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O'Donnell EA, Van Citters AD, Khayal IS, Wilson MM, Gustafson D, Barnato AE, Buccellato AC, Young C, Holthoff MM, Korsunskiy E, Tomlin SC, Cullinan AM, Steinbaugh AC, Hinson JJ, Johnson KR, Williams A, Thomson RM, Haines JM, Holmes AB, Bradley AD, Nelson EC, Kirkland KB. A Web-Based Peer Support Network to Help Care Partners of People With Serious Illness: Co-Design Study. JMIR Hum Factors 2024; 11:e53194. [PMID: 38717809 PMCID: PMC11112480 DOI: 10.2196/53194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Care partners of people with serious illness experience significant challenges and unmet needs during the patient's treatment period and after their death. Learning from others with shared experiences can be valuable, but opportunities are not consistently available. OBJECTIVE This study aims to design and prototype a regional, facilitated, and web-based peer support network to help active and bereaved care partners of persons with serious illness be better prepared to cope with the surprises that arise during serious illness and in bereavement. METHODS An 18-member co-design team included active care partners and those in bereavement, people who had experienced serious illness, regional health care and support partners, and clinicians. It was guided by facilitators and peer network subject-matter experts. We conducted design exercises to identify the functions and specifications of a peer support network. Co-design members independently prioritized network specifications, which were incorporated into an early iteration of the web-based network. RESULTS The team prioritized two functions: (1) connecting care partners to information and (2) facilitating emotional support. The design process generated 24 potential network specifications to support these functions. The highest priorities included providing a supportive and respectful community; connecting people to trusted resources; reducing barriers to asking for help; and providing frequently asked questions and responses. The network platform had to be simple and intuitive, provide technical support for users, protect member privacy, provide publicly available information and a private discussion forum, and be easily accessible. It was feasible to enroll members in the ConnectShareCare web-based network over a 3-month period. CONCLUSIONS A co-design process supported the identification of critical features of a peer support network for care partners of people with serious illnesses in a rural setting, as well as initial testing and use. Further testing is underway to assess the long-term viability and impact of the network.
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Affiliation(s)
- Elizabeth A O'Donnell
- Communications, Marketing and Community Health, Alice Peck Day Memorial Hospital, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Inas S Khayal
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth, Lebanon, NH, United States
| | - Matthew M Wilson
- Palliative Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Section of Palliative Medicine, Dartmouth Health, Lebanon, NH, United States
| | - David Gustafson
- College of Engineering, University of Wisconsin, Madison, WI, United States
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Palliative Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Section of Palliative Medicine, Dartmouth Health, Lebanon, NH, United States
| | - Andrea C Buccellato
- Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth, Lebanon, NH, United States
| | - Colleen Young
- Mayo Clinic Connect, Mayo Clinic, Rochester, MN, United States
| | - Megan M Holthoff
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Eugene Korsunskiy
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Stephanie C Tomlin
- Patient and Family Advisors, Dartmouth Health, Lebanon, NH, United States
| | - Amelia M Cullinan
- Palliative Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Section of Palliative Medicine, Dartmouth Health, Lebanon, NH, United States
| | | | - Jennifer J Hinson
- Patient and Family Advisors, Dartmouth Health, Lebanon, NH, United States
| | - Kristen R Johnson
- Section of Palliative Medicine, Dartmouth Health, Lebanon, NH, United States
| | - Andrew Williams
- Patient and Family Advisors, Dartmouth Health, Lebanon, NH, United States
| | - Ruth M Thomson
- Palliative Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Section of Palliative Medicine, Dartmouth Health, Lebanon, NH, United States
| | - Janet M Haines
- Patient and Family Advisors, Dartmouth Health, Lebanon, NH, United States
| | - Anne B Holmes
- Patient and Family Advisors, Dartmouth Health, Lebanon, NH, United States
| | - Ann D Bradley
- Patient and Family Advisors, Dartmouth Health, Lebanon, NH, United States
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Kathryn B Kirkland
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Palliative Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Section of Palliative Medicine, Dartmouth Health, Lebanon, NH, United States
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Eis S, Solà-Morales O, Duarte-Díaz A, Vidal-Alaball J, Perestelo-Pérez L, Robles N, Carrion C. Mobile Applications in Mood Disorders and Mental Health: Systematic Search in Apple App Store and Google Play Store and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042186. [PMID: 35206373 PMCID: PMC8871536 DOI: 10.3390/ijerph19042186] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The main objective of this work was to explore and characterize the current landscape of mobile applications available to treat mood disorders such as depression, bipolar disorder, and dysthymia. METHODS We developed a tool that makes both the Apple App Store and the Google Play Store searchable using keywords and that facilitates the extraction of basic app information of the search results. All app results were filtered using various inclusion and exclusion criteria. We characterized all resultant applications according to their technical details. Furthermore, we searched for scientific publications on each app's website and PubMed, to understand whether any of the apps were supported by any type of scientific evidence on their acceptability, validation, use, effectiveness, etc. Results: Thirty apps were identified that fit the inclusion and exclusion criteria. The literature search yielded 27 publications related to the apps. However, these did not exclusively concern mood disorders. 6 were randomized studies and the rest included a protocol, pilot-, feasibility, case-, or qualitative studies, among others. The majority of studies were conducted on relatively small scales and 9 of the 27 studies did not explicitly study the effects of mobile application use on mental wellbeing. CONCLUSION While there exists a wealth of mobile applications aimed at the treatment of mental health disorders, including mood disorders, this study showed that only a handful of these are backed by robust scientific evidence. This result uncovers a need for further clinically oriented and systematic validation and testing of such apps.
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Affiliation(s)
- Sophie Eis
- Fundació HiTT (Health Innovation Technology Transfer), 08015 Barcelona, Spain;
| | - Oriol Solà-Morales
- Fundació HiTT (Health Innovation Technology Transfer), 08015 Barcelona, Spain;
- Correspondence:
| | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Barcelona, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | | | - Noemí Robles
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain; (N.R.); (C.C.)
| | - Carme Carrion
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain; (N.R.); (C.C.)
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Teepe GW, Da Fonseca A, Kleim B, Jacobson NC, Salamanca Sanabria A, Tudor Car L, Fleisch E, Kowatsch T. Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review. J Med Internet Res 2021; 23:e29412. [PMID: 34309569 PMCID: PMC8512178 DOI: 10.2196/29412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/06/2021] [Accepted: 07/26/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The number of smartphone apps that focus on the prevention, diagnosis, and treatment of depression is increasing. A promising approach to increase the effectiveness of the apps while reducing the individual's burden is the use of just-in-time adaptive intervention (JITAI) mechanisms. JITAIs are designed to improve the effectiveness of the intervention and reduce the burden on the person using the intervention by providing the right type of support at the right time. The right type of support and the right time are determined by measuring the state of vulnerability and the state of receptivity, respectively. OBJECTIVE The aim of this study is to systematically assess the use of JITAI mechanisms in popular apps for individuals with depression. METHODS We systematically searched for apps addressing depression in the Apple App Store and Google Play Store, as well as in curated lists from the Anxiety and Depression Association of America, the United Kingdom National Health Service, and the American Psychological Association in August 2020. The relevant apps were ranked according to the number of reviews (Apple App Store) or downloads (Google Play Store). For each app, 2 authors separately reviewed all publications concerning the app found within scientific databases (PubMed, Cochrane Register of Controlled Trials, PsycINFO, Google Scholar, IEEE Xplore, Web of Science, ACM Portal, and Science Direct), publications cited on the app's website, information on the app's website, and the app itself. All types of measurements (eg, open questions, closed questions, and device analytics) found in the apps were recorded and reviewed. RESULTS None of the 28 reviewed apps used JITAI mechanisms to tailor content to situations, states, or individuals. Of the 28 apps, 3 (11%) did not use any measurements, 20 (71%) exclusively used self-reports that were insufficient to leverage the full potential of the JITAIs, and the 5 (18%) apps using self-reports and passive measurements used them as progress or task indicators only. Although 34% (23/68) of the reviewed publications investigated the effectiveness of the apps and 21% (14/68) investigated their efficacy, no publication mentioned or evaluated JITAI mechanisms. CONCLUSIONS Promising JITAI mechanisms have not yet been translated into mainstream depression apps. Although the wide range of passive measurements available from smartphones were rarely used, self-reported outcomes were used by 71% (20/28) of the apps. However, in both cases, the measured outcomes were not used to tailor content and timing along a state of vulnerability or receptivity. Owing to this lack of tailoring to individual, state, or situation, we argue that the apps cannot be considered JITAIs. The lack of publications investigating whether JITAI mechanisms lead to an increase in the effectiveness or efficacy of the apps highlights the need for further research, especially in real-world apps.
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Affiliation(s)
- Gisbert W Teepe
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Ashish Da Fonseca
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Birgit Kleim
- Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Departments of Biomedical Data Science and Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Alicia Salamanca Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
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Baumel A, Muench FJ. Effort-Optimized Intervention Model: Framework for Building and Analyzing Digital Interventions That Require Minimal Effort for Health-Related Gains. J Med Internet Res 2021; 23:e24905. [PMID: 33709943 PMCID: PMC7998331 DOI: 10.2196/24905] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/16/2020] [Accepted: 01/16/2021] [Indexed: 02/02/2023] Open
Abstract
The majority of digital health interventions lean on the promise of bringing health and self-care into people’s homes and hands. However, these interventions are delivered while people are in their triggering environments, which places competing demands on their attention. Individuals struggling to change or learn a new behavior have to work hard to achieve even a minor change because of the automatic forces propelling them back to their habitual behaviors. We posit that effort and burden should be explored at the outset and throughout the digital intervention development process as a core therapeutic mechanism, beyond the context of design or user experience testing. In effort-focused conceptualization, it is assumed that, even though goals are rational and people want to achieve them, they are overtaken by competing cognitive, emotional, and environmental processes. We offer the term effort-optimized intervention to describe interventions that focus on user engagement in the face of competing demands. We describe design components based on a 3-step process for planning an effort-optimized intervention: (1) nurturing effortless cognitive and environmental salience to help people keep effort-related goals prominent despite competition; (2) making it as effortless as possible to complete therapeutic activities to avoid ego depletion and self-efficacy reduction; and (3) turning the necessary effortful activities into sustainable assets. We conclude by presenting an example of designing a digital health intervention based on the effort-optimized intervention model.
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Affiliation(s)
- Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Baumel A, Edan S, Kane JM. Is there a trial bias impacting user engagement with unguided e-mental health interventions? A systematic comparison of published reports and real-world usage of the same programs. Transl Behav Med 2020; 9:1020-1033. [PMID: 31689344 DOI: 10.1093/tbm/ibz147] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Trial settings that include proactive recruitment, human contact, and assessment procedures may substantially impact the way users engage with unguided e-mental health programs and the generalizability of reported findings. This study examined the impact of trial setting on user behavior by directly comparing reported user engagement in trial-based research and objective measures of real-world usage of the same unguided mental health programs. The authors conducted a systematic search for papers reporting user engagement with off-the-shelf unguided e-mental health programs. Real-world usage was obtained from a panel that presents aggregated nonpersonal information on user engagement with digital programs across the world. A total of 13 papers yielding 14 comparable usage metrics met all inclusion criteria. In three papers reporting the use of programs by lay users without any proactive trial procedures, the ratios calculated by dividing the usage reported in the paper by the usage documented within the objective dataset were 0.84, 1.05, and 1.27-suggesting a sufficient criterion validity for our examination. In studies that proactively recruited users and included pre- to post-assessment procedures (11 comparisons), the median program usage rate reported was 4.06 times higher (IQR = 4.49) than the real-world usage of the same program. Severity of clinical symptoms, in-person versus remote assessment procedures, study design, and program cost had no impact on these differences. The results suggest that trial settings have a large impact on user engagement with unguided interventions and, therefore, on the generalizability of the findings to the real world.
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Affiliation(s)
- Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Stav Edan
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - John M Kane
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
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Cherba M, Thoër C, Turbide O, Denault V, Renaud L, Valderrama A, Courcy I, Cordelier B, Laquerre ME, Cyr C, Hovington J, Muloin C. [Online social support as a mode of psychosocial intervention: A review of scientific literature, avenues for future research, and recommendations for practitioners]. SANTE PUBLIQUE 2019; Vol. 31:83-92. [PMID: 31210521 DOI: 10.3917/spub.191.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The goal of this review is to present online social support interventions described in recent scientific literature, in order to (i) guide organizations wishing to develop such an intervention or to improve an existing program, and (ii) to identify future research directions and recommendations for practitioners. METHODS AND RESULTS 59 peer-reviewed articles presenting online social support interventions (2006-2016) were analyzed by using a thematic grid focusing on theoretical perspectives on social support, the online platforms used and their functionalities, the process of intervention development and evaluation, the modalities of participation and the facilitation methods, the documented impacts of interventions, and finally future research directions and recommendations for practitioners. A narrative methodology was used to identify challenges in intervention development and implementation, in order to provide guidance to organizations who want to develop or improve their online social support services. CONCLUSIONS Several research directions and recommendations for the development of online social support interventions are suggested, including the need to develop theoretical models of online social support and enrich traditional models of social support, the need to understand the benefits associated with different levels of participation, the importance of needs assessment in the development of interventions, and the contribution of qualitative methods to the evaluation of interventions.
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Van Meter AR, Birnbaum ML, Rizvi A, Kane JM. Online help-seeking prior to diagnosis: Can web-based resources reduce the duration of untreated mood disorders in young people? J Affect Disord 2019; 252:130-134. [PMID: 30981056 PMCID: PMC6529208 DOI: 10.1016/j.jad.2019.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/26/2019] [Accepted: 04/07/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Mood and anxiety disorders typically begin in adolescence or early adulthood, but those at the age of highest risk are among those least likely to access mental health services. However, they may be more likely than other demographic groups to seek help online. The goal of the present study was to investigate the online help- and information-seeking activity of young people newly diagnosed with mood and anxiety disorders in order to better understand how digital resources might serve this population. METHOD Participants, aged 15 to 35, with a diagnosis of a mood or anxiety disorder were eligible if they had received their first mental health diagnosis within 24 months. Participants were interviewed with the Pathways to Care Questionnaire, which inquires about online activity prior to one's first interaction with mental healthcare providers. RESULTS Forty people participated (depression n = 30, bipolar disorder n = 5, generalized anxiety disorder n = 5); average age 21 years (SD=3.2), 60% female. Eighty-one percent reported seeking help and/or information about their symptoms online. The gap between symptom onset and in-person help seeking was 91.90 weeks (SD=133.7). Most participants (85%) reported they would be open to communicating with a mental health professional online. CONCLUSION A majority of young people experiencing clinically-significant symptoms seek help online. However, the gap between symptom onset and treatment initiation remains unacceptably long. Better strategies are needed to translate young people's interest in online resources into meaningful care, whether through web-based services or facilitated pathways to traditional treatment.
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Affiliation(s)
- Anna R. Van Meter
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA,Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Michael L. Birnbaum
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA,Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Asra Rizvi
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - John M. Kane
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA,Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
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Aref-Adib G, McCloud T, Ross J, O'Hanlon P, Appleton V, Rowe S, Murray E, Johnson S, Lobban F. Factors affecting implementation of digital health interventions for people with psychosis or bipolar disorder, and their family and friends: a systematic review. Lancet Psychiatry 2019; 6:257-266. [PMID: 30522979 DOI: 10.1016/s2215-0366(18)30302-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Abstract
Digital health interventions present an important opportunity to improve health care for people with psychosis or bipolar disorder, but despite their potential, integrating and implementing them into clinical settings has been difficult worldwide. This Review aims to identify factors affecting implementation of digital health interventions for people affected by psychosis or bipolar disorder. We searched seven databases and synthesised data from 26 studies using the Consolidated Framework for Implementation Research. Attitudes and beliefs about interventions were crucial factors for both staff and service users, with negative attitudes and scepticism resulting in a lack of motivation to engage with interventions or complete them. The complexity of the interventions was a barrier for people with psychiatric symptoms, low premorbid intelligence quotient, or minimal information technology skills. The accessibility and adaptability of interventions were key facilitators, but insufficient resources, finances, and staff time were barriers to implementation. Interventions need to be user friendly and adaptable to the needs and capabilities of people with psychosis or bipolar disorder, and the staff who support their implementation. Service users and staff should cofacilitate the process of developing and implementing the interventions.
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Affiliation(s)
- Golnar Aref-Adib
- Division of Psychiatry, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, London, UK.
| | - Tayla McCloud
- Division of Psychiatry, University College London, London, UK
| | - Jamie Ross
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Puffin O'Hanlon
- Division of Psychiatry, University College London, London, UK
| | - Victoria Appleton
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
| | - Sarah Rowe
- Division of Psychiatry, University College London, London, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, London, UK
| | - Fiona Lobban
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
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Baumel A, Tinkelman A, Mathur N, Kane JM. Digital Peer-Support Platform (7Cups) as an Adjunct Treatment for Women With Postpartum Depression: Feasibility, Acceptability, and Preliminary Efficacy Study. JMIR Mhealth Uhealth 2018; 6:e38. [PMID: 29439944 PMCID: PMC5829455 DOI: 10.2196/mhealth.9482] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/25/2017] [Accepted: 01/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background Peer support is considered to be an important framework of support for mothers experiencing postpartum depression (PPD); however, some barriers exist that may limit its use including peer availability and mothers’ lack of time due to child care. Objective This non-randomized study was designed to examine the feasibility, acceptance, and preliminary clinical outcomes of using 7 Cups of Tea (7Cups), a digital platform that delivers self-help tools and 24/7 emotional support delivered by trained volunteers, as an adjunct treatment for mothers diagnosed with PPD. Methods Mothers with PPD were referred during intake to the study coach who provided guidance about 7Cups. 7Cups features included self-help tools and chats with trained volunteers who had experienced a perinatal mood disorder in their past. Acceptability was measured by examining self-reports and user engagement with the program. The primary outcome was the Edinburgh Postnatal Depression Scale (EPDS) change score between pre- and postintervention at 2 months, as collected in usual care by clinicians blinded to the study questions. Using a propensity score matching to control for potential confounders, we compared women receiving 7Cups to women receiving treatment as usual (TAU). Results Participants (n=19) proactively logged into 7Cups for a median of 12 times and 175 minutes. Program use was mostly through the mobile app (median of mobile use 94%) and between 18:00 and 08:00 when clinicians are unavailable (68% of total program use time). Participants chatted with volunteers for a total of 3064 minutes and have indicated in their responses 0 instances in which they felt unsafe. Intent-to-treat analysis revealed that 7Cups recipients experienced significant decreases in EPDS scores (P<.001, Cohen d=1.17). No significant difference in EPDS decrease over time was found between 7Cups and TAU, yet the effect size was medium favoring 7Cups (P=.05, Cohen d=0.58). Conclusions This study supports using a computerized method to train lay people, without any in-person guidance or screening, and engage them with patients diagnosed with mental illness as part of usual care. The medium effect size (d=0.58) favoring the 7Cups group relative to TAU suggests that 7Cups might enhance treatment outcomes. A fully powered trial has to be conducted to examine this effect.
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Affiliation(s)
- Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel.,Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Amanda Tinkelman
- Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Nandita Mathur
- Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - John M Kane
- Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, United States
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10
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Hoermann S, McCabe KL, Milne DN, Calvo RA. Application of Synchronous Text-Based Dialogue Systems in Mental Health Interventions: Systematic Review. J Med Internet Res 2017; 19:e267. [PMID: 28784594 PMCID: PMC5595406 DOI: 10.2196/jmir.7023] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/05/2017] [Accepted: 05/16/2017] [Indexed: 01/04/2023] Open
Abstract
Background Synchronous written conversations (or “chats”) are becoming increasingly popular as Web-based mental health interventions. Therefore, it is of utmost importance to evaluate and summarize the quality of these interventions. Objective The aim of this study was to review the current evidence for the feasibility and effectiveness of online one-on-one mental health interventions that use text-based synchronous chat. Methods A systematic search was conducted of the databases relevant to this area of research (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Central, Scopus, EMBASE, Web of Science, IEEE, and ACM). There were no specific selection criteria relating to the participant group. Studies were included if they reported interventions with individual text-based synchronous conversations (ie, chat or text messaging) and a psychological outcome measure. Results A total of 24 articles were included in this review. Interventions included a wide range of mental health targets (eg, anxiety, distress, depression, eating disorders, and addiction) and intervention design. Overall, compared with the waitlist (WL) condition, studies showed significant and sustained improvements in mental health outcomes following synchronous text-based intervention, and post treatment improvement equivalent but not superior to treatment as usual (TAU) (eg, face-to-face and telephone counseling). Conclusions Feasibility studies indicate substantial innovation in this area of mental health intervention with studies utilizing trained volunteers and chatbot technologies to deliver interventions. While studies of efficacy show positive post-intervention gains, further research is needed to determine whether time requirements for this mode of intervention are feasible in clinical practice.
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Affiliation(s)
- Simon Hoermann
- Positive Computing Laboratory, School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia
| | - Kathryn L McCabe
- Positive Computing Laboratory, School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia.,Psychiatry and Behavioral Sciences, University of California, Davis, CA, United States
| | - David N Milne
- Positive Computing Laboratory, School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia
| | - Rafael A Calvo
- Positive Computing Laboratory, School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia
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Ben-Zeev D, Fathy C, Jonathan G, Abuharb B, Brian RM, Kesbeh L, Abdelkader S. mHealth for mental health in the Middle East: Need, technology use, and readiness among Palestinians in the West Bank. Asian J Psychiatr 2017; 27:1-4. [PMID: 28558877 DOI: 10.1016/j.ajp.2017.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/19/2017] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
Abstract
Palestinians in the West Bank are at heightened risk for mental health problems. Limited availability of clinicians and a host of geopolitical, topographical, and infrastructural challenges create significant regional barriers to clinic-based care. The objective of this study was to examine whether mHealth approaches that leverage mobile phones for remote mental health treatment may be viable alternatives. We surveyed 272 Palestinian adults in urban, rural, and refugee camp settings. Most participants (93.4%) reported owning mobile phones. The penetration of mobile devices was high across all study sites. Males and females did not differ in their access to this resource. Among mobile phone owners, 79.9% had smartphones, 32.2% had basic mobile phones, and 12.2% owned both. Respondents reported having reliable access to electricity (99.6%) and Wi-Fi (80.9%). Almost all mobile phone owners (99.6%) reported using social media such as Facebook, WhatsApp, or Twitter. When asked to estimate the prevalence of mental health problems in the region, 61.4% of participants reported that over half of the people in their communities struggled with depression, posttraumatic stress, or auditory hallucinations. Most participants indicated that they would personally be interested in mHealth for Mental Health options such as bi-directional texting with clinicians (68.8%), smartphone applications (66.5%), unidirectional support texts (64.7%), or web-based interventions (64.0%). Given the Palestinian populations' broad access to technology and technological infrastructure, need for care, and openness to engage in mobile interventions, mHealth should be considered a promising strategy for mental health services in the West Bank.
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Affiliation(s)
- Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle WA, USA; Departments of Psychiatry and Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Hanover NH, USA.
| | | | - Geneva Jonathan
- Departments of Psychiatry and Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Hanover NH, USA
| | | | - Rachel M Brian
- Departments of Psychiatry and Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Hanover NH, USA
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Villani M, Kovess-Masfety V. How Do People Experiencing Schizophrenia Spectrum Disorders or Other Psychotic Disorders Use the Internet to Get Information on Their Mental Health? Literature Review and Recommendations. JMIR Ment Health 2017; 4:e1. [PMID: 28049620 PMCID: PMC5241504 DOI: 10.2196/mental.5946] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/23/2016] [Accepted: 11/25/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Studies show that the Internet has become an influential source of information for people experiencing serious psychiatric conditions such as schizophrenia spectrum disorders or other psychotic disorders, among which the rate of Internet users is growing, with rates ranging from 33.3% to 79.5% given the country. Between 20.5% and 56.4% of these Internet users seek mental health information. OBJECTIVE Focusing on this population's Web searches about their mental health, this paper examines what type of content they look for and what could be the benefits and disadvantages of this navigation. METHODS We conducted a literature review through medical and psychological databases between 2000 and 2015 using the keywords "Internet," "Web," "virtual," "health information," "schizophrenia," "psychosis," "e-mental health," "e-support," and "telepsychiatry." RESULTS People experiencing schizophrenia spectrum disorders or other psychotic disorders wish to find on the Internet trustful, nonstigmatizing information about their disease, flexibility, security standards, and positive peer-to-peer exchanges. E-mental health also appears to be desired by a substantial proportion of them. In this field, the current developments towards intervention and early prevention in the areas of depression and bipolar and anxiety disorders become more and more operational for schizophrenia spectrum disorders and other psychotic disorders as well. The many benefits of the Internet as a source of information and support, such as empowerment, enhancement of self-esteem, relief from peer information, better social interactions, and more available care, seem to outbalance the difficulties. CONCLUSIONS In this paper, after discussing the challenges related to the various aspects of the emergence of the Internet into the life of people experiencing schizophrenia spectrum disorders or other psychotic disorders, we will suggest areas of future research and practical recommendations for this major transition.
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Affiliation(s)
- Murielle Villani
- Fondation Pierre Deniker, Paris, France.,Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Boulogne-Billancourt, France
| | - Viviane Kovess-Masfety
- Fondation Pierre Deniker, Paris, France.,Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Boulogne-Billancourt, France.,École des Hautes Études en Santé Publique, Paris, France
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Making the Case for a Feasible Evaluation Method of Available E-Mental Health Products. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 45:1-4. [DOI: 10.1007/s10488-016-0764-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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