD, Chan SR, Yellowlees PM. Asynchronous Technologies in Mental Health Care and Education. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2023; 10:1-13. [PMID: 37360962 PMCID: PMC10157570 DOI: 10.1007/s40501-023-00286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 06/28/2023]
Abstract
Purpose of review Patients, providers, and trainees should understand the current types of asynchronous technologies that can be used to enhance the delivery and accessibility of mental health care. Asynchronous telepsychiatry (ATP) removes the need for real time communication between the clinician and patient, which improves efficiency and enables quality specialty care. ATP can be applied as distinct consultative and supervisory models in clinician-to-clinician, clinician-to-patient, and patient-to-mobile health settings. Recent findings This review is based on research literature and the authors' clinical and medical training, using experiences with asynchronous telepsychiatry from before, during, and after the COVID-19 pandemic. Our studies demonstrate that ATP provides positive outcomes in the clinician-to-patient model with demonstrated feasibility, outcomes and patient satisfaction. One author's medical education experience in the Philippines during COVID-19 highlights the potential to utilize asynchronous technology in areas with limitations to online learning. We emphasize the need to teach media skills literacy around mental health to students, coaches, therapists, and clinicians when advocating for mental well-being. Several studies have demonstrated the feasibility of incorporating asynchronous e-tools such as self-guided multimedia and artificial intelligence for data collection at the clinician-to-clinician and patient-to-mobile health level. In addition, we offer fresh perspectives on recent trends in asynchronous telehealth in wellness, applying concepts such as "tele-exercise" and "tele-yoga." Summary Asynchronous technologies continue to be integrated into mental health care services and research. Future research must ensure that the design and the usability of this technology puts the patient and provider first.
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Affiliation(s)
- Pamela Gail D. Lagera
- Division of Hospital Medicine, Clinical Informatics, University of California, San Francisco, CA USA
| | - Steven R. Chan
- Division of Hospital Medicine, Clinical Informatics, University of California, San Francisco, CA USA
- Department of Psychiatry, University of California, San Francisco, CA USA
- Department of Psychiatry, University of California, Davis, CA USA
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Crompton D, Kohleis P, Shakespeare-Finch J, FitzGerald G, Young R. Opportunistic Mental Health Screening: Is there a Role Following a Disaster? Lessons from the 2010-2011 Queensland (Australia) Floods and Cyclones. Prehosp Disaster Med 2023; 38:223-231. [PMID: 36691688 PMCID: PMC10027488 DOI: 10.1017/s1049023x23000092] [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] [Indexed: 01/25/2023]
Abstract
BACKGROUND Following the 2010-2011 floods and cyclones that affected 78% of Queensland, Australia, a State-wide mental health response was established. The response plan included a 24-hour access line. This study examines the effectiveness of the mental health screening program conducted via the State-wide health call center (13HEALTH) in 2012. METHODS Callers to the 13HEALTH line were screened to assess the impact of the disaster. The 13HEALTH clinicians administered the Primary Care-Posttraumatic Stress Disorder Scale (PC-PTSD) screening measure. Those scoring more than two on the PC-PTSD Scale were provided information on the emotional impact of disasters and a referral to the post-disaster specialist mental health program (SMHP). For calls related to those under 18, a single-item question assessed behavioral or emotional changes since the natural disasters. Those with identified changes were offered a referral to a post-disaster SMHP.The study evaluates the relationship between disaster exposure and the likelihood of 13HEALTH callers experiencing physical health concerns and unacknowledged mental health symptoms. The program's cost for the 12 months of 2012 was assessed using data from the financial contract. RESULTS In 2012, there were 205,064 calls to 13HEALTH: 19,708 identified as residing in a flood or cyclone-affected area, 7,315 adults indicated they were personally affected, and 907 scored more than two on the PC-PTSD Scale. Only 700 agreed to a referral to the SMHP. There were 290 children under 18 assessed as at risk; 207 accepted a referral to a SMHP.Regions that experienced a greater impact from the floods and cyclones were 1.3-2.3 times more likely to report being personally affected by the floods and cyclones. Similarly, these regions had more callers scoring more than two on the PC-PTSD Scale. The total cost of the 13HEALTH program for 2012 was $53,284 (AU) across all age groups. CONCLUSION The 13HEALTH general health post-disaster screening program demonstrates opportunistic screening may assist identification of those with unmet mental health needs. The data indicate an increased likelihood of personal exposure in the more affected regions with an increased risk of unrecognized psychological symptoms as assessed by the PC-PTSD Scale. However, more than 20% declined referral to a SMHP.
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Affiliation(s)
- David Crompton
- Queensland University of Technology, Brisbane, Queensland, Australia
- Griffith University, Nathan, Queensland, Australia
| | - Peter Kohleis
- Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | | | - Gerard FitzGerald
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ross Young
- Queensland University of Technology, Brisbane, Queensland, Australia
- Griffith University, Nathan, Queensland, Australia
- University Sunshine Coast, Maroochydore DC, Queensland, Australia
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Licinio J, Wong ML. Digital footprints as a new translational approach for mental health care: a commentary. DISCOVER MENTAL HEALTH 2023; 3:5. [PMID: 37861744 PMCID: PMC10501006 DOI: 10.1007/s44192-023-00032-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/20/2023] [Indexed: 10/21/2023]
Abstract
There is a crisis in mental health care, with more people suffering from psychiatric disorders than resources that are available for treatment, even though spending is substantial. Millions who suffer from addiction, psychosis, depression and suicidality are either untreated or inadequately treated and organized psychiatry is unable to reach them. Possibly as reflection of under-treatment of psychiatric disorders, the rates of suicide have risen: from 1999 through 2014, the age-adjusted suicide rate in the US increased 24%, from 10.5 to 13.0 per 100,000. Assessment of psychiatric symptoms in ongoing outpatient settings is costly, inadequate and unable to detect clinical changes over time. One's digital phenotype is assessed through footprints left over as result of our interface with technology, including automated assessments of quantity and quality of social media activity, patterns and speed of device usage, and physiological data that is automatically collected, such as location, quantity and type of movement, heart rate, and sleep patterns. The use of digital footprints has been advocated for large-scale data collection that can facilitate psychiatric research in naturalistic settings. We highlight recent papers in Discover Mental Health addressing digital approaches to mental health and we also advance here the concept that digital footprints are ready for clinical use. However, before that happens there needs to be discussion on the appropriate boundaries between care that is driven by signals from digital footprints and the rights to privacy and self-determination.
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Affiliation(s)
- Julio Licinio
- Precision Medicine Laboratory in Psychiatry (PMLP), Institute for Human Performance, State University of New York, Upstate Medical University, 505 Irving Ave 3302, Syracuse, NY, 13210, USA.
| | - Ma-Li Wong
- Precision Medicine Laboratory in Psychiatry (PMLP), Institute for Human Performance, State University of New York, Upstate Medical University, 505 Irving Ave 3302, Syracuse, NY, 13210, USA
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Spottswood M, Lim CT, Davydow D, Huang H. Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review. Front Med (Lausanne) 2022; 9:892205. [PMID: 35712115 PMCID: PMC9196265 DOI: 10.3389/fmed.2022.892205] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Importance Suicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is vital to suicide prevention and is applied throughout this review. Methods A narrative review was performed. Observations Many interventions help improve suicide prevention care. PCP education, screening, safety planning/lethal means reduction, care transitions, psychotherapy, and medication management are all evidence-based strategies. Additionally, the pragmatic topics of financing suicide prevention, supporting providers, enacting suicide postvention, and preparing for future directions in the field at each level of primary care/behavioral health integration are discussed. Conclusions and Relevance The findings are clinically relevant for practices interested in implementing evidence-based suicide prevention strategies by attending to the behavioral health/medical interface. Leveraging the patient/provider relationship to allow for optimal suicide prevention care requires clinics to structure provider time to allow for emotionally present care. Defining clear roles for staff and giving attention to provider well being are also critical factors to supporting primary care-based suicide prevention efforts.
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Affiliation(s)
- Margaret Spottswood
- Department of Psychiatry, University of Vermont Medical Center, University of Vermont, Burlington, VT, United States
- Department of Psychiatry, Community Health Centers of Burlington, Burlington, VT, United States
| | - Christopher T. Lim
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Dimitry Davydow
- Executive Leadership, Comprehensive Life Resources, Tacoma, WA, United States
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
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Cavanagh R, Gerson SM, Gleason A, Mackey R, Ciulla R. Competencies Needed for Behavioral Health Professionals to Integrate Digital Health Technologies into Clinical Care: a Rapid Review. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-14. [PMID: 35194561 PMCID: PMC8853702 DOI: 10.1007/s41347-022-00242-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/06/2022] [Accepted: 02/02/2022] [Indexed: 11/18/2022]
Abstract
This rapid review examines literature on training and competencies for behavioral health professionals to integrate digital health technologies into clinical practice. While the evidence for digital health is growing, research evidence supports its use in behavioral healthcare. Despite this, behavioral health professionals have been slow to integrate technologies into care for various reasons. The aim of this review is to inform behavioral health professionals on competencies needed to support the adoption of digital health technologies. PubMed and Google Scholar were searched for articles from 2010 through 2020. Search terms associated with digital health technologies, behavioral health professionals, and competencies, skills, training, and best practices yielded 1972 articles. Twenty-three articles met inclusion criteria indicating foundational core competencies and data was extracted and organized based on profession and technology platform in order to detect similarities and differences. The findings were used to generate an interdisciplinary approach for the clinical integration of digital health. Recommendations are presented for foundational digital health competencies applicable across behavioral health disciplines, rather than technology- or discipline-specific training. The universal digital health inter-professional competencies identified include: (a) privacy, security, and patient safety; (b) digital health technical skills; (c) ethical and legal considerations; (d) clinical skills; (e) art of therapy and digital health; and (f) administrative tasks. Research is needed to understand if the development of professional digital health competencies helps to improve patients' behavioral health.
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Affiliation(s)
- Renée Cavanagh
- Connected Health Branch, U.S. Department of Defense, Defense Health Agency, Joint Base Lewis-McChord, 9933 West Hayes Street, Box 339500 MS 34, Tacoma, WA 98433-9500 USA
| | - Sheri Mila Gerson
- Connected Health Branch, U.S. Department of Defense, Defense Health Agency, Joint Base Lewis-McChord, 9933 West Hayes Street, Box 339500 MS 34, Tacoma, WA 98433-9500 USA
| | - Ann Gleason
- Connected Health Branch, U.S. Department of Defense, Defense Health Agency, Joint Base Lewis-McChord, 9933 West Hayes Street, Box 339500 MS 34, Tacoma, WA 98433-9500 USA
| | - Rachel Mackey
- Connected Health Branch, U.S. Department of Defense, Defense Health Agency, Joint Base Lewis-McChord, 9933 West Hayes Street, Box 339500 MS 34, Tacoma, WA 98433-9500 USA
| | - Robert Ciulla
- Connected Health Branch, U.S. Department of Defense, Defense Health Agency, Joint Base Lewis-McChord, 9933 West Hayes Street, Box 339500 MS 34, Tacoma, WA 98433-9500 USA
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Kim SK, Lee M, Jeong H, Jang YM. Effectiveness of mobile applications for patients with severe mental illness: A meta-analysis of randomized controlled trials. Jpn J Nurs Sci 2022; 19:e12476. [PMID: 35174976 DOI: 10.1111/jjns.12476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/25/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A systematic review and meta-analysis was conducted to evaluate the effectiveness of mobile applications used by patients diagnosed with mental disorders. METHODS An electronic literature search in five databases including PubMed, Embase, the Cochrane Library, CINAHL, and PsychInfo was conducted. The keywords used were "mental disorder," "mental illness," "mobile phone," "smartphone," "mHealth," "application," and "app". The search was restricted to randomized controlled trials (RCTs) written in English and Korean. RESULTS Fourteen RCTs, involving 1307 patients diagnosed with depression, schizophrenia, and bipolar disorder were included in the analysis. The included studies were published between 2012 and 2020 and used mobile applications. The risk of bias tool was used to assess methodological quality and the overall risk of bias of the included studies was moderate. The pooled data favored mobile application interventions in reducing the disease-related symptoms of depression (standardized mean difference [SMD] = -0.255, 95% CI: -0.370 to -0.141), mania symptoms (SMD = -0.279, 95% CI: -0.456 to -0.102), and positive (SMD = -0.205, 95% CI: -0.388 to -0.022) and negative psychotic symptoms (SMD = -0.406, 95% CI: -0.791 to -0.020). In subgroup analysis, the incorporation of feedback, notification, and data tracking features in the mobile application intervention produced better outcomes. CONCLUSION This review provided evidence that mobile applications could well-assist patients diagnosed with mental disorders. Greater benefits could be achieved by well-designed interventions incorporating strategies with thoughtful consideration of the disease characteristics. Mobile applications present the potential to be effective supplements to clinical treatment.
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Affiliation(s)
- Sun Kyung Kim
- Department of Nursing, and Department of Biomedicine, Health & Life Convergence Sciences, BK21 Four, Biomedical and Healthcare Research Institute, Mokpo National University, Muan-gun, South Korea
| | - Mihyun Lee
- College of Nursing, Daejeon Health Institute of Technology, Daejeon, South Korea
| | - Hyun Jeong
- College of Nursing, Daejeon Health Institute of Technology, Daejeon, South Korea
| | - Young Mi Jang
- Department of Nursing, Daejeon Institute of Science and Technology, Daejeon, South Korea
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Abstract
PURPOSE OF REVIEW To describe examples of adapting apps for use in mental healthcare and to formulate recommendations for successful adaptation in mental healthcare settings. RECENT FINDINGS International examples are given to explore implementation procedures to address this multitude of challenges. There are only few published examples of adapting apps for use in mental healthcare. From these examples and from results of studies in implementation science in general clinical settings, it can be concluded that the process of adapting apps for mental healthcare needs to address clinician training and information needs, user needs which include cultural adaptation and go beyond mere translation, and organizational needs for blending app use into everyday clinical mental healthcare workflows.
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12
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Duvall MJ, Miller NE, North F, Leasure WB, Pecina JL. Portal Message Language Use Prior to Suicide, Suicide Attempts, and Hospitalization for Depression. Telemed J E Health 2021; 28:1143-1150. [PMID: 34936819 DOI: 10.1089/tmj.2021.0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Previous research suggests patients may be willing to communicate serious psychiatric concerns through patient portals. Methods: Retrospective chart review of portal messages sent by patients who had an emergency department (ED) visit or hospitalization for depression, self-harm, or suicidality or had a completed suicide (cases) was reviewed for content that was suggestive of depression or self-harm and language indicating emotional distress. Comparison with a randomly selected group (controls) was performed. Results: During the study period 420 messages were sent by 149 patients within 30 days of death by suicide, ED visit, and/or hospitalization related to depression, suicidality, or suicide attempt. Thirteen patients died by suicide but only 23% (3 of 13) sent one or more portal messages within 30 days before their death. None mentioned thoughts of self-harm. There were 271 messages sent by patients who were hospitalized, 142 messages by those who presented to the ED, and 56 messages patients who attempted suicide. Patient messages from cases were more likely than messages from controls to convey a depressed mood (17.1% vs. 3.1%, odds ratio 6.5; 95% confidence interval 3.6-11.9, p < 0.0001), thoughts of suicide or self-harm (4.8% vs. 0% p < 0.0001), or have a distressed tone (24.0% vs. 1.7%, odds ratio 18.7; 95% confidence interval 8.6-41, p < 0.0001). Conclusions: Patient portal messages from patients with subsequent hospitalizations for depression and suicidality do report thoughts of depression, distress, and thoughts of self-harm. However, portal use before completed suicide was not helpful at identifying at-risk patients although total numbers were small.
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Affiliation(s)
- Michelle J Duvall
- Department of Family Medicine, Employee and Community Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathaniel E Miller
- Department of Family Medicine, Employee and Community Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Frederick North
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William B Leasure
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L Pecina
- Department of Family Medicine, Employee and Community Health, Mayo Clinic, Rochester, Minnesota, USA
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13
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Mucic D, Shore JH, Hilty DM, Krysta K, Krzystanek M. Lessons Learned or Forgotten? Impacts of COVID-19 on the Future Direction of Global (e-)Mental Health Care. Curr Psychiatry Rep 2021; 23:86. [PMID: 34842979 PMCID: PMC8628486 DOI: 10.1007/s11920-021-01300-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has impacted lives globally, posing unique challenges to mental health services exposing vulnerability and limitations within these systems. During the course of the pandemic, telecommunications technologies (e-mental health care) have served a critical role in psychiatric care. It is important to understand current lessons learned in e-mental health care and implications for global mental health systems for both emerging from the pandemic and after the pandemic has ended. RECENT FINDINGS There are significant regulatory, policy, and evaluation challenges for global e-mental health impacting patients, clinicians, health systems, and decision-makers. These include complex regulatory issues, difficulties of providing care across boundaries, and keeping pace with the implementation of new technologies in behavioral health. The collaborative development of global standards along with policies, appropriate regulations, and developing new models of research and development opens the possibility of improved access to care across national boundaries.
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Affiliation(s)
- D Mucic
- Little Prince Treatment Centre, Havneholmen 82, 5th, 1561, Copenhagen V, Denmark.
| | - J H Shore
- Office of Telehealth and Technology Implementation for Behavioral Health Practice and Science (TIPS), Department of Psychiatry, Aurora, USA
- Department of Psychiatry and Family Medicine, School of Medicine And Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - D M Hilty
- VA Northern California Health Care, System & UC Davis School of Medicine, 2230 Stockton Boulevard, Sacramento, CA, 95817, USA
| | - K Krysta
- Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences in Katowice, Clinic of Psychiatric Rehabilitation, Medical University of Silesia, Ziołowa 45/47, 40-635, Katowice, Poland
| | - M Krzystanek
- Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences in Katowice, Clinic of Psychiatric Rehabilitation, Medical University of Silesia, Ziołowa 45/47, 40-635, Katowice, Poland
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14
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Mosher Henke R. Knowing Well, Being Well: well-being born of understanding: Shifts in Health Behaviors Amid the COVID-19 Pandemic. Am J Health Promot 2021; 35:1162-1183. [DOI: 10.1177/08901171211055310a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Satre DD, Meacham MC, Asarnow LD, Fisher WS, Fortuna LR, Iturralde E. Opportunities to Integrate Mobile App-Based Interventions Into Mental Health and Substance Use Disorder Treatment Services in the Wake of COVID-19. Am J Health Promot 2021; 35:1178-1183. [PMID: 34652971 DOI: 10.1177/08901171211055314] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has heightened concerns about the impact of depression, anxiety, alcohol, and drug use on public health. Mobile apps to address these problems were increasingly popular even before the pandemic, and may help reach people who otherwise have limited treatment access. In this review, we describe pandemic-related substance use and mental health problems, the growing evidence for mobile app efficacy, how health systems can integrate apps into patient care, and future research directions. If equity in access and effective implementation can be addressed, mobile apps are likely to play an important role in mental health and substance use disorder treatment.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Meredith C Meacham
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lauren D Asarnow
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Weston S Fisher
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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16
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Chattu VK, Lopes CA, Javed S, Yaya S. Fulfilling the promise of digital health interventions (DHI) to promote women's sexual, reproductive and mental health in the aftermath of COVID-19. Reprod Health 2021; 18:112. [PMID: 34088319 PMCID: PMC8177268 DOI: 10.1186/s12978-021-01168-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Vijay Kumar Chattu
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 2C4, Canada. .,Division of Occupational Medicine, Occupational Medicine Clinic, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, M5C 2C5, Canada.
| | - Claudia Abreu Lopes
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Sumbal Javed
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada.,The George Institute for Global Health, Imperial College London, London, UK
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17
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Intelligent Cognitive Assistants for Attitude and Behavior Change Support in Mental Health: State-of-the-Art Technical Review. ELECTRONICS 2021. [DOI: 10.3390/electronics10111250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intelligent cognitive assistant (ICA) technology is used in various domains to emulate human behavior expressed through synchronous communication, especially written conversation. Due to their ability to use individually tailored natural language, they present a powerful vessel to support attitude and behavior change. Behavior change support systems are emerging as a crucial tool in digital mental health services, and ICAs exceed in effective support, especially for stress, anxiety and depression (SAD), where ICAs guide people’s thought processes and actions by analyzing their affective and cognitive phenomena. Currently, there is no comprehensive review of such ICAs from a technical standpoint, and existing work is conducted exclusively from a psychological or medical perspective. This technical state-of-the-art review tried to discern and systematize current technological approaches and trends as well as detail the highly interdisciplinary landscape of intersections between ICAs, attitude and behavior change, and mental health, focusing on text-based ICAs for SAD. Ten papers with systems, fitting our criteria, were selected. The systems varied significantly in their approaches, with the most successful opting for comprehensive user models, classification-based assessment, personalized intervention, and dialogue tree conversational models.
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18
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Patoz MC, Hidalgo-Mazzei D, Blanc O, Verdolini N, Pacchiarotti I, Murru A, Zukerwar L, Vieta E, Llorca PM, Samalin L. Patient and physician perspectives of a smartphone application for depression: a qualitative study. BMC Psychiatry 2021; 21:65. [PMID: 33514333 PMCID: PMC7847000 DOI: 10.1186/s12888-021-03064-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite an increasing number of smartphone apps, such therapeutic tools have not yet consistently demonstrated their efficacy and many suffer from low retention rates. To ensure the development of efficient apps associated with high adherence, we aimed to identify, through a user-centred design approach, patient and physician expectations of a hypothetical app dedicated to depression. METHODS We conducted semi-structured interviews with physicians (psychiatrists and general practitioners) and patients who had experienced a major depressive episode during the last 12 months using the focus group method. The interviews were audio recorded, transcribed and analysed using qualitative content analysis to define codes, categories and emergent themes. RESULTS A total of 26 physicians and 24 patients were included in the study. The focus groups showed balanced sex and age distributions. Most participants owned a smartphone (83.3% of patients, 96.1% of physicians) and were app users (79.2% of patients and 96.1% of physicians). The qualitative content analysis revealed 3 main themes: content, operating characteristics and barriers to the use of the app. Expected content included the data collected by the app, aiming to provide information about the patient, data provided by the app, gathering psychoeducation elements, therapeutic tools and functionalities to help with the management of daily life and features expected for this tool. The "operating characteristics" theme gathered aims considered for the app, its potential target users, considered modalities of use and considerations around its accessibility and security of use. Finally, barriers to the use of the app included concerns about potential app users, its accessibility, safety, side-effects, utility and functioning. All themes and categories were the same for patients and physicians. CONCLUSIONS Physician and patient expectations of a hypothetical smartphone app dedicated to depression are high and confirmed the important role it could play in depression care. The key points expected by the users for such a tool are an easy and intuitive use and a personalised content. They are also waiting for an app that gives information about depression, offers a self-monitoring functionality and helps them in case of emergency.
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Affiliation(s)
- Marie-Camille Patoz
- grid.494717.80000000115480420Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia Spain
| | - Olivier Blanc
- grid.494717.80000000115480420Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France ,Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia Spain
| | - Andrea Murru
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia Spain
| | | | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia Spain
| | - Pierre-Michel Llorca
- grid.494717.80000000115480420Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280 Clermont-Ferrand, France ,Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France
| | - Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France. .,Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, Créteil, France.
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19
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Lehner A, Nuißl K, Schlee W, Langguth B. Staying Connected: Reaching Out to Psychiatric Patients During the Covid-19 Lockdown Using an Online Blog. Front Public Health 2021; 8:592618. [PMID: 33425836 PMCID: PMC7793636 DOI: 10.3389/fpubh.2020.592618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/24/2020] [Indexed: 01/18/2023] Open
Abstract
Health systems worldwide are challenged by the coronavirus pandemic and all medical specialties have struggle to meet the conflicting requirements for virus containment on the one hand and treatment of other medical conditions on the other. This holds true also for psychiatry. Per se, psychiatric patients are highly vulnerable to suffer from social isolation and loneliness. As a result of the Covid-19 pandemic and lockdown measures, unfortunately, this vulnerability is even further increased. As a part of its pandemic risk management, the outpatient clinic of the Psychiatric District Hospital Regensburg launched an online blog as a means of assisting patients who were required to stay home. Aim of the blog was to stay by patients' side in those uncertain times by offering an online connection to their therapists, by providing important information about the pandemic situation, by offering some ideas on how to build a daily routine and how to meaningfully spend their time at home during the lockdown. We also aimed at involving patients as experts in their own affairs by inviting them to contribute to the blog's shape and content. As a result of coordinated team effort, it was possible to launch a blog within few days, and this was perceived helpful by many patients. Overall, however, patient involvement turned out to be a challenge requiring more attention in future work.
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Affiliation(s)
- Astrid Lehner
- Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Klaus Nuißl
- Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Winfried Schlee
- Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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20
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Elbers S, Pool J, Wittink H, Köke A, Smeets R. Exploring the Feasibility of Relapse Prevention Strategies in Interdisciplinary Multimodal Pain Therapy Programs: Qualitative Study. JMIR Hum Factors 2020; 7:e21545. [PMID: 33306035 PMCID: PMC7762683 DOI: 10.2196/21545] [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: 06/17/2020] [Revised: 10/01/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although interdisciplinary multimodal pain treatment (IMPT) programs are widely regarded as treatment of choice for patients with chronic pain, there are signs that many patients are unable to maintain their treatment gains in the long term. To facilitate the maintenance of positive treatment outcomes over time, we developed two relapse prevention strategies. OBJECTIVE The main objective of this study was to explore the feasibility of these strategies within the context of IMPT programs. METHODS We performed a feasibility study using 3 workbook prototypes containing either one or both strategies. For a period of 6 months, the workbooks were made available in two IMPT facilities. Qualitative data were collected through a focus group and semistructured interviews. We performed a thematic analysis using a deductive approach with (1) applicability to the treatment program, (2) acceptability of the workbook content, and (3) form, as predefined themes. RESULTS The final dataset consisted of transcripts from a focus group with health care providers and 11 telephone interviews and 2 additional in-depth interviews with patients. In general, the intervention was perceived as useful, easy to use, and in line with the treatment program. The data also include suggestions to further improve the use of both strategies, including more specific implementation guidelines, revised goal-setting procedure, and development of a mobile health version. However, several factors, including a high dropout rate and small sample size, impact the external validity of our findings. CONCLUSIONS This study should be regarded as a first step in the process of transforming the prototype workbook into an effective intervention for clinical practice. Although these initial results indicate a favorable evaluation of both behavior regulation strategies within the workbook, this study encountered multiple barriers regarding implementation and data collection that limit the generalizability of these results. Future research efforts should specifically address the fidelity of HCPs and patients and should include clear procedures regarding recruitment and use of both relapse prevention strategies during treatment.
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Affiliation(s)
- Stefan Elbers
- Research Group Lifestyle & Health, Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, Netherlands
- Department of Rehabilitation Medicine, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, Netherlands
| | - Jan Pool
- Research Group Lifestyle & Health, Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Harriët Wittink
- Research Group Lifestyle & Health, Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Albère Köke
- Department of Rehabilitation Medicine, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, Netherlands
- Centre of Expertise in Pain and Rehabilitation, Adelante, Hoensbroek, Netherlands
- South University of Applied Sciences, Heerlen, Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, Netherlands
- Centrum voor Integrale Revalidatie, Eindhoven, Netherlands
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21
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Shakespeare-Finch J, Alichniewicz KK, Strodl E, Brown K, Quinn C, Hides L, White A, Gossage G, Poerio L, Batras D, Jackson S, Styles J, Kavanagh D. Experiences of Serving and Ex-Serving Members With the PTSD Coach Australia App: Mixed Methods Study. J Med Internet Res 2020; 22:e18447. [PMID: 33030438 PMCID: PMC7582151 DOI: 10.2196/18447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/25/2020] [Accepted: 07/26/2020] [Indexed: 01/30/2023] Open
Abstract
Background PTSD Coach Australia is an app for serving and ex-serving defense members and was adapted for the Australian context in 2013 from PTSD Coach, which was created in the United States. Objective This study aimed to provide a user-centered evaluation of the app from the perspective of serving and ex-serving members of the Australian Defence Force. Methods Qualitative data were collected in response to questions to participants in 1 of 5 workshops (n=29) or in telephone interviews (n=24). Quantitative data were collected using the user version of Mobile Apps Rating Scale (uMARS). Results Analysis of the qualitative data demonstrated mixed support for the app. While some people found it extremely useful, especially as an adjunct to therapy, others pointed out limitations and cautioned against the app potentially triggering symptoms in people with PTSD. This perceived risk was usually found to stem from frustration with the app’s functionality rather than its content. Participants spoke about the helpful and unhelpful aspects of the app and barriers to its use and made suggestions for improvement. Many participants encouraged its continued use and highlighted the need for it to be promoted more broadly, as many were not aware of it until they were invited to participate in this research. Conclusions PTSD Coach Australia was seen in a positive light by some participants, but others thought it had too much text and the potential to trigger a traumatic response in users with PTSD. A need to update the app was also a common comment as was the need to increase awareness of the app’s existence.
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Affiliation(s)
| | | | - Esben Strodl
- Queensland University of Technology, Brisbane, Australia
| | - Kelly Brown
- Queensland University of Technology, Brisbane, Australia.,Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Australia
| | | | | | - Angela White
- Royal Brisbane and Womens Hospital, Brisbane, Australia
| | | | | | | | - Samantha Jackson
- Mental Health Strategy & Research, Joint Health Command, Canberra, Australia
| | - Jess Styles
- Mental Health Strategy & Research, Joint Health Command, Canberra, Australia
| | - David Kavanagh
- Queensland University of Technology, Brisbane, Australia
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22
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Abstract
BACKGROUND Identifying and safeguarding ethics in eHealth services from the service users' perspective in social care and healthcare is important. The use of eHealth services should not prejudice the quality of services or the social interaction required in care. There is a lack of studies about the ethics of eHealth services from the service users' perspective. AIM The aim of this study is to identify and analyse ethical issues related to eHealth in social care and healthcare from the service users' perspective. RESEARCH DESIGN An integrative literature review. ETHICAL CONSIDERATIONS The review followed good scientific conduct. RESEARCH CONTEXT AND DATA SOURCES A systematic literature search was performed using CINAHL, Scopus, PubMed/MEDLINE, Web of Science, Cochrane Library and Academic Search Premier to find relevant empirical studies published in English from their earliest up to 30 November 2018. In addition, reference lists from the identified research papers were searched. A quality appraisal of each paper included in the review was conducted before thematic analysis. RESULTS In total, 26 studies were included in the review, and from these four ethical themes were identified: (1) privacy in eHealth, (2) beneficence and nonmaleficence in eHealth, (3) justice in eHealth and (4) trust in eHealth. The ethical issues within these themes were related to information sharing; ownership; access to information and data protection; informed consent; defence of rights; and equity, equality and proportionality of response. CONCLUSION eHealth inequality occurs in social care and healthcare. eHealth service designers and social care and healthcare professionals need to act to maintain and improve user access and data accuracy and provide different levels of security in eHealth services, relative to the information stored. There is a need for further research about ethical issues of eHealth from the user's perspective, including the customer-oriented availability and usability of eHealth services which avoid discrimination.
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Affiliation(s)
| | | | - Riitta Suhonen
- 8058University of Turku, Finland; Turku University Hospital, Finland
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23
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Bhaskar S, Bradley S, Chattu VK, Adisesh A, Nurtazina A, Kyrykbayeva S, Sakhamuri S, Moguilner S, Pandya S, Schroeder S, Banach M, Ray D. Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2). Front Public Health 2020; 8:410. [PMID: 33014958 PMCID: PMC7505101 DOI: 10.3389/fpubh.2020.00410] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia.,Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,The University of New South Wales (UNSW) Medicine Sydney, South West Sydney Clinical School, Sydney, NSW, Australia
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Anil Adisesh
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Alma Nurtazina
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Saltanat Kyrykbayeva
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Sateesh Sakhamuri
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sebastian Moguilner
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Shawna Pandya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Alberta Health Services and Project PoSSUM, University of Alberta, Edmonton, AB, Canada
| | - Starr Schroeder
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Penn Medicine Lancaster General Hospital and Project PoSSUM, Lancaster, PA, United States
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.,Department of Hypertension, Medical University of Lodz, Łódz, Poland
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
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Strodl E, Shakespeare-Finch J, Alichniewicz KK, Brown K, Quinn C, Hides L, White A, Gossage G, Poerio L, Batras D, Jackson S, Styles J, Kavanagh DJ. Clinicians' perceptions of PTSD Coach Australia. Internet Interv 2020; 21:100333. [PMID: 32939341 PMCID: PMC7476854 DOI: 10.1016/j.invent.2020.100333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Applications or "mobile apps" are a potentially important source of assistance for serving and ex-serving Defence members with mental health problems. PTSD Coach Australia is a modified version of an application developed by the US Department of Veteran Affairs. Clinician perceptions of mobile apps are important as they influence the dissemination and adoption of apps. This study aimed to explore the perceptions of PTSD Coach Australia by clinicians with experience in assisting Defence members with mental health problems. METHOD The study involved two samples of participants who were asked about their perceptions of PTSD Coach Australia. The first involved 33 clinicians who participated in one of five focus groups. The second comprised 30 clinicians who were individually interviewed by telephone. Qualitative responses to questions regarding PTSD Coach Australia were analysed to identify representative themes. Participants in the focus group sample also rated the app on the user version of the Mobile Apps Rating Scale (uMARS). RESULTS On the uMARS, clinicians rated the mobile app's subjective quality as 'average' to 'good'. Participants generally saw the app as a useful to help track symptoms, improve engagement and help implement strategies between sessions. However, they also expressed concerns with the app not being user-friendly (e.g. too wordy, poor layout/navigation) and having technical issues (freezing or crashing on Android devices). DISCUSSION PTSD Coach Australia is generally seen as being acceptable and useful by mental health clinicians. However, it is important to include their concerns in future developments of PTSD Coach Australia and similar mobile apps in order to maximize their utilisation in Defence members.
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Affiliation(s)
- Esben Strodl
- Institute of Health & Biomedical Innovation, School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia
| | - Jane Shakespeare-Finch
- Institute of Health & Biomedical Innovation, School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia
| | - Karolina K. Alichniewicz
- Centre for Children's Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane, Qld 4101, Australia
| | - Kelly Brown
- Centre for Children's Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane, Qld 4101, Australia
| | - Catherine Quinn
- Lives Lived Well Research Group, School of Psychology, University of Queensland, St Lucia, Qld 4072, Australia
| | - Leanne Hides
- Lives Lived Well Research Group, School of Psychology, University of Queensland, St Lucia, Qld 4072, Australia
| | - Angela White
- Royal Brisbane & Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Gabrial Gossage
- Department of Veterans' Affairs, GPO Box 9998, Brisbane, QLD 4001, Australia
| | - Loretta Poerio
- Department of Veterans' Affairs, GPO Box 9998, Brisbane, QLD 4001, Australia
| | - Dimitri Batras
- Department of Veterans' Affairs, GPO Box 9998, Brisbane, QLD 4001, Australia
- Attained Success Consulting, GPO Box 2728, Melbourne, Vic 3001, Australia
| | - Samantha Jackson
- Mental Health Strategy & Research, Joint Health Command, CP3-7-100, Northcott Drive, Campbell, ACT 2600, Australia
| | - Jess Styles
- Mental Health Strategy & Research, Joint Health Command, CP3-7-100, Northcott Drive, Campbell, ACT 2600, Australia
| | - David J. Kavanagh
- Institute of Health & Biomedical Innovation, School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia
- Centre for Children's Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane, Qld 4101, Australia
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Olmert T, Cooper JD, Han SYS, Barton-Owen G, Farrag L, Bell E, Friend LV, Ozcan S, Rustogi N, Preece RL, Eljasz P, Tomasik J, Cowell D, Bahn S. A Combined Digital and Biomarker Diagnostic Aid for Mood Disorders (the Delta Trial): Protocol for an Observational Study. JMIR Res Protoc 2020; 9:e18453. [PMID: 32773373 PMCID: PMC7445599 DOI: 10.2196/18453] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background Mood disorders affect hundreds of millions of people worldwide, imposing a substantial medical and economic burden. Existing diagnostic methods for mood disorders often result in a delay until accurate diagnosis, exacerbating the challenges of these disorders. Advances in digital tools for psychiatry and understanding the biological basis of mood disorders offer the potential for novel diagnostic methods that facilitate early and accurate diagnosis of patients. Objective The Delta Trial was launched to develop an algorithm-based diagnostic aid combining symptom data and proteomic biomarkers to reduce the misdiagnosis of bipolar disorder (BD) as a major depressive disorder (MDD) and achieve more accurate and earlier MDD diagnosis. Methods Participants for this ethically approved trial were recruited through the internet, mainly through Facebook advertising. Participants were then screened for eligibility, consented to participate, and completed an adaptive digital questionnaire that was designed and created for the trial on a purpose-built digital platform. A subset of these participants was selected to provide dried blood spot (DBS) samples and undertake a World Health Organization World Mental Health Composite International Diagnostic Interview (CIDI). Inclusion and exclusion criteria were chosen to maximize the safety of a trial population that was both relevant to the trial objectives and generalizable. To provide statistical power and validation sets for the primary and secondary objectives, 840 participants were required to complete the digital questionnaire, submit DBS samples, and undertake a CIDI. Results The Delta Trial is now complete. More than 3200 participants completed the digital questionnaire, 924 of whom also submitted DBS samples and a CIDI, whereas a total of 1780 participants completed a 6-month follow-up questionnaire and 1542 completed a 12-month follow-up questionnaire. The analysis of the trial data is now underway. Conclusions If a diagnostic aid is able to improve the diagnosis of BD and MDD, it may enable earlier treatment for patients with mood disorders. International Registered Report Identifier (IRRID) DERR1-10.2196/18453
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Affiliation(s)
- Tony Olmert
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Jason D Cooper
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Sung Yeon Sarah Han
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | | | | | | | | | - Sureyya Ozcan
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Nitin Rustogi
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Rhian L Preece
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Pawel Eljasz
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | - Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
| | | | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
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Hilty DM, Torous J, Parish MB, Chan SR, Xiong G, Scher L, Yellowlees PM. A Literature Review Comparing Clinicians' Approaches and Skills to In-Person, Synchronous, and Asynchronous Care: Moving Toward Competencies to Ensure Quality Care. Telemed J E Health 2020; 27:356-373. [PMID: 32412882 DOI: 10.1089/tmj.2020.0054] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Research is increasing on asynchronous technologies used by specialist clinicians and primary care, including e-mail, text, e-consultation, and store-and-forward (asynchronous) options. Studies typically describe interventions and care outcomes rather than development of clinical skills for using technology. Methods: This article attempts to compare clinicians' approaches to, and skills for, asynchronous technologies versus in-person and synchronous (i.e., video) care. Literature from technology, health care, pedagogy, and business were searched from 2000 to 2019 for title words, including synchronous (e.g., video, telemental or behavioral health, telepsychiatry), asynchronous (e.g., app, e-consultation, e-mail, text, sensor in a wearable device), education, clinical, and consultation. Results: From a total of 4,812 potential references, two authors (D.M.H., J.T.) found 4,622 eligible for full text review and found 381 articles directly relevant to the concept areas in combination for full text review. However, exclusion criteria subtracted 305, leaving a total of 76 articles. While in-person and synchronous care are similar in many ways, the clinical approach to asynchronous care has many differences. As asynchronous technologies and models of care are feasible and effective, often for consultation, an outline of patient, primary care provider, and specialist clinician goals and skills are presented. Few studies specifically discuss skills or competencies for asynchronous care, but components from published clinical informatics, video, social media, and mobile health competencies were organized into Accreditation Council of Graduate Medical Education domains. Conclusions: Further implementation of science research is needed for asynchronous technology interventions, as well as clinician competencies using asynchronous technologies, to ensure optimal outcomes for patients in health care.
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Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System, Mather, California, USA.,Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Burke Parish
- Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - Steven R Chan
- Stanford University School of Medicine, Palo Alto, California, USA.,Veterans Affairs Palo Alto Health Care System, UC Davis School of Medicine, Sacramento, California, USA
| | - Glen Xiong
- Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA.,Department of Internal Medicine, UC Davis School of Medicine, Sacramento, California, USA
| | - Lorin Scher
- Department of Psychiatry & Behavioral Sciences, UC Davis, Sacramento, California, USA
| | - Peter M Yellowlees
- Department of Psychiatry, UC Davis School of Medicine, Sacramento, California, USA
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Moshe I, Terhorst Y, Cuijpers P, Cristea I, Pulkki-Råback L, Sander L. Three Decades of Internet- and Computer-Based Interventions for the Treatment of Depression: Protocol for a Systematic Review and Meta-Analysis. JMIR Res Protoc 2020; 9:e14860. [PMID: 32207695 PMCID: PMC7139420 DOI: 10.2196/14860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Depression is one of the leading causes of disability worldwide. Internet- and computer-based interventions (IBIs) have been shown to provide effective, scalable forms of treatment. More than 100 controlled trials and a growing number of meta-analyses published over the past 30 years have demonstrated the efficacy of IBIs in reducing symptoms in the short and long term. Despite the large body of research, no comprehensive review or meta-analysis has been conducted to date that evaluates how the effectiveness of IBIs has evolved over time. OBJECTIVE This systematic review and meta-analysis aims to evaluate whether there has been a change in the effectiveness of IBIs on the treatment of depression over the past 30 years and to identify potential variables moderating the effect size. METHODS A sensitive search strategy will be executed across the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO. Data extraction and evaluation will be conducted by two independent researchers. Risk of bias will be assessed. A multilevel meta-regression model will be used to analyze the data and estimate effect size. RESULTS The search was completed in mid-2019. We expect the results to be submitted for publication in early 2020. CONCLUSIONS The year 2020 will mark 30 years since the first paper was published on the use of IBIs for the treatment of depression. Despite the large and rapidly growing body of research in the field, evaluations of effectiveness to date are missing the temporal dimension. This review will address that gap and provide valuable analysis of how the effectiveness of interventions has evolved over the past three decades; which participant-, intervention-, and study-related variables moderate changes in effectiveness; and where research in the field may benefit from increased focus. TRIAL REGISTRATION PROSPERO CRD42019136554; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=136554. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/14860.
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Affiliation(s)
- Isaac Moshe
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Yannik Terhorst
- Department of Research Methods, University of Ulm, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ioana Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
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Fulford H, McSwiggan L, Kroll T, MacGillivray S. Exploring the use of mobile information and communication technologies by people with mood disorders. Int J Ment Health Nurs 2019; 28:1268-1277. [PMID: 31325245 DOI: 10.1111/inm.12632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 11/29/2022]
Abstract
Information and communication technologies (ICTs) have become increasingly integrated into how care is delivered and received. However, no research has yet explored how people with mood disorders use mobile information and communication technologies (mICTs) in their everyday lives and, more specifically, how they might use mICTs to look after themselves. An exploratory qualitative study, within secondary and specialist mental health Services, was undertaken. Data generation involved in-depth, semi-structured interviews with 26 people with mood disorders. Participants' data sets were analysed using constructivist grounded theory (CGT). The resultant theory explains how mICTs were used in daily life, and also, more specifically, how they were used to manage recovery from mood disorders. The findings reveal that people with mood disorders used their mICTs to centralize themselves within their on- and offline worlds and their importance of attachment were central in their continued use. These findings have the potential to inform and encourage the further incorporation of mICTs into the health and social care settings; spanning the therapeutic to systemic levels so that the full potential of these ubiquitous technologies can be harnessed to improve care and care delivery. Yet, without adequate resource and support, health and social care professionals' efforts will be hampered, contributing to technology redundancy and high attrition rates in the use of this type of technology.
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Chan S, Li L, Torous J, Gratzer D, Yellowlees PM. Review and Implementation of Self-Help and Automated Tools in Mental Health Care. Psychiatr Clin North Am 2019; 42:597-609. [PMID: 31672210 DOI: 10.1016/j.psc.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Self-help and automated technologies can be useful for behavioral and mental health education and interventions. These technologies include interactive media, online courses, artificial intelligence-powered chatbots, voice assistants, and video games. Self-help media can include books, videos, audible media like podcasts, blog and print articles, and self-contained Internet sites. Social media, online courses, and mass-market mobile apps also can include such media. These technologies serve to decrease geospatial, temporal, and financial barriers. This article describes different self-help and automated technologies, how to implement such technologies in existing clinical services, and how to implement according to patient needs.
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Affiliation(s)
- Steven Chan
- Palo Alto Veterans Affairs Health System, Palo Alto, CA, USA; Division of Hospital Medicine, Clinical Informatics, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry, University of California, Davis, Davis, CA, USA.
| | - Luming Li
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - John Torous
- Beth Israel Deaconess Medical Center, Boston, MA 02115, USA; Harvard University, Cambridge, MA, USA
| | - David Gratzer
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON M5T 1L8, USA
| | - Peter M Yellowlees
- Department of Psychiatry, University of California, Davis, Sacramento, CA 95817-1353, USA
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Dewa LH, Lavelle M, Pickles K, Kalorkoti C, Jaques J, Pappa S, Aylin P. Young adults' perceptions of using wearables, social media and other technologies to detect worsening mental health: A qualitative study. PLoS One 2019; 14:e0222655. [PMID: 31532786 PMCID: PMC6750581 DOI: 10.1371/journal.pone.0222655] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/03/2019] [Indexed: 01/24/2023] Open
Abstract
Background Technological interventions may help support and improve mental health. However young peoples’ perspectives on using different technologies to detect deteriorating mental health in those already diagnosed with a mental health condition is lacking. The study aim was to explore the perspectives of young patients on the feasibility and acceptability of using wearables, social media and technologies to detect mental health deterioration. Methods The study was co-produced with young adults with past mental health difficulties. Semi-structured interviews were conducted with young adults with a severe mental health condition in a private room at a community mental health site. Data was triangulated by comparing codes and ideas across the two co-researchers and two researchers over two virtual meetings. Themes were finalised and presented in a thematic map. Results Sixteen participants were interviewed (81% female). There were four main themes: dealing with mental health symptoms, signs of mental health deterioration, technology concerns and technological applications to identify worsening mental health. Wearables and mobile apps were considered acceptable and feasible to detect mental health deterioration in real-time if they could measure changes in sleep patterns, mood or activity levels as signs of deterioration. Getting help earlier was deemed essential particularly in reference to dissatisfaction with the current non-technological mental health services. However, patients identified issues to consider before implementation including practicality, safeguarding and patient preference. Conclusion Wearables and mobile apps could be viable technological options to help detect deterioration in young people in order to intervene early and avoid delay in accessing mental health services. However, immediate action following detection is required for the patient to trust and use the intervention.
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Affiliation(s)
- Lindsay H. Dewa
- School of Public Health, Imperial College London, London, United Kingdom
- * E-mail:
| | - Mary Lavelle
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
| | - Katy Pickles
- The McPin Foundation, Young People’s Network, London, United Kingdom
| | | | - Jack Jaques
- The McPin Foundation, Young People’s Network, London, United Kingdom
| | - Sofia Pappa
- West London NHS Trust, London, United Kingdom
| | - Paul Aylin
- School of Public Health, Imperial College London, London, United Kingdom
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
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Hilty DM, Uno J, Chan S, Torous J, Boland RJ. Role of Technology in Faculty Development in Psychiatry. Psychiatr Clin North Am 2019; 42:493-512. [PMID: 31358128 DOI: 10.1016/j.psc.2019.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinicians, interprofessional teams, organizational systems, and patients increasingly use technology for health and health care, communication, networking, and business. In this era of ubiquitous connectivity, the digital age has solidified the role of technology in continuing medical education, faculty development, and integrating professional and personal roles and identities. Clinicians are shifting from treating technology as a supplemental modality to using it as a central organizing and facilitating tool, particularly important for clinical care. This is known as an information technology-business-medicine understanding or conceptual framework.
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Affiliation(s)
- Donald M Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry and Behavioral Sciences, University of California Davis, 10535 Hospital Way, Mather, CA 95655, USA.
| | - Jessica Uno
- Psychiatry, Kaweah Delta Health Care District, 400 West Mineral King Avenue, Visalia, CA 93291, USA
| | - Steven Chan
- Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System, University of California, San Francisco, 3801 Miranda Avenue, Building 520F, Mail Code 116A, Palo Alto, CA 94304, USA
| | - John Torous
- Digital Psychiatry Division, Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA
| | - Robert J Boland
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
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Maher NA, Senders JT, Hulsbergen AF, Lamba N, Parker M, Onnela JP, Bredenoord AL, Smith TR, Broekman ML. Passive data collection and use in healthcare: A systematic review of ethical issues. Int J Med Inform 2019; 129:242-247. [DOI: 10.1016/j.ijmedinf.2019.06.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/15/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022]
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Ng MM, Firth J, Minen M, Torous J. User Engagement in Mental Health Apps: A Review of Measurement, Reporting, and Validity. Psychiatr Serv 2019; 70:538-544. [PMID: 30914003 PMCID: PMC6839109 DOI: 10.1176/appi.ps.201800519] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Despite the potential benefits of mobile mental health apps, real-world results indicate engagement issues because of low uptake and sustained use. This review examined how studies have measured and reported on user engagement indicators (UEIs) for mental health apps. METHODS A systematic review of multiple databases was performed in July 2018 for studies of mental health apps for depression, bipolar disorder, schizophrenia, and anxiety that reported on UEIs, namely usability, user satisfaction, acceptability, and feasibility. The subjective and objective criteria used to assess UEIs, among other data, were extracted from each study. RESULTS Of 925 results, 40 studies were eligible. Every study reported positive results for the usability, satisfaction, acceptability, or feasibility of the app. Of the 40 studies, 36 (90%) employed 371 indistinct subjective criteria that were assessed with surveys, interviews, or both, and 23 studies used custom subjective scales, rather than preexisting standardized assessment tools. A total of 25 studies (63%) used objective criteria-with 71 indistinct measures. No two studies used the same combination of subjective or objective criteria to assess UEIs of the app. CONCLUSIONS The high heterogeneity and use of custom criteria to assess mental health apps in terms of usability, user satisfaction, acceptability, or feasibility present a challenge for understanding real-world low uptake of these apps. Every study reviewed claimed that UEIs for the app were rated highly, which suggests a need for the field to focus on engagement by creating reporting standards and more carefully considering claims.
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Affiliation(s)
- Michelle M Ng
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Ng, Torous); National Institute of Complementary Medicine Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia, and Division of Psychology and Mental Health, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (Firth); Headache Center, Department of Neurology, NYU Langone Health, NYU School of Medicine, New York (Minen)
| | - Joseph Firth
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Ng, Torous); National Institute of Complementary Medicine Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia, and Division of Psychology and Mental Health, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (Firth); Headache Center, Department of Neurology, NYU Langone Health, NYU School of Medicine, New York (Minen)
| | - Mia Minen
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Ng, Torous); National Institute of Complementary Medicine Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia, and Division of Psychology and Mental Health, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (Firth); Headache Center, Department of Neurology, NYU Langone Health, NYU School of Medicine, New York (Minen)
| | - John Torous
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (Ng, Torous); National Institute of Complementary Medicine Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia, and Division of Psychology and Mental Health, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom (Firth); Headache Center, Department of Neurology, NYU Langone Health, NYU School of Medicine, New York (Minen)
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Palanica A, Flaschner P, Thommandram A, Li M, Fossat Y. Physicians' Perceptions of Chatbots in Health Care: Cross-Sectional Web-Based Survey. J Med Internet Res 2019; 21:e12887. [PMID: 30950796 PMCID: PMC6473203 DOI: 10.2196/12887] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 01/07/2023] Open
Abstract
Background Many potential benefits for the uses of chatbots within the context of health care have been theorized, such as improved patient education and treatment compliance. However, little is known about the perspectives of practicing medical physicians on the use of chatbots in health care, even though these individuals are the traditional benchmark of proper patient care. Objective This study aimed to investigate the perceptions of physicians regarding the use of health care chatbots, including their benefits, challenges, and risks to patients. Methods A total of 100 practicing physicians across the United States completed a Web-based, self-report survey to examine their opinions of chatbot technology in health care. Descriptive statistics and frequencies were used to examine the characteristics of participants. Results A wide variety of positive and negative perspectives were reported on the use of health care chatbots, including the importance to patients for managing their own health and the benefits on physical, psychological, and behavioral health outcomes. More consistent agreement occurred with regard to administrative benefits associated with chatbots; many physicians believed that chatbots would be most beneficial for scheduling doctor appointments (78%, 78/100), locating health clinics (76%, 76/100), or providing medication information (71%, 71/100). Conversely, many physicians believed that chatbots cannot effectively care for all of the patients’ needs (76%, 76/100), cannot display human emotion (72%, 72/100), and cannot provide detailed diagnosis and treatment because of not knowing all of the personal factors associated with the patient (71%, 71/100). Many physicians also stated that health care chatbots could be a risk to patients if they self-diagnose too often (714%, 74/100) and do not accurately understand the diagnoses (74%, 74/100). Conclusions Physicians believed in both costs and benefits associated with chatbots, depending on the logistics and specific roles of the technology. Chatbots may have a beneficial role to play in health care to support, motivate, and coach patients as well as for streamlining organizational tasks; in essence, chatbots could become a surrogate for nonmedical caregivers. However, concerns remain on the inability of chatbots to comprehend the emotional state of humans as well as in areas where expert medical knowledge and intelligence is required.
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Affiliation(s)
- Adam Palanica
- Labs Department, Klick Health, Klick Inc, Toronto, ON, Canada
| | - Peter Flaschner
- Marketing Department, Klick Health, Klick Inc, Toronto, ON, Canada
| | | | - Michael Li
- Labs Department, Klick Health, Klick Inc, Toronto, ON, Canada
| | - Yan Fossat
- Labs Department, Klick Health, Klick Inc, Toronto, ON, Canada
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36
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Tellier PP. Improving health access for gender diverse children, youth, and emerging adults? Clin Child Psychol Psychiatry 2019; 24:193-198. [PMID: 30369254 DOI: 10.1177/1359104518808624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Gender diverse people are individuals who define their gender as different from the sex they were assigned as birth. This incongruence leads to a sense of discomfort within oneself, which according to the DSM-V is called gender dysphoria. The combination of dysphoria, ongoing stress, as outlined in the Minority Stress Theory (Meyer, 2003, Dohrenwend, 2000) and the stigma related to living in a society which traditionally defines gender as binary and rejects the notion of gender as fluid, is associated with psycho-social, mental, and physical health problems. Gender diverse children and young people require support from health practitioner to assist them not only in transitioning, if this is what they choose, but also to manage ongoing and preventive health care in a system which is not always welcoming and frequently hostile to them. In 2012 the United Nations General Assembly called for universal health coverage as a goal in the post-2015 Millennium Development Goal Framework. One step in attaining this goal is universal health access which is not currently being met for gender diverse individuals. Hence, we need to work together, with those that we serve, to develop appropriate, sensitive and accessible health care for all.
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Hoffman L, Benedetto E, Huang H, Grossman E, Kaluma D, Mann Z, Torous J. Augmenting Mental Health in Primary Care: A 1-Year Study of Deploying Smartphone Apps in a Multi-site Primary Care/Behavioral Health Integration Program. Front Psychiatry 2019; 10:94. [PMID: 30873053 PMCID: PMC6404548 DOI: 10.3389/fpsyt.2019.00094] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/08/2019] [Indexed: 01/20/2023] Open
Abstract
Background: Integrating behavioral health (BH) services into primary care is an evidence-based intervention that can increase access to care, improve patient outcomes, and decrease costs. Digital technology, including smartphone apps, has the potential to augment and extend the reach of these integrated behavioral health services through self-management support impacting lifestyle behaviors. To date, the feasibility and acceptability of using mental health mobile apps within an integrated primary care setting has not yet been explored as part of routine clinical care. Objectives: The objectives of this study were to (a) test the feasibility of using mental health applications to augment integrated primary care services; (b) solicit feedback from patients and providers to guide implementation, and (c) develop a mental health apps toolkit for system-wide dissemination. Methods: Cambridge Health Alliance (CHA) is a safety-net healthcare system that includes three community hospitals and 12 Primary Care (PC) clinics serving nearly 150,000 ethnically and socioeconomically diverse patients around Boston. To select and disseminate mental health apps, a four-phase implementation was undertaken: (1) Evaluation of mental health mobile applications (2) Development of an apps toolkit with stakeholder input, (3) Conducting initial pilot at six primary care locations, and (4) Rolling out the app toolkit across 12 primary care sites and conducting 1-year follow-up survey. Results: Among BH providers, 24 (75%) responded to the follow-up survey and 19 (83%) indicated they use apps as part of their clinical care. Anxiety was the most common condition for which app use was recommended by providers, and 10 (42%) expressed interest in further developing their knowledge of mental health apps. Among patients, 35 (65%) of participants provided feedback; 23 (66%) reported the tools to be helpful, especially for managing stress and anxiety. Conclusions: Our findings indicate mental health apps are applicable and relevant to patients within integrated primary care settings in safety-net health systems. Behavioral health providers perceive the clinical value of using these tools as part of patient care, but require training to increase their comfort-level and confidence applying these tools with patients. To increase provider and patient engagement, mobile apps must be accessible, simple, intuitive and directly relevant to patients' treatment needs.
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Affiliation(s)
- Liza Hoffman
- Department of Primary Care, Cambridge Health Alliance, Cambridge, MA, United States
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Emily Benedetto
- Department of Primary Care, Cambridge Health Alliance, Cambridge, MA, United States
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
| | - Ellie Grossman
- Department of Primary Care, Cambridge Health Alliance, Cambridge, MA, United States
| | - Dorosella Kaluma
- Department of Primary Care, Cambridge Health Alliance, Cambridge, MA, United States
| | - Ziva Mann
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
| | - John Torous
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Abstract
During the past two decades, it has been amply documented that neuropsychiatric disorders (NPDs) disproportionately account for burden of illness attributable to chronic non-communicable medical disorders globally. It is also likely that human capital costs attributable to NPDs will disproportionately increase as a consequence of population aging and beneficial risk factor modification of other common and chronic medical disorders (e.g., cardiovascular disease). Notwithstanding the availability of multiple modalities of antidepressant treatment, relatively few studies in psychiatry have primarily sought to determine whether improving cognitive function in MDD improves patient reported outcomes (PROs) and/or is cost effective. The mediational relevance of cognition in MDD potentially extrapolates to all NPDs, indicating that screening for, measuring, preventing, and treating cognitive deficits in psychiatry is not only a primary therapeutic target, but also should be conceptualized as a transdiagnostic domain to be considered regardless of patient age and/or differential diagnosis.
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Kim JW, Torous J, Chan S, Gipson SYMT. Developing a Digitally Informed Curriculum in Psychiatry Education and Clinical Practice. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:782-790. [PMID: 29473134 DOI: 10.1007/s40596-018-0895-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/09/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Jung Won Kim
- University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | - Steven Chan
- University of California at San Francisco, San Francisco, CA, USA
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Hilty DM, Sunderji N, Suo S, Chan S, McCarron RM. Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies. Int Rev Psychiatry 2018; 30:292-309. [PMID: 30821540 DOI: 10.1080/09540261.2019.1571483] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Telehealth facilitates integrated, patient-centred care. Synchronous video, telepsychiatry (TP), or telebehavioural health provide outcomes as good as in-person care. It also improves access to care, leverages expertise at a distance, and is effective for education and consultation to primary care. Other technologies on an e-behavioural health spectrum are also useful, like telephone, e-mail, text, and e-consults. This paper briefly organizes these technologies into low, mid and high intensity telehealth models and reviews the evidence base for interventions to primary care, and, specifically, for TP and integrated care (IC). Technology, mobile health, and IC competencies facilitate quality care. TP is a high intensity model and it is the best-studied option. Studies of IC are preliminary, but those with collaborative and consultative care show effectiveness. Low- and mid-intensity technology options like telephone, e-mail, text, and e-consults, may provide better access for patients and more timely provider communication and education. They are also probably more cost-effective and versatile for health system workflow. Research is needed upon all technology models related to IC for adult and paediatric primary care populations. Effective healthcare delivery matches the patients' needs with the model, emphasizes clinician competencies, standardizes interventions, and evaluates outcomes.
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Affiliation(s)
- Donald M Hilty
- a Mental Health Service , Northern California Veterans Administration Health Care System , Mather , CA , USA.,b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Nadiya Sunderji
- c Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Shannon Suo
- b Department of Psychiatry & Behavioral Sciences & Health System , University of California Davis School of Medicine , Sacramento , CA , USA
| | - Steven Chan
- d Physician, Addiction Treatment Services, Veterans Affairs Palo Alto Health Care System , Affiliate, University of California , San Francisco , CA , USA
| | - Robert M McCarron
- e Department of Psychiatry , University of California Irvine , Irvine , CA , USA
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Telemental Health in Low- and Middle-Income Countries: A Systematic Review. Int J Telemed Appl 2018; 2018:9602821. [PMID: 30519259 PMCID: PMC6241375 DOI: 10.1155/2018/9602821] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/03/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction The rising incidence of mental illness and its impact on individuals, families, and societies is becoming a major public health concern, especially in resource-constrained countries. Consequently, there is an increasing demand for mental health services in many middle- and low-income countries (LMIC). Challenges such as inequality in access, lack of staff and hospital beds, and underfunding, often present in the LMIC, might in part be addressed by telemental health services. However, little is known about telemental health in the LMIC. Methods A systematic review was performed, drawing on several electronic databases, including PubMed, PsycINFO, Web of Science, Springer Link, and Google Scholar. Original English language studies on the practice of telemental health in LMIC, involving patients and published between 1 January 2000 and 16 February 2017, were included. Results Nineteen studies met the inclusion criteria. Most of the articles were recent, which may reflect an increasing focus on telemental health in the LMIC. Eight of these studies were from Asia. Eight of the studies were interventional/randomized controlled trials, and 11 examined general mental health issues. Videoconferencing was the most frequently (6) studied telemental modality. Other modalities studied were online decision support systems (3), text messaging and bibliotherapy (1), e-chatting combined with videoconferencing (1), online therapy (2), e-counseling (1), store-and-forward technology (1), telephone follow-up (1), online discussion groups (1), audiovisual therapy and bibliotherapy (1), and computerized occupational therapy (1). Although many of the studies showed that telemental services had positive outcomes, some studies reported no postintervention improvements. Conclusion The review shows a rising trend in telemental activity in the LMIC. There is a greater need for telemental health in the LMIC, but more research is needed on empirical and theoretical aspects of telemental activity in the LMIC and on direct comparisons between telemental activity in the LMIC and the non-LMIC.
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Yellowlees P. The Need to Develop Specialized Formularies of Apps and Web-Based Tools. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2018; 42:677-678. [PMID: 30155602 DOI: 10.1007/s40596-018-0971-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
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Abstract
PURPOSE OF REVIEW The aim of the present review is to systematically examine published data regarding ecological momentary assessment (EMA) in children and adolescents with mood disorders. RECENT FINDINGS EMA is increasingly used to collect participant's information in their real environment and in real time. There are multiple studies focused on the evaluation of mood disorders in children and adolescents, but only a few of them used EMA protocols. Results found in this review showed a wide variability of works with different fields of study, methodological approaches, and EMA protocols. More than 60% of EMA studies in children and adolescents with mood disorders were conducted via phone call, showing high completion rates with data missing in 5 to 11.5% of the calls. Length of studies varied from a 4-day EMA protocol to a maximum of 8 weeks. Positive and negative affect, daily activities, and social context were the main EMA measures. Despite the limited number of studies using EMA in children and adolescents with mood disorders, EMA was useful in assessing mood symptoms in the moment and in patients' real-life environment. Studies also showed high completion and satisfaction rates. Although web pages and apps use have been increasing over the past years, the evidence base is still scarce. Future studies can facilitate understanding of EMA methodology among youth with mood disorders.
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Hirschtritt ME, Insel TR. Digital Technologies in Psychiatry: Present and Future. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:251-258. [PMID: 31975919 DOI: 10.1176/appi.focus.20180001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The digital revolution has reached the world of mental health. Prominent examples include the rapidly growing use of mobile health apps, the integration of sophisticated machine learning or artificial intelligence for clinical decision support and automated therapy, and the incorporation of virtual reality-based treatments. These diverse technologies hold the promise of addressing several important problems in mental health care, including lack of measurement, uneven access to clinicians, delay in receiving care, fragmentation of care, and negative attitudes toward psychiatry. Here, the authors summarize the current and swiftly changing state of digital mental health. Specifically, they highlight the current unmet needs that emerging technologies may be able to address; summarize what digital health can offer for assessment, treatment, and care integration; and describe some of the challenges and some new directions for innovations in this field. The review concludes with guidance for clinicians to integrate digital technologies into their work and to provide responsible and useful advice to their patients.
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Affiliation(s)
- Mathew E Hirschtritt
- Dr. Hirschtritt is with the Weill Institute for Neurosciences and Department of Psychiatry, University of California, San Francisco. Dr. Insel is with Mindstrong Health, Palo Alto, CA
| | - Thomas R Insel
- Dr. Hirschtritt is with the Weill Institute for Neurosciences and Department of Psychiatry, University of California, San Francisco. Dr. Insel is with Mindstrong Health, Palo Alto, CA
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Myers K, Cummings JR, Zima B, Oberleitner R, Roth D, Merry SM, Bohr Y, Stasiak K. Advances in Asynchronous Telehealth Technologies to Improve Access and Quality of Mental Health Care for Children and Adolescents. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s41347-018-0055-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Chandrashekar P. Do mental health mobile apps work: evidence and recommendations for designing high-efficacy mental health mobile apps. Mhealth 2018; 4:6. [PMID: 29682510 PMCID: PMC5897664 DOI: 10.21037/mhealth.2018.03.02] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/28/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Pooja Chandrashekar
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
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Kern A, Hong V, Song J, Lipson SK, Eisenberg D. Mental health apps in a college setting: openness, usage, and attitudes. Mhealth 2018; 4:20. [PMID: 30050916 PMCID: PMC6043844 DOI: 10.21037/mhealth.2018.06.01] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/17/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The ubiquity of smartphones and the development of mental health apps (MHAs) calls for evaluation of consumers' attitudes towards and usage of MHAs. Due to the increasing demand for mental health services on college campuses, research is especially needed to evaluate MHAs as a potentially viable treatment modality in that setting. METHODS The study team developed survey questions related to MHAs, added these to the Healthy Minds Study, and used Qualtrics as the platform. The participants were 741 students, age 18 and older, from a large Midwest public university. Students could answer a varying number of multiple choice questions based on embedded display logic, and the survey required 20-25 minutes for most participants to complete. Based on embedded display logic in the survey and how questions were answered, students could receive anywhere from 1-20 questions. Questions were primarily categorical (e.g., "Yes", "Maybe", "No"), with the remaining questions in free response format. The survey was fielded in April, 2016. RESULTS 26.1% of respondents were open to using an MHA yet only 7.3% had used an MHA. 9.0% of respondents preferred to use an MHA versus seeing a mental health professional. 13.2% of respondents felt that MHAs do have an evidence base. 23.8% of users felt that MHAs helped with their mental health. Those who reported receiving mental health services within the past 12 months were significantly more open to using MHAs than those who had not received services. Convenience, immediate availability, and confidentiality were common reasons for interest in MHAs. CONCLUSIONS There is interest in, but limited usage, of MHAs among university students, providing evidence of MHAs as a potentially untapped treatment modality for this population. Further research could help assess how best to integrate this technology into the university and college mental health system.
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Affiliation(s)
- Adam Kern
- Washington University in St. Louis, School of Social Work, St. Louis, MO, USA
| | - Victor Hong
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Joyce Song
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Ketchen Lipson
- Department of Health Law Policy and Management, School of Public Health, Boston University, Boston, MA, USA
| | - Daniel Eisenberg
- Department of Health Management and Policy, and Population Studies Center, University of Michigan, Ann Arbor, MI, USA
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