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Hsu JH, Wu CH, Lin ECL, Chen PS. MoodSensing: A smartphone app for digital phenotyping and assessment of bipolar disorder. Psychiatry Res 2024; 334:115790. [PMID: 38401488 DOI: 10.1016/j.psychres.2024.115790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/29/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Daily life tracking has proven to be of great help in the assessment of patients with bipolar disorder. Although there are many smartphone apps for tracking bipolar disorder, most of them lack academic verification, privacy policy and long-term maintenance. METHODS Our developed app, MoodSensing, aims to collect users' digital phenotyping for assessment of bipolar disorder. The data collection was approved by the Institutional Review Board. This study collaborated with professional clinicians to ensure that the app meets both clinical needs and user experience requirements. Based on the collected digital phenotyping, deep learning techniques were applied to forecast participants' weekly HAM-D and YMRS scale scores. RESULTS In experiments, the data collected by our app can effectively predict the scale scores, reaching the mean absolute error of 0.84 and 0.22 on the scales. The statistical data also demonstrate the increase in user engagement. CONCLUSIONS Our analysis reveals that the developed MoodSensing app can not only provide a good user experience, but also the recorded data have certain discriminability for clinical assessment. Our app also provides relevant policies to protect user privacy, and has been launched in the Apple Store and Google Play Store.
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Affiliation(s)
- Jia-Hao Hsu
- Department of Computer Science and Information Engineering, National Cheng Kung University, Taiwan
| | - Chung-Hsien Wu
- Department of Computer Science and Information Engineering, National Cheng Kung University, Taiwan.
| | | | - Po-See Chen
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Taiwan
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Giroux EE, Athanasopoulos P, Sweet SN, Gainforth HL. A case study of using community-based consensus methods to facilitate shared decision-making among a spinal cord injury network. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1335467. [PMID: 38434234 PMCID: PMC10904660 DOI: 10.3389/fresc.2024.1335467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024]
Abstract
Spinal cord injury (SCI) research and policy decisions are rarely made in partnership with people with SCI, making them less relevant, applicable, and used by those whom the decisions are intended to support. Across disciplines, consensus methods have been promoted as a viable solution for supporting shared research and policy-based decision-making. In this paper, we describe a partnered approach between academic researchers and the Ontario SCI Alliance, a non-profit, SCI community mobilization network to co-develop and co-disseminate a community-based consensus exercise. The community-based consensus exercise included two modified Delphi surveys and one in-person retreat. The partnership's goal with this exercise was to facilitate shared decision-making for the development of their upcoming strategic plan. We then interviewed partners and participants from the Delphi and in-person retreat to discuss successes, challenges, and lessons learned from the exercise. Survey 1 was disseminated to over 2,500 members of the Ontario SCI community and received 374 responses (276 coming from people with SCI). Survey 2 had 118 responses, with 87 coming from people with SCI. The retreat had 73 attendees, including people with SCI, family/friends of people with SCI, clinicians, researchers, and SCI community and research organization staff/volunteers. The retreat included a presentation of the survey results, a clinician/researcher panel, and externally-facilitated working groups. All survey responses and retreat materials were synthesized. Using the synthesized feedback, the Ontario SCI Alliance was able to implement several changes for the Ontario SCI community, including higher-quality primary care experiences (reduced wait times, more accessible examining rooms), the development of a wound care strategy with the Ontario government, and an advocacy campaign for public coverage for catheters and urinary care supplies. From the five interviews conducted, five themes were co-constructed regarding the successes, challenges, and lessons learned from the exercise: (1) Inclusion, Diversity, Equity, and Accessibility; (2) Partnership; (3) Design Considerations; (4) Transparency and Clarity in Communication; and (5) Sustainability. Findings from this community case study demonstrate the feasibility of conducting a community-level consensus exercise among an equity-deserving group while providing detailed guidance for how to ensure future research and policy-based decision-making is shared across diverse knowledge users.
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Affiliation(s)
- Emily E. Giroux
- Centre for Health Behaviour Change, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Peter Athanasopoulos
- Department of Public Policy and Government Relations, Spinal Cord Injury Ontario, Toronto, ON, Canada
| | - Shane N. Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, QC, Canada
| | - Heather L. Gainforth
- Centre for Health Behaviour Change, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
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Thomas E, Benjamin-Thomas TE, Sithambaram A, Shankar J, Chen SP. Participatory Action Research Among People With Serious Mental Illness: A Scoping Review. QUALITATIVE HEALTH RESEARCH 2024; 34:3-19. [PMID: 37929751 PMCID: PMC10714715 DOI: 10.1177/10497323231208111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Participatory action research (PAR) is a research approach that creates spaces for marginalized individuals and communities to be co-researchers to guide relevant social change. While working toward social transformation, all members of the PAR team often experience personal transformation. Engaging people with serious mental illness (PSMI) in PAR helps them to develop skills and build relationships with stakeholders in their communities. It supports positive changes that persist after the completion of the formal research project. With the increasing recognition of PAR's value in PSMI, it is helpful to consider the challenges and advantages of this approach to research with this population. This review aimed at determining how PAR has been conducted with PSMI and at summarizing strategies used to empower PSMI as co-researchers by engaging them in research. This scoping review followed five steps Arkesy and O'Malley (2005) outlined. We charted, collated, and summarized relevant information from 87 studies that met the inclusion criteria. We identified five strategies to empower PSMI through PAR. These are to build capacity, balance power distribution, create collaborative environments, promote peer support, and enhance their engagement as co-researchers. In conclusion, PAR is an efficient research approach to engage PSMI. Further, PSMI who engage in PAR may benefit from strategies for empowerment that meet their unique needs as co-researchers.
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Affiliation(s)
- Elizabethmary Thomas
- Faculty of Rehabilitation Medicine, College of Health Sciences University of Alberta, Edmonton, AB, Canada
| | | | - Abirame Sithambaram
- Department of Occupational Therapy, Rocky Mountain University of Health Professions (Online program), Colombo, Sri Lanka
| | - Janki Shankar
- Faculty of Social Work, University of Calgary, Edmonton, AB, Canada
| | - Shu-Ping Chen
- Faculty of Rehabilitation Medicine, College of Health Sciences University of Alberta, Edmonton, AB, Canada
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Keramatian K, Morton E, Levit A, Nunez JJ. Evidence of factors influencing delays in the diagnosis and treatment of bipolar disorder in adolescents and young adults. Protocol for a systematic scoping review. PLoS One 2023; 18:e0292923. [PMID: 37976281 PMCID: PMC10655988 DOI: 10.1371/journal.pone.0292923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/02/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Bipolar Disorder (BD) is a complex psychiatric condition that typically manifests during late adolescence and early adulthood. Over the past two decades, international studies have reported that BD often goes unrecognized and untreated for several years, which can lead to negative clinical and functional outcomes. However, the components of delay in the diagnosis and treatment of BD and various factors influencing those components have not been systematically explored. OBJECTIVES The scoping review described in this protocol aims to map the existing literature on potential factors that influence delays in the treatment of BD in adolescents and young adults, in order to identify the knowledge gaps and future research and policy priorities. METHODS This protocol for a systematic scoping review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline (PRISMA-ScR). We will search the electronic databases of MEDLINE (OVID), EMBASE, PsycINFO and CINAHL for peer-reviewed primary research articles published in academic journals. Grey literature will not be explored due to resource limitations. A conceptual framework based on the Model of Pathways to Treatment by Scott and colleagues was used as a foundation for our search and extraction strategy to ensure all components of delay and potential factors influencing each component are explored. Two independent reviewers will screen the references retrieved by the literature search and select relevant studies based on our inclusion criteria. The data from included studies will be synthesized into a narrative summary, and implications for future research, practice and policy will be discussed. DISCUSSION To the best of our knowledge, this will be the first scoping review to explore the potential factors that influence delays in the treatment of BD in adolescents and young adults. We intend to disseminate the review results through academic conferences and publication in a peer-reviewed journal.
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Affiliation(s)
- Kamyar Keramatian
- Department of Psychiatry, University of British Columbia, Wesbrook Mall, Vancouver, BC, Canada
- Coastal Early Psychosis Intervention Program, North Vancouver, British Columbia
- Mood Disorders Clinic, Djawad Movafighan Centre for Brain Health, Vancouver, British Columbia
| | - Emma Morton
- School of Psychological Sciences, Monash University, Monash, Australia
| | - Alexander Levit
- Department of Psychiatry, University of British Columbia, Wesbrook Mall, Vancouver, BC, Canada
| | - John-Jose Nunez
- Department of Psychiatry, University of British Columbia, Wesbrook Mall, Vancouver, BC, Canada
- Mood Disorders Clinic, Djawad Movafighan Centre for Brain Health, Vancouver, British Columbia
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Farr J, Rhodes JE, Smith JA. Recovering from first episode psychotic mania: The experience of people diagnosed with bipolar disorder. Early Interv Psychiatry 2023; 17:807-813. [PMID: 36646667 DOI: 10.1111/eip.13377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/12/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
AIM Early intervention for people diagnosed with bipolar disorder is a priority, but little is known about how recovery from first episode psychotic mania is experienced by this group. This study aimed to explore the experience of recovery from first episode psychotic mania for people diagnosed with bipolar disorder. METHODS Semi-structured interviews were conducted with 11 young adults during recovery from first episode psychotic mania and were analysed using Interpretative Phenomenological Analysis. RESULTS Three themes were identified: (i) 'Possession of purpose and staying well', (ii) 'Coping with compromise' and (iii) 'Manic relapse: pressure and proving self'. On becoming well, the participants experienced a sense of purpose through engaging with activities and goals that also drove their efforts to engage in strategies to stay well. However, these strategies created feelings of compromise that not all were prepared to accept. Though having purpose and goals created a positive sense of direction, for a minority of the participants they also created additional pressure, contributing to manic relapse. CONCLUSIONS The purpose created by engaging with aspirations and career-related activities during early intervention was found to be important for a meaningful recovery from first episode bipolar disorder. This instilled positivity and purpose, motivating efforts to maintain wellness. The feelings of compromise that some participants experienced point to the need for individually tailored interventions. Findings suggest a delicate relationship between the positivity of engaging in goals and the risk of manic relapse during recovery from first episode psychotic mania.
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Affiliation(s)
- Joanna Farr
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - John E Rhodes
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Jonathan A Smith
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
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Goulding EH, Dopke CA, Rossom R, Jonathan G, Mohr D, Kwasny MJ. Effects of a Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder on Relapse, Symptom Burden, and Quality of Life: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:109-118. [PMID: 36542401 PMCID: PMC9857325 DOI: 10.1001/jamapsychiatry.2022.4304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
Importance Bipolar disorder-specific psychotherapy combined with pharmacotherapy improves relapse risk, symptom burden, and quality of life, but psychotherapy is not easily accessible. Objective To determine if a smartphone-based self-management intervention (LiveWell) can assist individuals with bipolar disorder to maintain wellness. Design, Setting, and Participants An assessor-blind randomized clinical trial enrolled participants from March 20, 2017, to April 25, 2019, with 48-week follow-up ending on April 10, 2020. Participants were randomly assigned to usual care or usual care plus the smartphone intervention stratified by relapse risk based on initial clinical status (low risk: asymptomatic recovery; high risk: continued symptomatic, prodromal, recovering, symptomatic recovery). Participants with bipolar disorder I were recruited from clinics in the Chicago and Minneapolis-Saint Paul areas. Data were analyzed from June 19, 2020, to May 25, 2022. Interventions The smartphone-based self-management intervention consisted of an application (app), coach, and website. Over 16 weeks, participants had a coach visit followed by 6 phone calls, and they completed daily and weekly app check-ins. The app provided adaptive feedback and information for developing a personalized wellness plan, the coach provided support, and the website provided summary data and alerts. Main Outcomes and Measures The primary outcome was time to relapse. Secondary outcomes were percentage-time symptomatic, symptom severity, and quality of life. Results Of the 205 randomized participants (mean [SD] age, 42 [12] years; 125 female individuals [61%]; 5 Asian [2%], 21 Black [10%], 13 Hispanic or Latino [6%], 7 multiracial [3%], 170 White [83%], 2 unknown race [1%]), 81 (40%) were randomly assigned to usual care, and 124 (60%) were randomly assigned to usual care plus the smartphone intervention. This clinical trial did not detect a reduction in relapse risk for the smartphone intervention (hazard ratio [HR], 0.65; 95% CI, 0.39-1.09; log-rank P = .08). However, decreased relapse was observed for low-risk individuals (HR, 0.32; 95% CI, 0.12-0.88; log-rank P = .02) but not high-risk individuals (HR, 0.86; 95% CI, 0.47-1.57; log-rank P = .62). Reduced manic symptom severity was observed for low-risk individuals (mean [SE] difference, -1.4 [0.4]; P = .001) but not for high-risk individuals (mean [SE] difference, 0 [0.3]; P = .95). The smartphone-based self-management intervention decreased depressive symptom severity (mean [SE] difference, -0.80 [0.34]; P = .02) and improved relational quality of life (mean [SE] difference, 1.03 [0.45]; P = .02) but did not decrease percentage-time symptomatic (mean [SE] difference, -5.6 [4.3]; P = .20). Conclusions and Relevance This randomized clinical trial of a smartphone-based self-management intervention did not detect a significant improvement in the primary outcome of time to relapse. However, a significant decrease in relapse risk was observed for individuals in asymptomatic recovery. In addition, the intervention decreased depressive symptom severity and improved relational quality of life. These findings warrant further work to optimize the smartphone intervention and confirm that the intervention decreases relapse risk for individuals in asymptomatic recovery. Trial Registration ClinicalTrials.gov Identifier: NCT03088462.
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Affiliation(s)
- Evan H. Goulding
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia A. Dopke
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Geneva Jonathan
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David Mohr
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Mary J. Kwasny
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Facilitators and Barriers of Medication Adherence Based on Beliefs of Persons with Bipolar Disorder: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137633. [PMID: 35805291 PMCID: PMC9265403 DOI: 10.3390/ijerph19137633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022]
Abstract
One of the big challenges in treating individuals with bipolar disorder (BD) is nonadherence to medication. This is the principal factor associated with a worse prognosis or outcome of the disease. This study aimed to explore and analyze the individual perceptions that people with BD have about the positive and negative aspects when taking medication. A descriptive and interpretative study was carried out using the qualitative research paradigm with the use of the analytical technique of discourse analysis, extracting the data through the completion of focus groups. Participants’ speech was digitally audio-recorded in digital format. In order to complete the codification of the participants’ speech content, we relied on the qualitative data analysis (using the QRS NVivo 10 computer software). Thirty-six participants diagnosed with bipolar disorder took part in our study. In the participants’ speech concerning the main barriers to pharmacological treatment, three key topics were identified. Perceived facilitators were summarized in four factors. The main facilitators regarding the use of pharmacological treatment in individuals with BD were the ones related with the perceived need for treatment in the acute phase, the recognition of the illness, the shared clinical decision, and the causal biological attribution in the chronic phase. In terms of perceived barriers, social control was identified in both phases, adverse effects in the acute phase, and the absence of effective treatment in the chronic state.
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Duea SR, Zimmerman EB, Vaughn LM, Dias S, Harris J. A Guide to Selecting Participatory Research Methods Based on Project and Partnership Goals. JOURNAL OF PARTICIPATORY RESEARCH METHODS 2022; 3. [PMID: 35799626 PMCID: PMC9258244 DOI: 10.35844/001c.32605] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Participatory research engages community stakeholders in the research process, from problem identification and developing the research question, to dissemination of results. There is increasing recognition in the field of health research that community-engaged methods can be used throughout the research process. The volume of guidance for engaging communities and conducting participatory research has grown steadily in the past 40+ years, in many countries and contexts. Further, some institutions now require stakeholder engagement in research as a condition of funding. Interest in collaborating in the research process is also growing among patients and the public. This article provides an overview for selecting participatory research methods based on project and partnerships goals.
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Affiliation(s)
| | | | - Lisa M. Vaughn
- Cincinnati Children's Hospital Medical Center/University of Cincinnati
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Morton E, Nicholas J, Yang L, Lapadat L, Barnes SJ, Provencher MD, Depp C, Chan M, Kulur R, Michalak EE. Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management. Int J Bipolar Disord 2022; 10:10. [PMID: 35368207 PMCID: PMC8977125 DOI: 10.1186/s40345-022-00256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Individuals with bipolar disorder (BD) are increasingly turning to smartphone applications (apps) for health information and self-management support. While reviews have raised concerns regarding the effectiveness and safety of publicly available apps for BD, apps surveyed may not reflect what individuals with BD are using. The present study had two aims: first, to characterize the use of health apps to support mood and sleep amongst people with BD, and second, to evaluate the quality, safety and functionality of the most commonly used self-management apps. Methods A web-based survey was conducted to explore which apps people with BD reported using to support self-management of mood and sleep. The characteristics of the most commonly nominated apps were described using a standardized framework, including their privacy policy, clinical foundations, and functionality. Results Respondents (n = 919) were 77.9% female with a mean age of 36.9 years. 41.6% of participants (n = 382) reported using a self-management app to support mood or sleep. 110 unique apps were nominated in relation to mood, and 104 unique apps nominated in relation to sleep; however, most apps were only mentioned once. The nine most frequently nominated apps related to mood and sleep were subject to further evaluation. All reviewed apps offered a privacy policy, however user control over data was limited and the complexity of privacy policies was high. Only one app was developed for BD populations. Half of reviewed apps had published peer-reviewed evidence to support their claims of efficacy, but little research was specific to BD. Conclusion Findings illustrate the potential of smartphone apps to increase the reach of psychosocial interventions amongst people with BD. Apps were largely created by commercial developers and designed for the general population, highlighting a gap in the development and dissemination of evidence-informed apps for BD. There may be risks in using generic health apps for BD self-management; clinicians should enquire about patients’ app use to foster conversations about their particular benefits and limitations. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00256-6.
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Goulding EH, Dopke CA, Rossom RC, Michaels T, Martin CR, Ryan C, Jonathan G, McBride A, Babington P, Bernstein M, Bank A, Garborg CS, Dinh JM, Begale M, Kwasny MJ, Mohr DC. A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Empirical and Theoretical Framework, Intervention Design, and Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e30710. [PMID: 35188473 PMCID: PMC8902672 DOI: 10.2196/30710] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 12/18/2022] Open
Abstract
Background Bipolar disorder is a severe mental illness with high morbidity and mortality rates. Even with pharmacological treatment, frequent recurrence of episodes, long episode durations, and persistent interepisode symptoms are common and disruptive. Combining psychotherapy with pharmacotherapy improves outcomes; however, many individuals with bipolar disorder do not receive psychotherapy. Mental health technologies can increase access to self-management strategies derived from empirically supported bipolar disorder psychotherapies while also enhancing treatment by delivering real-time assessments, personalized feedback, and provider alerts. In addition, mental health technologies provide a platform for self-report, app use, and behavioral data collection to advance understanding of the longitudinal course of bipolar disorder, which can then be used to support ongoing improvement of treatment. Objective A description of the theoretical and empirically supported framework, design, and protocol for a randomized controlled trial (RCT) of LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder, is provided to facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar disorder. The goal of the trial is to determine the effectiveness of LiveWell for reducing relapse risk and symptom burden as well as improving quality of life (QOL) while simultaneously clarifying behavioral targets involved in staying well and better characterizing the course of bipolar disorder and treatment response. Methods The study is a single-blind RCT (n=205; 2:3 ratio of usual care vs usual care plus LiveWell). The primary outcome is the time to relapse. Secondary outcomes are percentage time symptomatic, symptom severity, and QOL. Longitudinal changes in target behaviors proposed to mediate the primary and secondary outcomes will also be determined, and their relationships with the outcomes will be assessed. A database of clinical status, symptom severity, real-time self-report, behavioral sensor, app use, and personalized content will be created to better predict treatment response and relapse risk. Results Recruitment and screening began in March 2017 and ended in April 2019. Follow-up ended in April 2020. The results of this study are expected to be published in 2022. Conclusions This study will examine whether LiveWell reduces relapse risk and symptom burden and improves QOL for individuals with bipolar disorder by increasing access to empirically supported self-management strategies. The role of selected target behaviors (medication adherence, sleep duration, routine, and management of signs and symptoms) in these outcomes will also be examined. Simultaneously, a database will be created to initiate the development of algorithms to personalize and improve treatment for bipolar disorder. In addition, we hope that this description of the theoretical and empirically supported framework, intervention design, and study protocol for the RCT of LiveWell will facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar and other mental health disorders. Trial Registration ClinicalTrials.gov NCT03088462; https://www.clinicaltrials.gov/ct2/show/NCT03088462 International Registered Report Identifier (IRRID) DERR1-10.2196/30710
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Affiliation(s)
- Evan H Goulding
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia A Dopke
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Tania Michaels
- Department of Psychiatry, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Clair R Martin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Chloe Ryan
- Carolina Outreach, Durham, NC, United States
| | - Geneva Jonathan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alyssa McBride
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Pamela Babington
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Mary Bernstein
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Andrew Bank
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - C Spencer Garborg
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | | | - Mary J Kwasny
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David C Mohr
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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11
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Goulding EH, Dopke CA, Michaels T, Martin CR, Khiani MA, Garborg C, Karr C, Begale M. A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Protocol Development for an Expert System to Provide Adaptive User Feedback. JMIR Form Res 2021; 5:e32932. [PMID: 34951598 PMCID: PMC8742209 DOI: 10.2196/32932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Bipolar disorder is a severe mental illness that results in significant morbidity and mortality. While pharmacotherapy is the primary treatment, adjunctive psychotherapy can improve outcomes. However, access to therapy is limited. Smartphones and other technologies can increase access to therapeutic strategies that enhance self-management while simultaneously augmenting care by providing adaptive delivery of content to users as well as alerts to providers to facilitate clinical care communication. Unfortunately, while adaptive interventions are being developed and tested to improve care, information describing the components of adaptive interventions is often not published in sufficient detail to facilitate replication and improvement of these interventions. OBJECTIVE To contribute to and support the improvement and dissemination of technology-based mental health interventions, we provide a detailed description of the expert system for adaptively delivering content and facilitating clinical care communication for LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder. METHODS Information from empirically supported psychotherapies for bipolar disorder, health psychology behavior change theories, and chronic disease self-management models was combined with user-centered design data and psychiatrist feedback to guide the development of the expert system. RESULTS Decision points determining the timing of intervention option adaptation were selected to occur daily and weekly based on self-report data for medication adherence, sleep duration, routine, and wellness levels. These data were selected for use as the tailoring variables determining which intervention options to deliver when and to whom. Decision rules linking delivery of options and tailoring variable thresholds were developed based on existing literature regarding bipolar disorder clinical status and psychiatrist feedback. To address the need for treatment adaptation with varying clinical statuses, decision rules for a clinical status state machine were developed using self-reported wellness rating data. Clinical status from this state machine was incorporated into hierarchal decision tables that select content for delivery to users and alerts to providers. The majority of the adaptive content addresses sleep duration, medication adherence, managing signs and symptoms, building and utilizing support, and keeping a regular routine, as well as determinants underlying engagement in these target behaviors as follows: attitudes and perceptions, knowledge, support, evaluation, and planning. However, when problems with early warning signs, symptoms, and transitions to more acute clinical states are detected, the decision rules shift the adaptive content to focus on managing signs and symptoms, and engaging with psychiatric providers. CONCLUSIONS Adaptive mental health technologies have the potential to enhance the self-management of mental health disorders. The need for individuals with bipolar disorder to engage in the management of multiple target behaviors and to address changes in clinical status highlights the importance of detailed reporting of adaptive intervention components to allow replication and improvement of adaptive mental health technologies for complex mental health problems.
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Affiliation(s)
- Evan H Goulding
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia A Dopke
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tania Michaels
- Deparment of Pediatrics, Loma Linda Children's Hospital, Loma Linda, CA, United States
| | - Clair R Martin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Christopher Garborg
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Chris Karr
- Audacious Software, Chicago, IL, United States
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Jonathan GK, Dopke CA, Michaels T, Martin CR, Ryan C, McBride A, Babington P, Goulding EH. A Smartphone-Based Self-Management Intervention for Individuals with Bipolar Disorder (LiveWell): Qualitative Study on User Experiences of the Behavior Change Process. JMIR Ment Health 2021; 8:e32306. [PMID: 34813488 PMCID: PMC8663488 DOI: 10.2196/32306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bipolar disorder is a severe mental illness characterized by recurrent episodes of depressed, elevated, and mixed mood states. The addition of psychotherapy to pharmacological management can decrease symptoms, lower relapse rates, and improve quality of life; however, access to psychotherapy is limited. Mental health technologies such as smartphone apps are being studied as a means to increase access to and enhance the effectiveness of adjunctive psychotherapies for bipolar disorder. Individuals with bipolar disorder find this intervention format acceptable, but our understanding of how people utilize and integrate these tools into their behavior change and maintenance processes remains limited. OBJECTIVE The objective of this study was to explore how individuals with bipolar disorder perceive and utilize a smartphone intervention for health behavior change and maintenance. METHODS Individuals with bipolar disorder were recruited via flyers placed at university-affiliated and private outpatient mental health practices to participate in a pilot study of LiveWell, a smartphone-based self-management intervention. At the end of the study, all participants completed in-depth qualitative exit interviews. The behavior change framework developed to organize the intervention design was used to deductively code behavioral targets and determinants involved in target engagement. Inductive coding was used to identify themes not captured by this framework. RESULTS In terms of behavioral targets, participants emphasized the importance of managing mood episode-related signs and symptoms. They also discussed the importance of maintaining regular routines, sleep duration, and medication adherence. Participants emphasized that receiving support from a coach as well as seeking and receiving assistance from family, friends, and providers were important for managing behavioral targets and staying well. In terms of determinants, participants stressed the important role of monitoring for their behavior change and maintenance efforts. Monitoring facilitated self-awareness and reflection, which was considered valuable for staying well. Some participants also felt that the intervention facilitated learning information necessary for managing bipolar disorder but others felt that the information provided was too basic. CONCLUSIONS In addition to addressing acceptability, satisfaction, and engagement, a person-based design of mental health technologies can be used to understand how people experience the impact of these technologies on their behavior change and maintenance efforts. This understanding may then be used to guide ongoing intervention development. The participants' perceptions aligned with the intervention's primary behavioral targets and use of a monitoring tool as a core intervention feature. Participant feedback further indicates that developing additional content and tools to address building and engaging social support may be an important avenue for improving LiveWell. A comprehensive behavior change framework to understand participant perceptions of their behavior change and maintenance efforts may help facilitate ongoing intervention development.
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Affiliation(s)
- Geneva K Jonathan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia A Dopke
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tania Michaels
- Department of Pediatrics, Loma Linda Children's Hospital, Loma Linda, CA, United States
| | - Clair R Martin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Chloe Ryan
- Department of Social Work, UPMC Western Psychiatric Hospital, Pittsburgh, PA, United States
| | - Alyssa McBride
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Pamela Babington
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Evan H Goulding
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Towards tailored psychosocial intervention for BD-II: Lived experience perspectives on current and future management options. J Affect Disord 2021; 289:110-116. [PMID: 33975089 DOI: 10.1016/j.jad.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/29/2021] [Accepted: 04/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite its significant morbidity and mortality, very little is known about how those with lived experience of bipolar II disorder (BD-II) manage their condition. This study sought to understand unmet needs in currently available psychosocial treatments, explore self-management strategies (SMS) that individuals with BD-II currently use, and determine the potential role of digital mental health interventions in this space. METHODS Individuals (aged 18-65) confirming they had received a diagnosis of BD-II from a mental health professional were invited to complete an online survey about treatments trialled, coping strategies used to manage their condition and perspectives on the role of digital mental interventions. RESULTS Ninety individuals commencing the survey confirmed a diagnosis of BD-II; of these, n = 35 were screened out based on self-reported hospitalisation for mania and/or experiencing a manic episode. A final sample of n = 55 was subsequently analysed. From the perspective of those with BD-II, current psychosocial treatments fall short in terms of meeting their specific needs. Tailored psychosocial interventions delivered by clinicians with BD-II expertise are sought after, however accessibility and cost are ongoing barriers. Participants were open to digital self-management interventions however uptake was limited. In terms of self-management, actively seeking external help was perceived as most helpful for stopping progression in depression, while self-care strategies were prioritised for hypomania. LIMITATIONS The study had several limitations: (1) BD-II diagnoses were not formally verified via standardised diagnostic interview, (2) Borderline personality disorder and comorbid substance abuse disorders were not assessed; (3) the influence of current mood state on participant responses was not assessed, (4) females were over-represented, limiting generalisation of findings to males with BD-II. CONCLUSIONS Study findings highlight the need for tailored interventions paying specific attention to nuanced features of BD-II, and the potential role of digital mental health interventions for this underserved group.
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Jonathan GK, Dopke CA, Michaels T, Bank A, Martin CR, Adhikari K, Krakauer RL, Ryan C, McBride A, Babington P, Frauenhofer E, Silver J, Capra C, Simon M, Begale M, Mohr DC, Goulding EH. A Smartphone-Based Self-management Intervention for Bipolar Disorder (LiveWell): User-Centered Development Approach. JMIR Ment Health 2021; 8:e20424. [PMID: 33843607 PMCID: PMC8076988 DOI: 10.2196/20424] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/13/2020] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bipolar disorder is a serious mental illness that results in significant morbidity and mortality. Pharmacotherapy is the primary treatment for bipolar disorder; however, adjunctive psychotherapy can help individuals use self-management strategies to improve outcomes. Yet access to this therapy is limited. Smartphones and other technologies have the potential to increase access to therapeutic strategies that enhance self-management while simultaneously providing real-time user feedback and provider alerts to augment care. OBJECTIVE This paper describes the user-centered development of LiveWell, a smartphone-based self-management intervention for bipolar disorder, to contribute to and support the ongoing improvement and dissemination of technology-based mental health interventions. METHODS Individuals with bipolar disorder first participated in a field trial of a simple smartphone app for self-monitoring of behavioral targets. To develop a complete technology-based intervention for bipolar disorder, this field trial was followed by design sessions, usability testing, and a pilot study of a smartphone-based self-management intervention for bipolar disorder. Throughout all phases of development, intervention revisions were made based on user feedback. RESULTS The core of the LiveWell intervention consists of a daily self-monitoring tool, the Daily Check-in. This self-monitoring tool underwent multiple revisions during the user-centered development process. Daily Check-in mood and thought rating scales were collapsed into a single wellness rating scale to accommodate user development of personalized scale anchors. These anchors are meant to assist users in identifying early warning signs and symptoms of impending episodes to take action based on personalized plans. When users identified personal anchors for the wellness scale, the anchors most commonly reflected behavioral signs and symptoms (40%), followed by cognitive (25%), mood (15%), physical (10%), and motivational (7%) signs and symptoms. Changes to the Daily Check-in were also made to help users distinguish between getting adequate sleep and keeping a regular routine. At the end of the pilot study, users reported that the Daily Check-in made them more aware of early warning signs and symptoms and how much they were sleeping. Users also reported that they liked personalizing their anchors and plans and felt this process was useful. Users experienced some difficulties with developing, tracking, and achieving target goals. Users also did not consistently follow up with app recommendations to contact providers when Daily Check-in data suggested they needed additional assistance. As a result, the human support roles for the technology were expanded beyond app use support to include support for self-management and clinical care communication. The development of these human support roles was aided by feedback on the technology's usability from the users and the coaches who provided the human support. CONCLUSIONS User input guided the development of intervention content, technology, and coaching support for LiveWell. Users valued the provision of monitoring tools and the ability to personalize plans for staying well, supporting the role of monitoring and personalization as important features of digital mental health technologies. Users also valued human support of the technology in the form of a coach, and user difficulties with aspects of self-management and care-provider communication led to an expansion of the coach's support roles. Obtaining feedback from both users and coaches played an important role in the development of both the LiveWell technology and human support. Attention to all stakeholders involved in the use of mental health technologies is essential for optimizing intervention development.
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Affiliation(s)
- Geneva K Jonathan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia A Dopke
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tania Michaels
- Pediatrics, Loma Linda Children's Hospital, Loma Linda, CA, United States
| | - Andrew Bank
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Clair R Martin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Krina Adhikari
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Chloe Ryan
- Department of Social Work, UPMC Western Psychiatric Hospital, Pittsburgh, PA, United States
| | - Alyssa McBride
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Pamela Babington
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ella Frauenhofer
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jamilah Silver
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Courtney Capra
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Melanie Simon
- Department of Psychology, School of Science and Engineering, Tulane University, New Orleans, LA, United States
| | | | - David C Mohr
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Evan H Goulding
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Sabatello M, Chen Y, Herrera CF, Brockhoff E, Austin J, Appelbaum PS. Teenagers and Precision Psychiatry: A Window of Opportunity. Public Health Genomics 2021; 24:14-25. [PMID: 33503628 PMCID: PMC7920903 DOI: 10.1159/000512475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 10/16/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Precision medicine raises hope for translating genetic-based knowledge about psychiatric risks into mental health benefits by motivating health-related, risk-reducing behaviors. Teenagers (ages 14-17) are an important age-group to engage in preventive efforts but, their views about psychiatric genetics are understudied. METHOD An online survey with a nationally representative sample of teenagers (n = 417) was conducted. Participants were randomly assigned to receive 1 of 2 handouts, 1 emphasizing the genetic underpinnings of psychiatric conditions; the other agency-oriented and focusing on gene-environment interactions. Survey questions queried their views about behavioral changes in response to psychiatric genetic risk information and expressed willingness to undertake them. Participants' decision-making characteristics (i.e., self-efficacy, empowerment, intolerance of uncertainty, and sensation-seeking) were assessed at baseline. RESULTS Teenagers strongly valued the information provided and its potential usefulness for their mental health. Information about psychiatric genetics alone impacted views about the causes of mental illness. Contrary to our hypothesis, the type of handout did not impact participants' expressed willingness to make behavioral changes to reduce their risk of developing a psychiatric condition, but their sense of empowerment played a key role in their responses. CONCLUSION Educating teenagers about gene-environment interactions may help facilitate the translational efforts of precision psychiatry. Research with teenagers across racial/ethnic groups, especially those with family histories, is needed to better understand the factors that impact teenagers' empowerment in psychiatric genomic settings and to identify measures, including the best enablers of empowerment (e.g., educators, parents), which would allow them to reap the benefits of precision psychiatry.
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Affiliation(s)
- Maya Sabatello
- Department of Medicine, Columbia University, New York, New York, USA,
- Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA,
| | - Ying Chen
- New York State Psychiatric Institute, New York, New York, USA
| | | | | | - Jehannine Austin
- Department of Psychiatry and Medical genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University, New York, New York, USA
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16
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Rodríguez Espinosa P, Sussman A, Pearson CR, Oetzel JG, Wallerstein N. Personal Outcomes in Community-based Participatory Research Partnerships: A Cross-site Mixed Methods Study. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:439-449. [PMID: 32706125 PMCID: PMC7772261 DOI: 10.1002/ajcp.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Community-based participatory research (CBPR) has been embraced by diverse populations to address health inequities within their communities. CBPR has been shown to produce favorable health outcomes, but little is known about personal outcomes (e.g., individual growth and capacities) resulting from the direct involvement in a CBPR partnership. We empirically examine which CBPR partnerships' processes and practices are associated with personal outcomes. We hypothesize that higher levels of collaborative approaches and adherence to CBPR principles and practices would be associated with personal outcomes. Based on a national cross-site CBPR study, Research for Improved Health, we utilized mixed-method data from a comprehensive community-engagement survey (N = 450) and seven in-depth case studies to explore the hypothesized relationships. Our multivariate mixed-effects model revealed the importance of various partnering practices. Relationship dynamics emerged as key predictors including the following: respect in the partnership, voice and influence in decision-making among partners, and stewardship. Qualitative findings highlighted individual, partnership, and community-level impacts, within and beyond the partnership. Our findings have implications for CBPR best practices and highlight the potential role of personal outcomes for partnerships' sustainability, long-term outcomes, and health equity research.
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Affiliation(s)
| | - Andrew Sussman
- Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Cynthia R Pearson
- Indigenous Wellness Research Institute, University of Washington, Seattle, WA, USA
| | - John G Oetzel
- School of Management and Marketing, University of Waikato, Hamilton, New Zealand
| | - Nina Wallerstein
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, NM, USA
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Wynter E, Perich T. Use of self‐care strategies in the management of bipolar disorder and their relationship to symptoms, illness intrusiveness, and quality of life. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Edward Wynter
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia,
| | - Tania Perich
- School of Social Sciences and Psychology, Western Sydney University, Sydney, New South Wales, Australia,
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia,
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18
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Morton E, Murray G. Assessment and treatment of sleep problems in bipolar disorder—A guide for psychologists and clinically focused review. Clin Psychol Psychother 2020; 27:364-377. [DOI: 10.1002/cpp.2433] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Emma Morton
- Department of Psychiatry, Faculty of MedicineUniversity of British Columbia Vancouver British Columbia Canada
- Centre for Mental Health, Faculty of Health, Arts and DesignSwinburne University of Technology Melbourne Victoria Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health, Arts and DesignSwinburne University of Technology Melbourne Victoria Australia
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19
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Raymaker DM, Sale T, Rija M, Buekea N, Caruso N, Melton R, Cohrs N, Gould V, Wall C, Scharer M. Early Assessment and Support Alliance Connections: Community-Based Participatory Research to Develop a Peer-based Early Psychosis Web Resource with Young Adults. Prog Community Health Partnersh 2020; 14:471-480. [PMID: 33416767 DOI: 10.1353/cpr.2020.0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Young adults (YA) who have experienced early psychosis (EP) have valuable information about their recovery process yet are often left out of research. OBJECTIVES We used a community-based participatory research (CBPR) approach in partnership with the Early Assessment and Support Alliance (EASA) EP program and Portland State University to develop a peer-driven, webbased, recovery resource. METHODS We used our CBPR process to collaboratively develop the resource and conducted an iterative usability study to test and refine it. LESSONS LEARNED The resource was well-received and accessible. YA partners emphasize the importance of being prepared to learn about research and one's self, being open to new experiences, and how being co-researchers can help with processing EP experiences for the benefit of one's self and peers. CONCLUSIONS Peer involvement in intervention development may increase usability. It benefits YA and adult coresearchers. We strongly recommend including YA who have experienced EP as co-researchers.
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van den Heuvel SCGH, Goossens PJJ, Terlouw C, Schoonhoven L, van Achterberg T. Self-Management Education for Bipolar Disorders: A Hermeneutic-Phenomenological Study on the Tacit Knowledge of Mental Health Nurses. Issues Ment Health Nurs 2019; 40:942-950. [PMID: 31381457 DOI: 10.1080/01612840.2019.1636166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Self-management of bipolar disorder (BD) education is a complex nursing intervention in which patients and informal caregivers are taught to be actively involved in self-monitoring and self-regulating activities. Some studies question if nurses are sufficiently equipped to deliver these educational tasks. Other studies suggest that nurses have gathered their knowledge implicitly by experience, but to date, this tacit knowledge is not described from the experiences of mental health nurses (MHNs) in ambulant BD care. Objective: To detect the tacit knowledge used by MHNs by interpreting their experiences in delivering self-management education to people with BD and their informal caregivers. Methods: A phenomenological-hermeneutical study amongst MHNs (N = 9) from three ambulant BD care clinics in the Netherlands. Face-to-face, open, in-depth interviews guided by a topic list, were conducted and transcribed verbatim prior to the hermeneutical analysis. Findings: We found five categories resembling the complex character of self-management interventions provided by MHNs: Building a trustful collaboration, Starting a dialogue about needs and responsibilities, Explaining BD, Utilizing mood monitoring instruments, and Conceptualizing self-management of BD. Conclusion: Eventually MHNs use tacit knowledge to cope with situations that demand an outside-the-box approach. Self-management education is partially trained and partially mastered through experience. Practice implications: In order to facilitate long-term self-management of BD, the collaboration of a supporting network is essential.
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Affiliation(s)
- S C G H van den Heuvel
- Expertise Centre for Health, Social Care and Technology, Saxion University of Applied Sciences , Deventer , The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare , Nijmegen , The Netherlands.,Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders , Deventer , The Netherlands.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven , Leuven , Belgium
| | - P J J Goossens
- Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders , Deventer , The Netherlands.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University Centre for Nursing and Midwifery, Ghent University , Ghent , Belgium
| | - C Terlouw
- Expertise Centre for Educational Innovations, Saxion University of Applied Sciences , Deventer , the Netherlands
| | - L Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Utrecht , the Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton , Southampton , UK
| | - T van Achterberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare , Nijmegen , The Netherlands.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven , Leuven , Belgium
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21
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Michalak EE, Morton E, Barnes SJ, Hole R, Murray G. Supporting Self-Management in Bipolar Disorder: Mixed-Methods Knowledge Translation Study. JMIR Ment Health 2019; 6:e13493. [PMID: 30985287 PMCID: PMC6487350 DOI: 10.2196/13493] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Self-management is increasingly recognized as an important method through which individuals with bipolar disorder (BD) may cope with symptoms and improve quality of life. Digital health technologies have strong potential as a method to support the application of evidence-informed self-management strategies in BD. Little is known, however, about how to most effectively maximize user engagement with digital platforms. OBJECTIVE The aims of this study were (1) to create an innovative Web-based Bipolar Wellness Centre, (2) to conduct a mixed-methods (ie, quantitative and qualitative) evaluation to assess the impact of different sorts of engagement (ie, knowledge translation [KT]), and (3) to support engagement with the self-management information in the Bipolar Wellness Centre. METHODS The project was implemented in 2 phases. In phase 1, community-based participatory research and user-centered design methods were used to develop a website (Bipolar Wellness Centre) housing evidence-informed tools and strategies for self-management of BD. In phase 2, a mixed-methods evaluation was conducted to explore the potential impact of 4 KT strategies (Web-based webinars, Web-based videos, Web-based one-to-one Living Library peer support, and in-person workshops). Quantitative assessments occurred at 2 time points-preintervention and 3 weeks postintervention. Purposive sampling was used to recruit a subsample of participants for the qualitative interviews, ensuring each KT modality was represented, and interviews occurred approximately 3 weeks postintervention. RESULTS A total of 94 participants were included in the quantitative analysis. Responses to evaluative questions about engagement were broadly positive. When averaged across the 4 KT strategies, significant improvements were observed on the Bipolar Recovery Questionnaire (F1,77=5.887; P=.02) and Quality of Life in Bipolar Disorder (F1,77=8.212; P=.005). Nonsignificant improvements in positive affect and negative affect were also observed. The sole difference that emerged between KT strategies related to the Chronic Disease Self-Efficacy measure, which decreased after participation in the webinar and video arms but increased after the Living Library and workshop arms. A subsample of 43 participants was included in the qualitative analyses, with the majority of participants describing positive experiences with the 4 KT strategies; peer contact was emphasized as a benefit across all strategies. Infrequent negative experiences were reported in relation to the webinar and video strategies, and included technical difficulties, the academic tone of webinars, and feeling unable to relate to the actor in the videos. CONCLUSIONS This study adds incremental evidence to a growing literature that suggests digital health technologies can provide effective support for self-management for people with BD. The finding that KT strategies could differentially impact chronic disease self-efficacy (hypothesized as being a product of differences in degree of peer contact) warrants further exploration. Implications of the findings for the development of evidence-informed apps for BD are discussed in this paper.
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Affiliation(s)
- Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Emma Morton
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Steven J Barnes
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Rachelle Hole
- School of Social Work, University of British Columbia, Okanagan, BC, Canada
| | | | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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Switsers L, Dauwe A, Vanhoudt A, Van Dyck H, Lombaerts K, Oldenburg J. Users' Perspectives on mHealth Self-Management of Bipolar Disorder: Qualitative Focus Group Study. JMIR Mhealth Uhealth 2018; 6:e108. [PMID: 29720363 PMCID: PMC5956163 DOI: 10.2196/mhealth.9529] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/13/2018] [Accepted: 02/28/2018] [Indexed: 12/12/2022] Open
Abstract
Background Recent research indicates that current mHealth apps for bipolar disorders (BDs) show crucial shortcomings. They lack important functionality, are of inconsistent quality, and are insufficiently evidence-based. mHealth apps need to be better adapted to the needs of users. The perspectives of adult service users with BD regarding mHealth apps have not been well investigated. Objective The objective of this study was to examine the needs and expectations of adults with BD regarding mHealth apps. Methods Two focus group sessions were organized in which patients’ views on self-management and design and functionality of an mHealth app for BD were assessed. During session 1, four focus groups were organized to identify users’ needs regarding support for self-management. Session 2 contained three cocreation focus groups. Through this method, the desired functionality and design were explored. Results Participants indicated that they were in need of support in various ways. Not only support in psychoeducation, including daily routine, sleep pattern, maintaining social contacts, maintaining a healthy lifestyle, and avoidance of stimuli, was considered important for them but also gaining insight into their illness was found to be crucial. Conclusions According to the participants, their illness-related information is a key factor in gaining insight into their mood pattern. Participants wanted a functional design that would increase daily use and prevent overstimulation. The results of this study should be taken into account when developing new mHealth apps.
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Affiliation(s)
- Lise Switsers
- Department of Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Arthur Dauwe
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | | | - Koen Lombaerts
- Department of Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jfe Oldenburg
- Collaborative Antwerp Psychiatric Research Institute, Faculty of Medicine, University of Antwerp, Antwerp, Belgium.,Psychiatric Hospital Duffel, University Department, Duffel, Belgium.,Curio NV, Antwerp, Belgium
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Stalman MN, Canham SL, Mahmood A, King D, O'Rourke N. Aspects of control and substance use among middle-aged and older adults with bipolar disorder. Int J Ment Health Nurs 2018; 27:833-840. [PMID: 28752582 DOI: 10.1111/inm.12371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 12/01/2022]
Abstract
High prevalence rates of alcohol and substance use disorders have been reported among persons with bipolar disorder (BD). In the present study, we explored the daily experiences of middle-aged and older adults living with BD who reported regular substance use and the ways in which participants expressed 'control' in relation to their use of alcohol and other substances. Semistructured, in-depth interviews were conducted with 12 participants (nine women and three men), aged 36-57 years of age (mean = 49 years). Thematic analyses identified emergent themes and patterns in participants' life histories. The theme of 'control' emerged as central to participants' reports, and was organized into four categories: (i) substance use to control BD symptoms; (ii) substance use provides a sense of being in control; (iii) methods of controlled substance use; and (iv) not having control: overreliance on substances. Implications of the present study include the need for nurses to openly discuss the use of alcohol and other drugs with persons with BD, provide health information and screening, and determine whether persons with BD feel they have control over their substance use. Several lines of research with persons who have BD and use substances are suggested.
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Affiliation(s)
- Marissa N Stalman
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Sarah L Canham
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Atiya Mahmood
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - David King
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Norm O'Rourke
- Department of Public Health, Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Morton E, Michalak EE, Hole R, Buzwell S, Murray G. 'Taking back the reins' - A qualitative study of the meaning and experience of self-management in bipolar disorder. J Affect Disord 2018; 228:160-165. [PMID: 29248822 DOI: 10.1016/j.jad.2017.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 11/12/2017] [Accepted: 12/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Self-management (SM) is increasingly emphasised as a key aspect of bipolar disorder (BD) treatment. However, little is known about the subjective experience of SM, which might have both positive and negative impacts. The present study aimed to advance this literature through qualitative investigation of the experiences of people with BD who participated in an SM intervention targeting quality of life (QoL). METHODS Forty-three individuals with BD engaged with an SM intervention and were later questioned about personal experiences of engagement with the intervention, including attempts to enact self-management strategies. Thematic analysis was used to identify important aspects of the experience of SM in BD. RESULTS Four themes describing people's experiences of SM were identified: 1) SM for BD is empowering, 2) individual responsibility to self-manage BD, 3) SM strategies lack power to control BD, and 4) the relationship of SM to the healthcare system. LIMITATIONS Potential limitations to generalisability may occur from self-selection bias in favour of SM and the QoL-focused nature of the present intervention. CONCLUSIONS The findings of this research generate novel insights into ways in which individuals with BD engage with SM interventions. For most people with BD, SM invokes a sense of empowerment and responsibility, although some feel symptoms remain beyond their control. A sense of partnership between consumers and clinicians may emerge from attention to SM, but traditional medical approaches were perceived as neglecting this aspect of care. Considerations from consumer perspectives are presented to assist clinicians and researchers utilising SM interventions in BD.
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Affiliation(s)
- Emma Morton
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Erin E Michalak
- Division of Mood Disorders, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Rachelle Hole
- School of Social Work, University of British Columbia, Okanagan, BC, Canada
| | - Simone Buzwell
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Greg Murray
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia.
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