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M VR, GNK G, D R, T VP, Rao GN. Neuro Receptor Signal Detecting and Monitoring Smart Devices for Biological Changes in Cognitive Health Conditions. Ann Neurosci 2024; 31:225-233. [PMID: 39156625 PMCID: PMC11325689 DOI: 10.1177/09727531231206888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/19/2023] [Indexed: 08/20/2024] Open
Abstract
Background Currently, wearable sensors significantly impact health care through continuous monitoring and event prediction. The types and clinical applications of wearable technology for the prevention of mental illnesses, as well as associated health authority rules, are covered in the current review. Summary The technologies behind wearable ECG monitors, biosensors, electronic skin patches, neural interfaces, retinal prosthesis, and smart contact lenses were discussed. We described how sensors will examine neuronal impulses using verified machine-learning algorithms running in real-time. These sensors will closely monitor body signals and demonstrate continuous sensing with wireless functionality. The wearable applications in the following medical fields were covered in our review: sleep, neurology, mental health, anxiety, depression, Parkinson's disease, epilepsy, seizures, and schizophrenia. These mental health conditions can cause serious issues, even death. Inflammation brought on by mental health problems can worsen hypothalamic-pituitary-adrenal axis dysfunction and interfere with certain neuroregulatory systems such as the neural peptide Y, serotonergic, and cholinergic systems. Severe depressive disorder symptoms are correlated with elevated Interleukin (IL-6) levels. On the basis of previous and present data collected utilizing a variety of sensory modalities, researchers are currently investigating ways to identify or detect the current mental state. Key message This review explores the potential of various mental health monitoring technologies. The types and clinical uses of wearable technology, such as ECG monitors, biosensors, electronic skin patches, brain interfaces, retinal prostheses, and smart contact lenses, were covered in the current review will be beneficial for patients with mental health problems like Alzheimer, epilepsy, dementia. The sensors will closely monitor bodily signals with wireless functionality while using machine learning algorithms to analyse neural impulses in real time.
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Affiliation(s)
- Vivek Reddy M
- Department of Regulatory Affairs, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamil Nadu, India
| | - Ganesh GNK
- Department of Regulatory Affairs, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamil Nadu, India
| | - Rudhresh D
- Department of Regulatory Affairs, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamil Nadu, India
| | - Vaishnavi Parimala T
- Department of Regulatory Affairs, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamil Nadu, India
| | - Gaddam Narasimha Rao
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Ooty, Nilgiris, Tamil Nadu, India
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Brooke-Sumner C, Machisa MT, Sikweyiya Y, Mahlangu P. Group-format, peer-facilitated mental health promotion interventions for students in higher education settings: a scoping review protocol. BMJ Open 2024; 14:e080629. [PMID: 38830731 PMCID: PMC11149131 DOI: 10.1136/bmjopen-2023-080629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Young people in higher education face various stressors that can make them vulnerable to mental ill-health. Mental health promotion in this group therefore has important potential benefits. Peer-facilitated and group-format interventions may be feasible and sustainable. The scoping review outlined in this protocol aims to map the literature on group-format, peer-facilitated, in-person interventions for mental health promotion for higher education students attending courses on campuses in high and low/middle-income countries. METHODS AND ANALYSIS Relevant studies will be identified through conducting searches of electronic databases, including Medline, CINAHL, Scopus, ERIC and PsycINFO. Searches will be conducted using Boolean operators (AND, OR, NOT) and truncation functions appropriate for each database. We will include a grey literature search. We will include articles from student participants of any gender, and published in peer-reviewed journals between 2008 and 2023. We will include English-language studies and all study types including randomised controlled trials, pilot studies and descriptive studies of intervention development. A draft charting table has been developed, which includes the fields: author, publication date, country/countries, aims, population and sample size, demographics, methods, intervention type, comparisons, peer training, number of sessions/duration of intervention, outcomes and details of measures. ETHICS AND DISSEMINATION No primary data will be collected from research participants to produce this review so ethics committee approval is not required. All data will be collated from published peer-reviewed studies already in the public domain. We will publish the review in an open-access, peer-reviewed journal accessible to researchers in low/middle-income countries. This protocol is registered on Open Science Framework (https://osf.io/agbfj/).
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Affiliation(s)
- Carrie Brooke-Sumner
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu Natal, Durban, South Africa
| | - Mercilene T Machisa
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Yandisa Sikweyiya
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinky Mahlangu
- School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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Eisner E, Richardson C, Thomas N, Rus-Calafell M, Syrett S, Firth J, Gumley A, Hardy A, Allan S, Kabir T, Ward T, Priyam A, Bucci S. Measurement of Adverse Events in Studies of Digital Health Interventions for Psychosis: Guidance and Recommendations Based on a Literature Search and Framework Analysis of Standard Operating Procedures. Schizophr Bull 2024:sbae048. [PMID: 38683836 DOI: 10.1093/schbul/sbae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Given the rapid expansion of research into digital health interventions (DHIs) for severe mental illness (SMI; eg, schizophrenia and other psychosis diagnoses), there is an emergent need for clear safety measures. Currently, measurement and reporting of adverse events (AEs) are inconsistent across studies. Therefore, an international network, iCharts, was assembled to systematically identify and refine a set of standard operating procedures (SOPs) for AE reporting in DHI studies for SMI. DESIGN The iCharts network comprised experts on DHIs for SMI from seven countries (United Kingdom, Belgium, Germany, Pakistan, Australia, United States, and China) and various professional backgrounds. Following a literature search, SOPs of AEs were obtained from authors of relevant studies, and from grey literature. RESULTS A thorough framework analysis of SOPs (n = 32) identified commonalities for best practice for certain domains, along with significant gaps in others; particularly around the classification of AEs during trials, and the provision of training/supervision for research staff in measuring and reporting AEs. Several areas which could lead to the observed inconsistencies in AE reporting and handling were also identified. CONCLUSIONS The iCharts network developed best-practice guidelines and a practical resource for AE monitoring in DHI studies for psychosis, based on a systematic process which identified common features and evidence gaps. This work contributes to international efforts to standardize AE measurement and reporting in this emerging field, ensuring that safety aspects of DHIs for SMI are well-studied across the translational pathway, with monitoring systems set-up from the outset to support safe implementation in healthcare systems.
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Affiliation(s)
- Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Cara Richardson
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Neil Thomas
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Australia
- Monash Alfred Psychiatry Research Centre, Alfred Hospital, Melbourne, Australia
| | - Mar Rus-Calafell
- Mental Health Research and Treatment Centre, Ruhr-Universität Bochum, Bochum, Germany
| | - Suzy Syrett
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- NHS Research Scotland Mental Health Network, Edinburgh, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andrew Gumley
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Amy Hardy
- Institute of Psychiatry, Psychology, and Neuroscience; King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Stephanie Allan
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Thomas Kabir
- McPin Foundation, London, UK
- Departments of Experimental Psychology & Psychiatry, Oxford University, Oxford, UK
| | - Thomas Ward
- Institute of Psychiatry, Psychology, and Neuroscience; King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Aansha Priyam
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Chakrabarti S. Digital psychiatry in low-and-middle-income countries: New developments and the way forward. World J Psychiatry 2024; 14:350-361. [PMID: 38617977 PMCID: PMC11008387 DOI: 10.5498/wjp.v14.i3.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/28/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Low- and middle-income countries (LMICs) bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap. The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap. Digital psychiatry in LMICs has always lagged behind high-income countries, but there have been encouraging developments in the last decade. There is increasing research on the efficacy of digital psychiatric interventions. However, the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs. A striking development has been the rise in mobile and smartphone ownership in LMICs, which has driven the increasing use of mobile technologies to deliver mental health services. An innovative use of mobile technologies has been to optimize task-shifting, which involves delivering mental healthcare services in community settings using non-specialist health professionals. Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious. Despite these promising developments, many barriers such as service costs, underdeveloped infrastructure, lack of trained professionals, and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs. To overcome these barriers, digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services, ensure collaboration between different stakeholders, and focus on reducing the digital divide.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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Yeo G, Reich SM, Liaw NA, Chia EYM. The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e51268. [PMID: 38421687 PMCID: PMC10941000 DOI: 10.2196/51268] [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: 07/26/2023] [Revised: 10/25/2023] [Accepted: 12/25/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions. OBJECTIVE This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health. METHODS We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health. RESULTS Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI -0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults. CONCLUSIONS For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995.
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Affiliation(s)
- GeckHong Yeo
- N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Stephanie M Reich
- School of Education, University of California, Irvine, Irvine, CA, United States
| | - Nicole A Liaw
- SHINE Children and Youth Services, Singapore, Singapore, Singapore
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Buitrago DCC, Rattner M, James LE, García JFB. Barriers and Facilitators to Implementing a Community-Based Psychosocial Support Intervention Conducted In-Person and Remotely: A Qualitative Study in Quibdó, Colombia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300032. [PMID: 38253391 PMCID: PMC10906549 DOI: 10.9745/ghsp-d-23-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024]
Abstract
Community-based psychosocial support group (CB-PSS) interventions using task-shifting approaches are well suited to provide culturally appropriate services in low- and middle-income countries. However, contextual barriers and facilitators must be considered to tailor interventions effectively, particularly considering the challenges introduced by the COVID-19 pandemic. We explore the barriers, facilitators, and psychosocial changes associated with implementing a CB-PSS group intervention delivered by local lay providers to conflict-affected adults in Quibdó, Colombia, using both in-person and remote modalities. Data were analyzed from 25 individual interviews with participants and a focus group discussion involving staff members, including 7 community psychosocial agent facilitators and 2 mental health professional supervisors. The analysis used a thematic approach grounded in a descriptive phenomenology to explore the lived experiences of participants and staff members during implementation. Participant attendance in the in-person modality was compromised by factors such as competing work and family responsibilities and disruption caused by the COVID-19 pandemic. Participants in the remote modality faced challenges concerning unstable Internet connectivity, recurrent power outages caused by heavy rain, distractions, interruptions, and threats to confidentiality by family and coworkers. Despite these challenges, data revealed key contextual facilitators, including the community-based knowledge of facilitators and integration of traditional practices, such as the comadreo (informal talks and gatherings). Respondents shared that the CB-PSS groups promoted stronger community relationships and created opportunities for participants to exchange peer support, practice leadership skills, develop problem-solving skills based on peers' experiences, and enhance emotional regulation skills. Differences and similarities across in-person and remote modalities are discussed, as are key considerations for practitioners and policymakers.
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Affiliation(s)
- Diana Carolina Chaparro Buitrago
- Department of Global Health, McMaster University, Hamilton, Canada.
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
| | - Michel Rattner
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
- Palo Alto University, Department of Psychology, Palo Alto, California, USA
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Berardi C, Antonini M, Jordan Z, Wechtler H, Paolucci F, Hinwood M. Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework. BMC Health Serv Res 2024; 24:243. [PMID: 38408938 PMCID: PMC10898174 DOI: 10.1186/s12913-023-10536-1] [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: 02/04/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Despite the potential for improved population mental health and wellbeing, the integration of mental health digital interventions has been difficult to achieve. In this qualitative systematic review, we aimed to identify barriers and facilitators to the implementation of digital technologies in mental healthcare systems, and map these to an implementation framework to inform policy development. METHODS We searched Medline, Embase, Scopus, PsycInfo, Web of Science, and Google Scholar for primary research articles published between January 2010 and 2022. Studies were considered eligible if they reported barriers and/or facilitators to the integration of any digital mental healthcare technologies. Data were extracted using EPPI-Reviewer Web and analysed thematically via inductive and deductive cycles. RESULTS Of 12,525 references identified initially, 81 studies were included in the final analysis. Barriers and facilitators were grouped within an implementation (evidence-practice gap) framework across six domains, organised by four levels of mental healthcare systems. Broadly, implementation was hindered by the perception of digital technologies as impersonal tools that add additional burden of care onto both providers and patients, and change relational power asymmetries; an absence of resources; and regulatory complexities that impede access to universal coverage. Facilitators included person-cantered approaches that consider patients' intersectional features e.g., gender, class, disability, illness severity; evidence-based training for providers; collaboration among colleagues; appropriate investment in human and financial resources; and policy reforms that tackle universal access to digital health. CONCLUSION It is important to consider the complex and interrelated nature of barriers across different domains and levels of the mental health system. To facilitate the equitable, sustainable, and long-term digital transition of mental health systems, policymakers should consider a systemic approach to collaboration between public and private sectors to inform evidence-based planning and strengthen mental health systems. PROTOCOL REGISTRATION The protocol is registered on PROSPERO, CRD42021276838.
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Affiliation(s)
- Chiara Berardi
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia.
| | - Marcello Antonini
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, UK
| | - Zephanie Jordan
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Heidi Wechtler
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Francesco Paolucci
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Madeleine Hinwood
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Riboldi I, Calabrese A, Piacenti S, Capogrosso CA, Paioni SL, Bartoli F, Carrà G, Armes J, Taylor C, Crocamo C. Understanding University Students' Perspectives towards Digital Tools for Mental Health Support: A Cross-country Study. Clin Pract Epidemiol Ment Health 2024; 20:e17450179271467. [PMID: 38660572 PMCID: PMC11037510 DOI: 10.2174/0117450179271467231231060255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 04/26/2024]
Abstract
Background Organisational and individual barriers often prevent university students from seeking mental health support. Digital technologies are recognised as effective in managing psychological distress and as a source of health-related information, thus representing useful options to address mental health needs in terms of accessibility and cost-effectiveness. However, university students' experiences and perspectives towards such interventions are little known. Objectives We thus aimed to expand the existing base of scientific knowledge, focusing on this special population. Methods Data were from the qualitative component of "the CAMPUS study", longitudinally assessing the mental health of students at the University of Milano-Bicocca (Italy) and the University of Surrey (UK). We conducted in-depth interviews and thematically analysed the transcripts using the framework approach. Results An explanatory model was derived from five themes identified across 33 interviews (15 for Italy, 18 for the UK). Students perceived that social media, apps, and podcasts could deliver relevant mental health content, ranging from primary to tertiary prevention. Wide availability and anonymity were perceived as advantages that make tools suitable for preventive interventions, to reduce mental health stigma, and as an extension of standard treatment. These goals can be hindered by disadvantages, namely lower efficacy compared to face-to-face contact, lack of personalisation, and problematic engagement. Individual and cultural specificities might influence awareness and perspectives on the use of digital technologies for mental health support. Conclusion Although considering some specific features, digital tools could be a useful instrument to support the mental health needs of students. Since personal contact remains crucial, digital tools should be integrated with face-to-face interventions through a multi-modal approach.
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Affiliation(s)
- Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | | | - Susanna Lucini Paioni
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
| | - Jo Armes
- Faculty of Health and Medical Sciences, School of Health and Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK
| | - Cath Taylor
- Faculty of Health and Medical Sciences, School of Health and Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
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Ho TQA, Le LKD, Engel L, Le N, Melvin G, Le HND, Mihalopoulos C. Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02386-x. [PMID: 38356043 DOI: 10.1007/s00787-024-02386-x] [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: 07/18/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Many young people (YP) are diagnosed with mental illnesses and require support. Web-based mental health interventions (W-MHIs) have been increasingly utilized by YP, healthcare providers, and parents due to reasons including convenience and anonymity. W-MHIs are effective in improving mental health in YP. However, real-world engagement with W-MHIs remains low. Therefore, understanding barriers/facilitators of user engagement with W-MHIs is necessary to promote W-MHIs and help users gain optimal benefits through higher engagement. This review aims to identify barriers/facilitators of user engagement with W-MHIs in YP aged 10-24 years. A systematic search of five databases for English language, peer-reviewed publications was conducted between January 2010 and February 2023. Studies examining factors influencing user engagement with W-MHIs, described as barriers or facilitators, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was performed. Of 4088 articles identified, 69 studies were included. Barriers/facilitators were reported by young people (63 studies), providers (17 studies), and parents/caregivers (8 studies). YP perceived that usefulness and connectedness were the most common facilitators, whereas low-perceived need was the most reported barrier. Both providers and parents reported that perceived usefulness for YP was the most common facilitator, whereas concerns about program effectiveness and privacy were noted as barriers. This review found that program- and individual-related factors were important determinants of engagement with W-MHIs. This review provides guidance on the future design and development of new interventions, narrowing the gap between existing W-MHIs and unmet needs of users.
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Affiliation(s)
- Thi Quynh Anh Ho
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia.
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ngoc Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ha N D Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Raeber F, Haldemann MI, Ray S, Huber J, Firima E, Fernandez LG, Amstutz A, Gerber F, Labhardt ND, Belus JM. Community-based models of care for adolescent and adult depression, suicidal behavior, anxiety, trauma, and substance use in Africa: a scoping review. Front Psychol 2024; 15:1241403. [PMID: 38406302 PMCID: PMC10885163 DOI: 10.3389/fpsyg.2024.1241403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background Community-based care (CBC), where care is delivered outside of the traditional health facility setting, has been proposed to narrow the mental health (MH) and substance use (SU) treatment gap in Africa. Objective This scoping review aims to comprehensively summarize CBC models addressing adolescent and adult MH (depression, anxiety, trauma, suicidal behavior) and (non-tobacco) SU problems in Africa. Methods We searched PsycINFO, Embase, Scopus, CINAHL, and Medline Ovid. Studies and protocols were included if they reported on CBC intervention's effects on MH or SU symptoms/ diagnoses, acceptability, feasibility, or patient engagement in care, regardless of whether the intervention itself was designed specifically for MH or SU. Results Among 11,477 screened publications, 217 were eligible. Of the unique intervention studies (n = 206), CBC models were classified into the following approaches (non-mutually exclusive): psychotherapeutic (n = 144), social (n = 81), lifestyle/physical health (n = 55), economic (n = 26), and psychopharmacological (n = 2). While quantitative results suggest possible efficacy of CBC models, description of CBC location was often poor. Fewer interventions addressed suicidal behavior (n = 12), the needs of adolescents (n = 49), or used traditional healers or religious figures as providers (n = 3). Conclusion Many CBC models have been tested on MH and SU in Africa and should be critically appraised and meta-analyzed in subsequent reviews, where possible.
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Affiliation(s)
- Fabian Raeber
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Maria-Inés Haldemann
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Somidha Ray
- Research Consultant, International Center for Research on Women, New Delhi, India
| | - Jacqueline Huber
- Swiss TPH Library, Swiss Tropical and Public Health Institute, Allschwil, Basel, Switzerland
| | - Emmanuel Firima
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Lucia Gonzalez Fernandez
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Alain Amstutz
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Felix Gerber
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Niklaus D. Labhardt
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Jennifer M. Belus
- Division of Clinical Epidemiology, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
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Mukherjee A, Yatirajula SK, Kallakuri S, Paslawar S, Lempp H, Raman U, Essue BM, Sagar R, Singh R, Peiris D, Norton R, Thornicroft G, Maulik PK. Using formative research to inform a mental health intervention for adolescents living in Indian slums: the ARTEMIS study. Child Adolesc Psychiatry Ment Health 2024; 18:14. [PMID: 38245796 PMCID: PMC10800058 DOI: 10.1186/s13034-024-00704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Adolescents are vulnerable to stressors because of the rapid physical and mental changes that they go through during this life period. Young people residing in slum communities experience additional stressors due to living conditions, financial stress, and limited access to healthcare and social support services. The Adolescents' Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) study, is testing an intervention intended to improve mental health outcomes for adolescents living in urban slums in India combining an anti-stigma campaign with a digital health intervention to identify and manage depression, self-harm/suicide risk or other significant emotional complaints. METHODS In the formative phase, we developed tools and processes for the ARTEMIS intervention. The two intervention components (anti-stigma and digital health) were implemented in purposively selected slums from the two study sites of New Delhi and Vijayawada. A mixed methods formative evaluation was undertaken to improve the understanding of site-specific context, assess feasibility and acceptability of the two components and identify required improvements to be made in the intervention. In-depth interviews and focus groups with key stakeholders (adolescents, parents, community health workers, doctors, and peer leaders), along with quantitative data from the digital health platform, were analysed. RESULTS The anti-stigma campaign methods and materials were found to be acceptable and received overall positive feedback from adolescents. A total of 2752 adolescents were screened using the PHQ9 embedded into a digital application, 133 (4.8%) of whom were identified as at high-risk of depression and/or suicide. 57% (n = 75) of those at high risk were diagnosed and treated by primary health care (PHC) doctors, who were guided by an electronic decision support tool based on WHO's mhGAP algorithm, built into the digital health application. CONCLUSION The formative evaluation of the intervention strategy led to enhanced understanding of the context, acceptability, and feasibility of the intervention. Feedback from stakeholders helped to identify key areas for improvement in the intervention; strategies to improve implementation included engaging with parents, organising health camps in the sites and formation of peer groups. TRIAL REGISTRATION The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries, Reference number: CTRI/2022/02/040307. Registered 18 February 2022.
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Affiliation(s)
| | | | | | | | - Heidi Lempp
- Centre for Rheumatic Diseases, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Usha Raman
- Department of Communication, University of Hyderabad, Hyderabad, India
| | - Beverley M Essue
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | | | - David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Robyn Norton
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
- The George Institute for Global Health, Imperial College London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India.
- The George Institute for Global Health, Imperial College London, London, UK.
- University of New South Wales, Sydney , Australia.
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Zemestani M, Ezzati S, Nasiri F, Gallagher MW, Barlow DH, Kendall PC. A culturally adapted unified protocol for transdiagnostic treatment of anxiety disorders in adolescents (UP-A): a randomized waitlist-controlled trial. Psychol Med 2024; 54:385-398. [PMID: 37458212 DOI: 10.1017/s0033291723001903] [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] [Indexed: 07/24/2023]
Abstract
BACKGROUND Anxiety disorders are highly prevalent and debilitating conditions that show high comorbidity rates in adolescence. The present article illustrates how Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) was adapted for Iranian adolescents with anxiety disorders. METHODS A total of 54 adolescents with comorbid anxiety disorders participated in a randomized, waitlist-controlled trial of group weekly sessions of either UP-A or waitlist control (WLC). Primary and process of change outcomes were assessed at baseline, posttreatment, and 1-month follow-up. RESULTS Significant changes were observed over time on major DSM-5 anxiety disorder symptoms (F(2, 51) = 117.09, p < 0.001), phobia type symptoms (F(2, 51) = 100.67, p < 0.001), and overall anxiety symptoms (F(2, 51) = 196.29, p < 0.001), as well as on emotion regulation strategies of reappraisal (F(2, 51) = 17.03, p < 0.001), and suppression (F(2, 51) = 21.13, p < 0.001), as well as on intolerance of uncertainty dimensions including prospective (F(2, 51) = 74.49, p < 0.001), inhibitory (F(2, 51) = 45.94, p < 0.001), and total intolerance of uncertainty (F(2, 51) = 84.42, p < 0.001), in favor of UP-A over WLC. CONCLUSION Overall, results provide a cultural application of the UP-A and support the protocol as useful for improving anxiety disorders as well as modifying of emotion regulation strategies and intolerance of uncertainty dimensions in Iranian adolescents. Future directions and study limitations are discussed.
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Affiliation(s)
- Mehdi Zemestani
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Saman Ezzati
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Farzad Nasiri
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | | | - David H Barlow
- Department of Psychology, Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
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Zhang X, Lewis S, Carter LA, Chen X, Zhou J, Wang X, Bucci S. Evaluating a smartphone-based symptom self-monitoring app for psychosis in China (YouXin): A non-randomised validity and feasibility study with a mixed-methods design. Digit Health 2024; 10:20552076231222097. [PMID: 38188856 PMCID: PMC10768587 DOI: 10.1177/20552076231222097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background Psychosis causes a significant burden globally, including in China, where limited mental health resources hinder access to care. Smartphone-based remote monitoring offers a promising solution. This study aimed to assess the validity, feasibility, acceptability, and safety of a symptom self-monitoring smartphone app, YouXin, for people with psychosis in China. Methods A pre-registered non-randomised validity and feasibility study with a mixed-methods design. Participants with psychosis were recruited from a major tertiary psychiatric hospital in Beijing, China. Participants utilised the YouXin app to self-monitor psychosis and mood symptoms for four weeks. Feasibility outcomes were recruitment, retention and outcome measures completeness. Active symptom monitoring (ASM) validity was tested against corresponding clinical assessments (PANSS and CDS) using Spearman correlation. Ten participants completed qualitative interviews at study end to explore acceptability of the app and trial procedures. Results Feasibility parameters were met. The target recruitment sample of 40 participants was met, with 82.5% completing outcome measures, 60% achieving acceptable ASM engagement (completing >33% of all prompts), and 33% recording sufficient passive monitoring data to extract mobility indicators. Five ASM domains (hallucinations, suspiciousness, guilt feelings, delusions, grandiosity) achieved moderate correlation with clinical assessment. Both quantitative and qualitative evaluation showed high acceptability of YouXin. Clinical measurements indicated no symptom and functional deterioration. No adverse events were reported, suggesting YouXin is safe to use in this clinical population. Conclusions The trial feasibility, acceptability and safety parameters were met and a powered efficacy study is indicated. However, refinements are needed to improve ASM validity and increase passive monitoring data completeness.
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Affiliation(s)
- Xiaolong Zhang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Lesley-Anne Carter
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Xu Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jiaojiao Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xingyu Wang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Mehjabeen D, Blignault I, Taha PH, Reavley N, Slewa-Younan S. A mixed methods systematic review of mental health self-care strategies for Arabic-speaking refugees and migrants. BMC Public Health 2023; 23:2544. [PMID: 38124024 PMCID: PMC10731719 DOI: 10.1186/s12889-023-17395-9] [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: 09/14/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations. METHODS English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456). RESULTS Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified-social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions. CONCLUSION Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries.
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Affiliation(s)
- Deena Mehjabeen
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia.
| | - Ilse Blignault
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Perjan Hashim Taha
- College of Medicine, University of Duhok, Duhok, Iraq
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shameran Slewa-Younan
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Kola L, Larsen A, Asafo S, Attah DA, Beaulieu A, Gavi JK, Hallgren K, Kadakia A, Obeng K, Ohene S, Snyder J, Ofori-Atta A, Ben-Zeev D. Developing the West African Digital Mental Health Alliance (WADMA). Nat Med 2023; 29:2680-2681. [PMID: 37758898 PMCID: PMC11037517 DOI: 10.1038/s41591-023-02548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Lola Kola
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK.
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA.
- University of Ibadan, Ibadan, Nigeria.
| | - Anna Larsen
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
| | - Seth Asafo
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Dzifa Abra Attah
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Alexa Beaulieu
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
| | - Jonathan Kuma Gavi
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Kevin Hallgren
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
| | - Arya Kadakia
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
| | | | - Sammy Ohene
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Jaime Snyder
- The Information School, University of Washington, Seattle, WA, USA
| | - Angela Ofori-Atta
- Department of Psychiatry, University of Ghana Medical School, Accra, Ghana
| | - Dror Ben-Zeev
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
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Eisner E, Berry N, Bucci S. Digital tools to support mental health: a survey study in psychosis. BMC Psychiatry 2023; 23:726. [PMID: 37803367 PMCID: PMC10559432 DOI: 10.1186/s12888-023-05114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/16/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND There is a notable a gap between promising research findings and implementation of digital health tools. Understanding and addressing barriers to use is key to widespread implementation. METHODS A survey was administered to a self-selecting sample in-person (n = 157) or online (n = 58), with questions examining: i) ownership and usage rates of digital devices among people with psychosis; ii) interest in using technology to engage with mental health services; and iii) facilitators of and barriers to using digital tools in a mental healthcare context. RESULTS Device ownership: Virtually all participants owned a mobile phone (95%) or smartphone (90%), with Android phones slightly more prevalent than iPhones. Only a minority owned a fitness tracker (15%) or smartwatch (13%). Device ownership was significantly lower in unemployed people and those without secondary education. Device cost and paranoid ideation were barriers to ownership. Technology and mental health services: Most participants (88%) said they would willingly try a mental health app. Symptom monitoring apps were most popular, then appointment reminders and medication reminders. Half the sample would prefer an app alongside face-to-face support; the other half preferred remote support or no other mental health support. Facilitators: Participants thought using a mental health app could increase their understanding of psychosis generally, and of their own symptoms. They valued the flexibility of digital tools in enabling access to support anywhere, anytime. Barriers: Prominent barriers to using mental health apps were forgetting, lack of motivation, security concerns, and concerns it would replace face-to-face care. Overall participants reported no substantial effects of technology on their mental health, although a quarter said using a phone worsened paranoid ideation. A third used technology more when psychotic symptoms were higher, whereas a third used it less. Around half used technology more when experiencing low mood. CONCLUSIONS Our findings suggest rapidly increasing device ownership among people with psychosis, mirroring patterns in the general population. Smartphones appear appropriate for delivering internet-enabled support for psychosis. However, for a sub-group of people with psychosis, the sometimes complex interaction between technology and mental health may act as a barrier to engagement, alongside more prosaic factors such as forgetting.
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Affiliation(s)
- Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Natalie Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Volpe U, Ramalho R, Orsolini L, Ransing R, de Filippis R, Gürcan A, Samal S, Gaebel W. An update from the WPA Working Group on Digitalization in Mental Health and Care. World Psychiatry 2023; 22:494-495. [PMID: 37713546 PMCID: PMC10503917 DOI: 10.1002/wps.21143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 09/17/2023] Open
Affiliation(s)
- Umberto Volpe
- Unit of Clinical Psychiatry, Università Politecnica delle Marche, Ancona, Italy
| | - Rodrigo Ramalho
- Department of Social and Community Health, University of Auckland, Auckland, New Zealand
| | - Laura Orsolini
- Unit of Clinical Psychiatry, Università Politecnica delle Marche, Ancona, Italy
| | - Ramdas Ransing
- Department of Psychiatry, Clinical Neurosciences, and Addiction Medicine, All India Institute of Medical Sciences, Guwahati, Asam, India
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Ahmet Gürcan
- Department of Psychiatry, Bas¸kent University Medical Faculty, Ankara, Turkey
| | - Shreyasta Samal
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Wolfgang Gaebel
- WHO Collaborating Centre DEU-131, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Marciano L, Vocaj E, Bekalu MA, La Tona A, Rocchi G, Viswanath K. The Use of Mobile Assessments for Monitoring Mental Health in Youth: Umbrella Review. J Med Internet Res 2023; 25:e45540. [PMID: 37725422 PMCID: PMC10548333 DOI: 10.2196/45540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/12/2023] [Accepted: 07/06/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Improving mental health in youth is a major concern. Future approaches to monitor and intervene in youth mental health problems should rely on mobile tools that allow for the daily monitoring of mental health both actively (eg, using ecological momentary assessments [EMAs]) and passively (eg, digital phenotyping) by capturing individuals' data. OBJECTIVE This umbrella review aims to (1) report the main characteristics of existing reviews on mental health and young people, including mobile approaches to mental health; (2) describe EMAs and trace data and the mental health conditions investigated; (3) report the main results; and (4) outline promises, limitations, and directions for future research. METHODS A systematic literature search was carried out in 9 scientific databases (Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, ERIC, MEDLINE, the ProQuest Sociology Database, Web of Science, and PubMed) on January 30, 2022, coupled with a hand search and updated in July 2022. We included (systematic) reviews of EMAs and trace data in the context of mental health, with a specific focus on young populations, including children, adolescents, and young adults. The quality of the included reviews was evaluated using the AMSTAR (Assessment of Multiple Systematic Reviews) checklist. RESULTS After the screening process, 30 reviews (published between 2016 and 2022) were included in this umbrella review, of which 21 (70%) were systematic reviews and 9 (30%) were narrative reviews. The included systematic reviews focused on symptoms of depression (5/21, 24%); bipolar disorders, schizophrenia, or psychosis (6/21, 29%); general ill-being (5/21, 24%); cognitive abilities (2/21, 9.5%); well-being (1/21, 5%); personality (1/21, 5%); and suicidal thoughts (1/21, 5%). Of the 21 systematic reviews, 15 (71%) summarized studies that used mobile apps for tracing, 2 (10%) summarized studies that used them for intervention, and 4 (19%) summarized studies that used them for both intervention and tracing. Mobile tools used in the systematic reviews were smartphones only (8/21, 38%), smartphones and wearable devices (6/21, 29%), and smartphones with other tools (7/21, 33%). In total, 29% (6/21) of the systematic reviews focused on EMAs, including ecological momentary interventions; 33% (7/21) focused on trace data; and 38% (8/21) focused on both. Narrative reviews mainly focused on the discussion of issues related to digital phenotyping, existing theoretical frameworks used, new opportunities, and practical examples. CONCLUSIONS EMAs and trace data in the context of mental health assessments and interventions are promising tools. Opportunities (eg, using mobile approaches in low- and middle-income countries, integration of multimodal data, and improving self-efficacy and self-awareness on mental health) and limitations (eg, absence of theoretical frameworks, difficulty in assessing the reliability and effectiveness of such approaches, and need to appropriately assess the quality of the studies) were further discussed. TRIAL REGISTRATION PROSPERO CRD42022347717; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347717.
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Affiliation(s)
- Laura Marciano
- Lee Kum Sheung Center for Health and Happiness, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Dana Farber Cancer Institute, Boston, MA, United States
| | - Emanuela Vocaj
- Lombard School of Cognitive-Neuropsychological Psychotherapy, Pavia, Italy
| | - Mesfin A Bekalu
- Lee Kum Sheung Center for Health and Happiness, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Dana Farber Cancer Institute, Boston, MA, United States
| | - Antonino La Tona
- Dipartimento di Scienze Umane e Sociali, Università degli Studi di Bergamo, Bergamo, Italy
| | - Giulia Rocchi
- Department of Dynamic, Clinical Psychology and Health Studies, Sapienza University, Rome, Italy
| | - Kasisomayajula Viswanath
- Lee Kum Sheung Center for Health and Happiness, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Dana Farber Cancer Institute, Boston, MA, United States
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Sandri E, Cantín Larumbe E, Part-Ferrer R, Ferrer-Torregrosa J, Fernández-Ehrling N. Diet and Lifestyle in the Spanish Population and Their Relationship with Sociodemographic Variables: A Descriptive Study. Foods 2023; 12:3409. [PMID: 37761118 PMCID: PMC10527864 DOI: 10.3390/foods12183409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
A healthy lifestyle and proper nutrition have a major impact on the well-being of a population. Therefore, the aim of this research is to describe the behavior of these habits in relation to sociodemographic variables to provide data on the development of effective training and awareness-raising actions. METHODS An observational, descriptive and cross-sectional study was carried out. To study the behavior of a series of variables related to eating habits and lifestyle, a questionnaire was designed and validated and subsequently disseminated online, by means of nonprobabilistic snowball sampling, relying on social networks. The sample collected consisted of 18,070 young adults of Spanish nationality. Bivariate comparative analyses were performed using t-test independent samples, and the effect size (ES) was calculated by determining Cohen's D coefficient. A multivariate analysis were conducted using linear regression and principal component analysis. RESULTS Adults eat better but have a poorer quality of rest and are more sedentary than young people. No gender differences were found in nutritional habits; however, men engage in more sports and sleep better. People with a higher educational level have better nutritional and sleep habits, but are more sedentary, as are people of a higher socioeconomic level. CONCLUSIONS Higher socioeconomic and educational levels seem to favor a healthier lifestyle. The Spanish population aged 18-45 years needs to make dietary changes but leads an active lifestyle.
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Affiliation(s)
- Elena Sandri
- Doctorate School, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain;
- Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, c/Quevedo 2, 46001 Valencia, Spain
| | - Eva Cantín Larumbe
- Escuela Técnica Superior de Ingeniería Informática, Polytechnical University of Valencia, Camí de Vera s/n, 46022 Valencia, Spain;
| | - Roser Part-Ferrer
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Ramiro de Maeztu, 14, 46900 Torrent, Spain; (R.P.-F.); (N.F.-E.)
| | - Javier Ferrer-Torregrosa
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Ramiro de Maeztu, 14, 46900 Torrent, Spain; (R.P.-F.); (N.F.-E.)
| | - Nadia Fernández-Ehrling
- Podiatry Department, Faculty of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Ramiro de Maeztu, 14, 46900 Torrent, Spain; (R.P.-F.); (N.F.-E.)
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Zhang X, Lewis S, Carter LA, Bucci S. A Digital System (YouXin) to Facilitate Self-Management by People With Psychosis in China: Protocol for a Nonrandomized Validity and Feasibility Study With a Mixed Methods Design. JMIR Res Protoc 2023; 12:e45170. [PMID: 37698905 PMCID: PMC10523209 DOI: 10.2196/45170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Psychosis is one of the most disabling mental health conditions and causes significant personal, social, and economic burden. Accurate and timely symptom monitoring is critical to offering prompt and time-sensitive clinical services. Digital health is a promising solution for the barriers encountered by conventional symptom monitoring approaches, including accessibility, the ecological validity of assessments, and recall bias. However, to date, there has been no digital health technology developed to support self-management for people with psychosis in China. OBJECTIVE We report the study protocol to evaluate the validity, feasibility, acceptability, usability, and safety of a symptom self-monitoring smartphone app (YouXin; Chinese name ) for people with psychosis in China. METHODS This is a nonrandomized validity and feasibility study with a mixed methods design. The study was approved by the University of Manchester and Beijing Anding Hospital Research Ethics Committee. YouXin is a smartphone app designed to facilitate symptom self-monitoring for people with psychosis. YouXin has 2 core functions: active monitoring of symptoms (ie, smartphone survey) and passive monitoring of behavioral activity (ie, passive data collection via embedded smartphone sensors). The development process of YouXin utilized a systematic coproduction approach. A series of coproduction consultation meetings was conducted by the principal researcher with service users and clinicians to maximize the usability and acceptability of the app for end users. Participants with psychosis aged 16 years to 65 years were recruited from Beijing Anding Hospital, Beijing, China. All participants were invited to use the YouXin app to self-monitor symptoms for 4 weeks. At the end of the 4-week follow-up, we invited participants to take part in a qualitative interview to explore the acceptability of the app and trial procedures postintervention. RESULTS Recruitment to the study was initiated in August 2022. Of the 47 participants who were approached for the study from August 2022 to October 2022, 41 participants agreed to take part in the study. We excluded 1 of the 41 participants for not meeting the inclusion criteria, leaving a total of 40 participants who began the study. As of December 2022, 40 participants had completed the study, and the recruitment was complete. CONCLUSIONS This study is the first to develop and test a symptom self-monitoring app specifically designed for people with psychosis in China. If the study shows the feasibility of YouXin, a potential future direction is to integrate the app into clinical workflows to facilitate digital mental health care for people with psychosis in China. This study will inform improvements to the app, trial procedures, and implementation strategies with this population. Moreover, the findings of this trial could lead to optimization of digital health technologies designed for people with psychosis in China. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45170.
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Affiliation(s)
- Xiaolong Zhang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Lesley-Anne Carter
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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21
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Wong BHC, Cross S, Zavaleta-Ramírez P, Bauda I, Hoffman P, Ibeziako P, Nussbaum L, Berger GE, Hassanian-Moghaddam H, Kapornai K, Mehdi T, Tolmac J, Barrett E, Romaniuk L, Davico C, Moghraby OS, Ostrauskaite G, Chakrabarti S, Carucci S, Sofi G, Hussain H, Lloyd ASK, McNicholas F, Meadowcroft B, Rao M, Csábi G, Gatica-Bahamonde G, Öğütlü H, Skouta E, Elvins R, Boege I, Dahanayake DMA, Anderluh M, Chandradasa M, Girela-Serrano BM, Uccella S, Stevanovic D, Lamberti M, Piercey A, Nagy P, Mehta VS, Rohanachandra Y, Li J, Tufan AE, Mirza H, Rozali F, Baig BJ, Noor IM, Fujita S, Gholami N, Hangül Z, Vasileva A, Salucci K, Bilaç Ö, Yektaş Ç, Cansız MA, Aksu GG, Babatunde S, Youssef F, Al-Huseini S, Kılıçaslan F, Kutuk MO, Pilecka I, Bakolis I, Ougrin D. Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study. J Am Acad Child Adolesc Psychiatry 2023; 62:998-1009. [PMID: 36806728 PMCID: PMC9933093 DOI: 10.1016/j.jaac.2022.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. METHOD This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. RESULTS Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). CONCLUSION Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
- Ben Hoi-Ching Wong
- East London NHS Foundation Trust, London, United Kingdom; King's College London, United Kingdom.
| | | | - Patricia Zavaleta-Ramírez
- Children's Psychiatric Hospital Dr. Juan N. Navarro., Servicios de Atención Psiquiatrica, Mexico City, Mexico
| | - Ines Bauda
- Medical University of Vienna, Vienna Austria
| | - Pamela Hoffman
- Yale Child Study Center, Child Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Patricia Ibeziako
- Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Laura Nussbaum
- Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Tauseef Mehdi
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Jovanka Tolmac
- Harrow Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Omer S Moghraby
- King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | | | - Sara Carucci
- "A. Cao" Pediatric Hospital, "ARNAS G. Brotzu" Hospital Trust, Cagliari, Italy, and the University of Cagliari, Italy
| | - Gyula Sofi
- Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Haseena Hussain
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, United Kingdom
| | - Alexandra S K Lloyd
- Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | | | - Ben Meadowcroft
- NHS Lothian, Child and Adolescent Mental Health Services, Edinburgh, United Kingdom
| | - Manish Rao
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | | | - Hakan Öğütlü
- Cognitive Behavioral Psychotherapies Association, Ankara, Turkey
| | - Eirini Skouta
- South London and Maudsley NHS Foundation Trust, London, United Kingdom; Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Rachel Elvins
- Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Isabel Boege
- ZfP Suedwuerttemberg, Child and Adolescent Psychiatry, Ravensburg, Germany, and University of Graz, Graz, Austria
| | | | - Marija Anderluh
- Child Psychiatry Unit, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | | | | | - Sara Uccella
- DINOGMI, University of Genoa, Genoa, Italy, and IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Dejan Stevanovic
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Marco Lamberti
- Child and Adolescent Psychiatry Unit, "Franz Tappeiner" Hospital, Merano, Italy
| | - Amy Piercey
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Peter Nagy
- Bethesda Children's Hospital, Budapest, Hungary
| | - Varun S Mehta
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Jie Li
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University
| | | | | | - Farah Rozali
- NHS Lothian, Child and Adolescent Mental Health Services, Edinburgh, United Kingdom
| | - Benjamin J Baig
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Isa M Noor
- Dr. Soeharto Heerdjan Teaching Mental Hospital, Jakarta, Indonesia
| | - Saori Fujita
- Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Narges Gholami
- Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Anna Vasileva
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg, Russia
| | - Katie Salucci
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Öznur Bilaç
- Manisa Celal Bayar University, Manisa, Turkey
| | | | | | | | | | - Fatima Youssef
- Dubai Department of Medical Education, Dubai, United Arab Emirates
| | - Salim Al-Huseini
- Psychiatry Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | | | | | | | | | - Dennis Ougrin
- King's College London, United Kingdom; Queen Mary University of London
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Mazumder H, Faizah F, Gain EP, Sharmin Eva I, Ferdouse Mou K, Saha N, Rahman F, Das J, Islam AMK, Nesa F, Hossain MM. Effectiveness of mental health interventions for older adults in South Asia: A scoping review. PLoS One 2023; 18:e0287883. [PMID: 37418368 PMCID: PMC10328249 DOI: 10.1371/journal.pone.0287883] [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: 11/28/2022] [Accepted: 06/14/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVE Mental health problems among older adults are becoming a growing public health concern in South Asia due to continued changes in population dynamics caused by declining fertility rates and increasing life expectancy. This scoping review aimed to explore and summarize evidence about mental health interventions and their impacts on geriatric mental health and highlight gaps and areas for future research. METHODS We searched six electronic databases and additional sources for experimental/non-experimental studies evaluating the effectiveness of geriatric mental health interventions in eight countries in the South Asia region from the date of inception of each database up to August 5, 2022. Following the preliminary screening, we extracted data from the eligible articles using a Microsoft Excel data extraction worksheet. We followed Joanna Briggs Institute (JBI) guidelines for this scoping review and reported evidence adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist. RESULTS From a total of 3432 potential articles retrieved, 19 were included in this review following pre-determined eligibility criteria. Across studies, mental health interventions can be broadly categorized into the following types- 1) traditional Yoga, Tai chi, or other meditative movements; 2) behavioral, occupational, or learning-based interventions; 3) tech-based interventions; 4) music therapy; and 5) new healthcare model. The evidence was predominantly based on India (n = 16), whereas three articles were identified from Pakistan. No article was found from six other South Asian countries. Depression and anxiety were the most frequent mental health outcomes, followed by quality of life, cognitive function, self-esteem, physical performance, and many more. CONCLUSION Although limited, this review found various interventions that have varying effects on different geriatric mental health outcomes. A handful of evidence on mental health intervention in South Asia indicates a lack of acknowledgment that may develop a serious paucity of geriatric mental health practice. Therefore, future researchers are encouraged to conduct empirical studies to understand disease burden, including associated factors of geriatric mental health, which may help to construct contextually appropriate mental health interventions in this region.
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Affiliation(s)
- Hoimonty Mazumder
- Division of Global Health, Research Initiative for Health Equity (RiHE), Khulna, Bangladesh
| | - Farah Faizah
- Division of Global Health, Research Initiative for Health Equity (RiHE), Khulna, Bangladesh
| | - Easter Protiva Gain
- Division of Global Health, Research Initiative for Health Equity (RiHE), Khulna, Bangladesh
| | - Irfath Sharmin Eva
- Response Plan, United Nations Children Fund (UNICEF) Bangladesh, Ukhiya, Bangladesh
| | - Kaniz Ferdouse Mou
- Division of Global Health, Research Initiative for Health Equity (RiHE), Khulna, Bangladesh
| | - Nobonita Saha
- Institute of Nutrition and Food Sciences, University of Dhaka, Dhaka, Bangladesh
| | - Farzana Rahman
- Department of Biochemistry, Armed Forces Medical College, Dhaka, Bangladesh
| | - Jyoti Das
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - A. M. Khairul Islam
- Division of Nutrition and Clinical Service, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fazilatun Nesa
- Division of Global Health, Research Initiative for Health Equity (RiHE), Khulna, Bangladesh
| | - M. Mahbub Hossain
- Division of Global Health, Research Initiative for Health Equity (RiHE), Khulna, Bangladesh
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Shania M, Handayani PW, Asih S. Designing High-Fidelity Mobile Health for Depression in Indonesian Adolescents Using Design Science Research: Mixed Method Approaches. JMIR Form Res 2023; 7:e48913. [PMID: 37399059 PMCID: PMC10365601 DOI: 10.2196/48913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND COVID-19 mitigation protocols, enacted to control the pandemic, have also been shown to have a negative impact on mental health, including the mental health of adolescents. The threat of being infected by SARS-CoV-2 and substantial changes in lifestyle, including limited social interaction due to stay-at-home orders, led to loneliness as well as depressive symptoms. However, offline psychological assistance is restricted, as psychologists are bounded by mitigation protocols. Further, not all adolescents' guardians are open to their children attending or have the means to pay for psychological service; thus, adolescents remain untreated. Having a mobile health (mHealth) app for mental health that uses monitoring, provides social networks, and delivers psychoeducation may provide a solution, especially in countries that have limited health facilities and mental health workers. OBJECTIVE This study aimed to design an mHealth app to help prevent and monitor depression in adolescents. The design of this mHealth app was carried out as a high-fidelity prototype. METHODS We used a design science research (DSR) methodology with 3 iterations and 8 golden rule guidelines. The first iteration used interviews, and the second and third iterations used mixed method approaches. The DSR stages include the following: (1) identify the problem; (2) define the solution; (3) define the solution objective; (4) develop, demonstrate, and evaluate the solution; and (5) communicate the solution. This study involved students and medical experts. RESULTS The first iteration resulted in a wireframe and prototype for the next iteration. The second iteration resulted in a System Usability Scale score of 67.27, indicating a good fit. In the third iteration, the system usefulness, information quality, interface quality, and overall values were 2.416, 2.341, 2.597, and 2.261, respectively, indicating a good design. Key features of this mHealth app include a mood tracker, community, activity target, and meditation, and supporting features that complement the design include education articles and early detection features. CONCLUSIONS Our findings provide guidance for health facilities and to design and implement future mHealth apps to help treat adolescent depression.
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Affiliation(s)
- Mila Shania
- Faculty of Psychology, University of Indonesia, Depok, Indonesia
| | | | - Sali Asih
- Faculty of Psychology, University of Indonesia, Depok, Indonesia
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Henriques Franca M, Bharat C, Novello E, Hwang I, Medina-Mora ME, Benjet C, Andrade LH, Vigo DV, Viana MC. Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil. Int J Ment Health Syst 2023; 17:19. [PMID: 37328832 DOI: 10.1186/s13033-023-00583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/18/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) contributes to a significant proportion of disease burden, disability, economic losses, and impact on need of treatment and health care in Brazil, but systematic information about its treatment coverage is scarce. This paper aims to estimate the gap in treatment coverage for MDD and identify key bottlenecks in obtaining adequate treatment among adult residents in the São Paulo Metropolitan area, Brazil. METHODS A representative face-to-face household survey was conducted among 2942 respondents aged 18+ years to assess 12-month MDD, characteristics of 12-month treatment received, and bottlenecks to deliver care through the World Mental Health Composite International Diagnostic Interview. RESULTS Among those with MDD (n = 491), 164 (33.3% [SE, 1.9]) were seen in health services, with an overall 66.7% treatment gap, and only 25.2% [SE, 4.2] received effective treatment coverage, which represents 8.5% of those in need, with a 91.5% gap in adequate care (66.4% due to lack of utilization and 25.1% due to inadequate quality and adherence). Critical service bottlenecks identified were: use of psychotropic medication (12.2 percentage points drop), use of antidepressants (6.5), adequate medication control (6.8), receiving psychotherapy (19.8). CONCLUSIONS This is the first study demonstrating the huge treatment gaps for MDD in Brazil, considering not only overall coverage, but also identifying specific quality- and user-adjusted bottlenecks in delivering pharmacological and psychotherapeutic care. These results call for urgent combined actions focused in reducing effective treatment gaps within services utilization, as well as in reducing gaps in availability and accessibility of services, and acceptability of care for those in need.
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Affiliation(s)
- Mariane Henriques Franca
- Post-Graduate Program in Public Health, Federal University of Espirito Santo, Vitória, ES, Brazil.
- National Drug & Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Chrianna Bharat
- National Drug & Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Laura Helena Andrade
- Nucleo de Epidemiologia Psiquiatrica, Departamento e Instituto de Psiquiatria, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo-LIM 23, Sao Paulo, Brazil
| | - Daniel V Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Viana
- Department of Social Medicine and Post-Graduate Program in Public Health, Federal University of Espirito Santo, Vitoria, ES, Brazil
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Tyagi V, Khan A, Siddiqui S, Kakra Abhilashi M, Dhurve P, Tugnawat D, Bhan A, Naslund JA. Development of a Digital Program for Training Community Health Workers in the Detection and Referral of Schizophrenia in Rural India. Psychiatr Q 2023; 94:141-163. [PMID: 36988785 PMCID: PMC10052309 DOI: 10.1007/s11126-023-10019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
This study aimed to develop and assess the acceptability of a digital program for training community health workers (CHWs) in the detection and referral of patients with schizophrenia in community settings in rural India. An iterative design process was employed. First, evidence-based content from existing community programs for schizophrenia care was incorporated into the curriculum, and reviewed by experts to ensure clinical utility and fidelity of the adapted content. Second, CHWs provided feedback on the appropriateness of language, content, and an initial prototype of the digital training program to ensure relevance for the local context. Focus group discussions were then used to understand the acceptability of the digital training prototype and to inform modifications to the design and layout. Qualitative data was analysed using a rapid thematic analysis approach based on predetermined topics pertaining to acceptability of the training content and digital platform. Development of the initial prototype involved content review by 13 subject matter experts with clinical expertise or experience accessing and receiving mental health services, and engagement of 23 CHWs, of which 11 provided feedback for contextualization of the training content and 12 participated in focus group discussions on the acceptability of the prototype. Additionally, 2 service-users with lived experience of schizophrenia contributed to initial testing of the digital training prototype and offered feedback in a focus group discussion. During contextualization of the training content, key feedback pertained to simplifying the language and presentation of the content by removing technical terms and including interactive content and images to enhance interest and engagement with the digital training. During prototype testing, CHWs shared their familiarity with similar symptoms but were unaware of schizophrenia as a treatable illness. They shared that training can help them identify symptoms of schizophrenia and connect patients with specialized care. They were also able to understand misconceptions and discrimination towards people with schizophrenia, and how to address these challenges by supporting others and spreading awareness in their communities. Participants also appreciated the digital training, as it could save them time and could be incorporated within their routine work. This study shows the acceptability of leveraging digital technology for building capacity of CHWs to support early detection and referral of schizophrenia in community settings in rural India. These findings can inform the subsequent evaluation of this digital training program to determine its impact on enhancing the knowledge and skills of CHWs.
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Affiliation(s)
| | | | | | | | | | | | | | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, USA.
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Castro-Ramirez F, Paz-Pérez MA, McGuire TC, Rankin O, Alfaro MCG, Audirac AM, Campuzano MLG, Coady P, Núñez-Delgado M, Manana J, Hernández-de la Rosa C, Tambedou T, Vergara GA, Barranco LA, Cudris-Torres L, Nock MK, Naslund JA, Benjet C. A Qualitative Examination of the Impact of Suicidal Thoughts and Behavior on Help-Seeking Among University Students in Colombia and Mexico. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2023; 33:67-80. [PMID: 37680902 PMCID: PMC10482072 DOI: 10.1016/j.jbct.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
This study examined descriptions of suicidal thoughts and behavior (STB) to identify risk and protective factors that may present in clinical settings among university students from Latin America. Our focus was on answering the following key questions: How are suicidal thoughts and behavior described? What are reasons for wanting to die and for living? What impact do STBs have on motivations to seek or avoid psychological treatment? To this end, 55 qualitative interviews were completed with university students from Colombia and Mexico who recently endorsed emotional difficulties in the World Mental Health International College Student (WMH-ICS) surveys. Interviews were coded to identify themes specific to STBs. Findings revealed insight on symptom presentations and consequences of STBs. Participants described uncontrollable somatic symptoms during periods of high suicide risk, which serves as a relevant clinical marker for health providers. An important reason for living was to avoid suffering for family, which was protective against suicide and motivates familial involvement in treatment planning. Participants sought solutions to emotional problems after experiencing STBs, including psychological treatment. Cultural stigma of mental illness induced feelings of shame and burden, which led to avolition, avoidance, and nondisclosure of symptom severity. This study provides insight into the utility of evaluating cultural context in (a) detecting antecedents to STBs frequently reported as somatic symptoms, (b) identifying protective factors against suicide, and (c) recognizing how stigma of mental illness and suicide, shame avoidance, and familism might influence personal motivations to seek or avoid help for emotional distress.
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Affiliation(s)
| | | | | | - Osiris Rankin
- Department of Psychology, Harvard University, United States
| | | | | | | | - Parker Coady
- Department of Psychology, Harvard University, United States
| | | | | | | | - Tida Tambedou
- Department of Psychology, Harvard University, United States
| | | | | | | | - Matthew K Nock
- Department of Psychology, Harvard University, United States
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, United States
| | - Corina Benjet
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México City, México
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Drews-Windeck E, Greenwood K, Cavanagh K. A systematic review and meta-analysis of digital interventions targeted at individuals with borderline personality disorder (BPD), emotionally unstable personality disorder (EUPD), and related symptoms. J Clin Psychol 2023. [PMID: 37185891 DOI: 10.1002/jclp.23523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 02/22/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The present review investigates the impact of digital interventions for individuals with features of borderline personality disorder (BPD)/emotional unstable personality disorder (EUPD) as digital interventions show promise as therapeutic tools in underserved groups. BPD/EUPD features are identified as clinically relevant, yet previous reviews on the use of digital interventions fail to include subthreshold symptomatology. METHODS Five online databases were searched for terminology in three categories: BPD/EUPD and related symptoms, mental-health interventions, and digital technology. Additionally, four relevant journals and two trial registers were searched for additional papers meeting the inclusion criteria. RESULTS Twelve articles met all inclusion criteria. Meta-analyses revealed statistically significant differences in symptom measures between intervention and control groups at postintervention and decreases in BPD/EUPD symptomatology and well-being from pre- to postintervention. Service users' engagement, satisfaction, and acceptability of interventions were high. Results support the previous literature on the value of using digital interventions in populations with BPD/EUPD. CONCLUSION Overall, it was identified that digital interventions show promise for successful implementation with this population.
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Affiliation(s)
- Elea Drews-Windeck
- School of Psychology, The University of Sussex, Brighton, UK
- Research & Development and Digital Services, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Kathryn Greenwood
- School of Psychology, The University of Sussex, Brighton, UK
- Research & Development and Digital Services, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Kate Cavanagh
- School of Psychology, The University of Sussex, Brighton, UK
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Bondre AP, Shrivastava R, Raghuram H, Tugnawat D, Khan A, Gupta S, Kumar M, Mehta UM, Keshavan M, Lakhtakia T, Chand PK, Thirthalli J, Patel V, Torous J, Rozatkar AR, Naslund JA, Bhan A. A qualitative exploration of perceived needs and barriers of individuals with schizophrenia, caregivers and clinicians in using mental health applications in Madhya Pradesh, India. SSM - MENTAL HEALTH 2022; 2:100063. [PMID: 36688236 PMCID: PMC9792372 DOI: 10.1016/j.ssmmh.2022.100063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/27/2021] [Accepted: 01/26/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction About 3.5 million people are living with schizophrenia in India, with most failing to receive minimally adequate care. Digital mental health applications could potentially decrease this treatment gap; however, these applications should be tailored to meet the needs and overcoming barriers of its end-users to ensure their adoption and sustained usage. Few studies in India have explored the perspectives of target stakeholders to understand how digital tools could be viable for supporting care. Therefore, this study explores the perceived needs and barriers of patients with schizophrenia, caregivers and clinicians in using digital mental health applications. Methods Focus group discussions (FGDs) were conducted with patients having schizophrenia attending outpatient clinics at a government tertiary hospital, and their caregivers, and mental health clinicians in Bhopal, Madhya Pradesh, India. FGDs were audio-recorded and coded. Framework analysis was employed to guide the analysis, involving deductive and inductive generation of themes, data triangulation and comparison of perspectives between participant groups. Results Six FGDs were conducted with individuals with schizophrenia (n = 11), their caregivers (n = 14), and mental health clinicians (n = 19). Four a priori themes were established: a) Prior experiences with health applications; b) Content of a mental health application; c) Involvement of caregivers in mental health application usage and d) Supporting doctors' work through mental health applications. Additionally, two themes were generated inductively: a) Qualities of a mental health application and b) Data privacy and confidentiality. Conclusion Exploration of stakeholder perspectives on the content, features, and uses of mental health applications is crucial to yield initial insights about the use of these digital programs in India. This study generated a multitude of suggestions on app functionality and components, which can guide ongoing efforts to develop and deliver digital mental health applications for patients living with schizophrenia in low-resource settings, with limited access to mental health services.
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Affiliation(s)
- Ameya P. Bondre
- Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India,Corresponding author. 120 Deepak Society: Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India.
| | - Ritu Shrivastava
- Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India
| | | | - Deepak Tugnawat
- Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India
| | - Azaz Khan
- Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India
| | - Snehil Gupta
- All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bagh Swaniya, Bhopal, Madhya Pradesh, 462020, India
| | - Mohit Kumar
- All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bagh Swaniya, Bhopal, Madhya Pradesh, 462020, India
| | - Urvakhsh Meherwan Mehta
- National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India
| | - Matcheri Keshavan
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center (BIDMC), 330 Brookline Ave, Boston, MA, 02215, United States
| | - Tanvi Lakhtakia
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center (BIDMC), 330 Brookline Ave, Boston, MA, 02215, United States
| | - Prabhat Kumar Chand
- National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India
| | - Jagadisha Thirthalli
- National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India
| | - Vikram Patel
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center (BIDMC), 330 Brookline Ave, Boston, MA, 02215, United States
| | - Abhijit R. Rozatkar
- All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bagh Swaniya, Bhopal, Madhya Pradesh, 462020, India
| | - John A. Naslund
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Anant Bhan
- Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India
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Naslund JA, Tyagi V, Khan A, Siddiqui S, Kakra Abhilashi M, Dhurve P, Mehta UM, Rozatkar A, Bhatia U, Vartak A, Torous J, Tugnawat D, Bhan A. Schizophrenia Assessment, Referral and Awareness Training for Health Auxiliaries (SARATHA): Protocol for a Mixed-Methods Pilot Study in Rural India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14936. [PMID: 36429654 PMCID: PMC9690971 DOI: 10.3390/ijerph192214936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Workforce shortages pose major obstacles to the timely detection and treatment of schizophrenia, particularly in low-income and middle-income countries. The SARATHA (Schizophrenia Assessment, Referral, and Awareness Training for Health Auxiliaries) project involves the systematic development, iterative refinement, and pilot testing of a digital program for training community health workers in the early detection and referral of schizophrenia in primary care settings in rural India. METHODS SARATHA is a three-phase study. Phase 1 involves consulting with experts and clinicians, and drawing from existing evidence to inform the development of a curriculum for training community health workers. Phase 2 consists of designing and digitizing the training content for delivery on a smartphone app. Design workshops and focus group discussions will be conducted to seek input from community health workers and service users living with schizophrenia to guide revisions and refinements to the program content. Lastly, Phase 3 entails piloting the training program with a target sample of 20 community health workers to assess feasibility and acceptability. Preliminary effectiveness will be explored, as measured by community health workers' changes in knowledge about schizophrenia and the program content after completing the training. DISCUSSION If successful, this digital training program will offer a potentially scalable approach for building capacity of frontline community health workers towards reducing delays in early detection of schizophrenia in primary care settings in rural India. This study can inform efforts to improve treatment outcomes for persons living with schizophrenia in low-resource settings.
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Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | | | | | - Saher Siddiqui
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | | | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Abhijit Rozatkar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal 462026, India
| | - Urvita Bhatia
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford OX3 0BP, UK
- Sangath, Porvorim 403501, India
| | - Anil Vartak
- Schizophrenia Awareness Association, Pune 411041, India
| | - John Torous
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Telehealth interventions for substance use disorders in low- and- middle income countries: A scoping review. PLOS DIGITAL HEALTH 2022; 1:e0000125. [PMID: 36812539 PMCID: PMC9931245 DOI: 10.1371/journal.pdig.0000125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/09/2022] [Indexed: 02/24/2023]
Abstract
The increasing prevalence and magnitude of harmful effects of substance use disorders (SUDs) in low- and middle-income countries (LMICs) make it imperative to embrace interventions which are acceptable, feasible, and effective in reducing this burden. Globally, the use of telehealth interventions is increasingly being explored as possible effective approaches in the management of SUDs. Using a scoping review of literature, this article summarizes and evaluates evidence for the acceptability, feasibility, and effectiveness of telehealth interventions for SUDs in LMICs. Searches were conducted in five bibliographic databases: PubMed, Psych INFO, Web of Science, Cumulative Index of Nursing and Allied Professionals and the Cochrane database of systematic review. Studies from LMICs which described a telehealth modality, identified at least one psychoactive substance use among participants, and methods that either compared outcomes using pre- and post-intervention data, treatment versus comparison groups, post-intervention data, behavioral or health outcome, and outcome of either acceptability, feasibility, and/or effectiveness were included. Data is presented in a narrative summary using charts, graphs, and tables. The search produced 39 articles across 14 countries which fulfilled our eligibility criteria over a period of 10 years (2010 to 2020). Research on this topic increased remarkably in the latter five years with the highest number of studies in 2019. The identified studies were heterogeneous in their methods and various telecommunication modalities were used to evaluate substance use disorder, with cigarette smoking as the most assessed. Most studies used quantitative methods. The highest number of included studies were from China and Brazil, and only two studies from Africa assessed telehealth interventions for SUDs. There has been an increasingly significant body of literature which evaluates telehealth interventions for SUDs in LMICs. Overall, telehealth interventions showed promising acceptability, feasibility, and effectiveness for SUDs. This article identifies gaps and strengths and suggests directions for future research.
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Stein DJ, Shoptaw SJ, Vigo DV, Lund C, Cuijpers P, Bantjes J, Sartorius N, Maj M. Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration. World Psychiatry 2022; 21:393-414. [PMID: 36073709 PMCID: PMC9453916 DOI: 10.1002/wps.20998] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Psychiatry has always been characterized by a range of different models of and approaches to mental disorder, which have sometimes brought progress in clinical practice, but have often also been accompanied by critique from within and without the field. Psychiatric nosology has been a particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in crisis, and to advocacy for entirely new paradigms for diagnosis and assessment. When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this approach has received significant critique, being considered by some observers overly eclectic and vague. Despite the development of a range of evidence-based pharmacotherapies and psychotherapies, current evidence points to both a treatment gap and a research-practice gap in mental health. In this paper, after considering current clinical practice, we discuss some proposed novel perspectives that have recently achieved particular prominence and may significantly impact psychiatric practice and research in the future: clinical neuroscience and personalized pharmacotherapy; novel statistical approaches to psychiatric nosology, assessment and research; deinstitutionalization and community mental health care; the scale-up of evidence-based psychotherapy; digital phenotyping and digital therapies; and global mental health and task-sharing approaches. We consider the extent to which proposed transitions from current practices to novel approaches reflect hype or hope. Our review indicates that each of the novel perspectives contributes important insights that allow hope for the future, but also that each provides only a partial view, and that any promise of a paradigm shift for the field is not well grounded. We conclude that there have been crucial advances in psychiatric diagnosis and treatment in recent decades; that, despite this important progress, there is considerable need for further improvements in assessment and intervention; and that such improvements will likely not be achieved by any specific paradigm shifts in psychiatric practice and research, but rather by incremental progress and iterative integration.
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Affiliation(s)
- Dan J. Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape TownCape TownSouth Africa
| | - Steven J. Shoptaw
- Division of Family MedicineDavid Geffen School of Medicine, University of California Los AngelesLos AngelesCAUSA
| | - Daniel V. Vigo
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental PsychologyAmsterdam Public Health Research Institute, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jason Bantjes
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilCape TownSouth Africa
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
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Oliveira ACN, Guariente SMM, Zazula R, Mesas AE, Oliveira CEC, Reiche EMV, Nunes SOV. Hybrid and Remote Psychosocial Interventions Focused on Weight and Sedentary Behavior Management Among Patients with Severe Mental Illnesses: a Systematic Review. Psychiatr Q 2022; 93:813-840. [PMID: 35739407 PMCID: PMC9225878 DOI: 10.1007/s11126-022-09994-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/29/2022]
Abstract
Severe mental illness could be defined through its diagnosis, disability, and duration, and one of their main characteristics is the high prevalence of some clinical conditions such as obesity and metabolic syndrome. Although the promotion of a healthier lifestyle has been demonstrated as an effective strategy to reduce both body mass index and abdominal circumference in this population, there is a lack of studies focusing on digital intervention in this population. The aim of this systematic review was to evaluate the efficacy of studies that used digital technologies to reduce weight, body mass index (BMI) and abdominal circumference in individuals with severe mental illness. This current review also compared remote and hybrid interventions, the effects of those interventions in metabolic biomarkers as well as in the development of a healthier lifestyle. The main findings included the following: (a) the use of digital devices or strategies might be feasible and useful to reduce sedentary behavior among individuals with severe mental illnesses, 2) most interventions used digital pedometers and mobile phone communication (either text messages or phone calls) as main strategies, 3) all remote interventions and six of nine hybrid interventions found significant outcomes in favor of their interventions. In conclusion, even with a limited number of studies promoting healthier lifestyle through digital interventions among individuals with severe mental illnesses, evidence from studies included in this review showed that they might be useful to improve a healthier lifestyle and increase the frequency of physical activity behavior.
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Affiliation(s)
- Ana Cecília Novaes Oliveira
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
| | | | - Robson Zazula
- School of Medicine, Federal University of Latin American Integration, Foz do Iguacu, Parana, 85870-901, Brazil.
| | | | | | - Edna Maria Vissosi Reiche
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Parana, Brazil
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Potential and Pitfalls of Mobile Mental Health Apps in Traditional Treatment: An Umbrella Review. J Pers Med 2022; 12:jpm12091376. [PMID: 36143161 PMCID: PMC9505389 DOI: 10.3390/jpm12091376] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 12/25/2022] Open
Abstract
While the rapid growth of mobile mental health applications has offered an avenue of support unbridled by physical distance, time, and cost, the digitalization of traditional interventions has also triggered doubts surrounding their effectiveness and safety. Given the need for a more comprehensive and up-to-date understanding of mobile mental health apps in traditional treatment, this umbrella review provides a holistic summary of their key potential and pitfalls. A total of 36 reviews published between 2014 and 2022—including systematic reviews, meta-analyses, scoping reviews, and literature reviews—were identified from the Cochrane library, Medline (via PubMed Central), and Scopus databases. The majority of results supported the key potential of apps in helping to (1) provide timely support, (2) ease the costs of mental healthcare, (3) combat stigma in help-seeking, and (4) enhance therapeutic outcomes. Our results also identified common themes of apps’ pitfalls (i.e., challenges faced by app users), including (1) user engagement issues, (2) safety issues in emergencies, (3) privacy and confidentiality breaches, and (4) the utilization of non-evidence-based approaches. We synthesize the potential and pitfalls of mental health apps provided by the reviews and outline critical avenues for future research.
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Synthesizing Stakeholders Perspectives on Online Psychological Interventions to Improve the Mental Health of the Italian Population during the COVID-19 Pandemic: An Online Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127008. [PMID: 35742257 PMCID: PMC9222987 DOI: 10.3390/ijerph19127008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic is expected to significantly increase the prevalence of mental health problems, thus raising the need for psychological support interventions around the world. Online psychological interventions have already been shown to be an effective solution to promote psychological treatments. Nevertheless, planning and developing an online intervention, involving possible stakeholders, might facilitate the dissemination of, willingness to use, and success of the future intervention. This study aims to explore and compare the experiences that Italians living in Italy and abroad had with available support services during the COVID-19 pandemic, their needs, and attitudes, as well as possible barriers to online psychological interventions. A sample of 1024 Italians (F = 69.8%; mean age = 41.3; SD = 15.3) was recruited through social media platforms and personal contacts and they were asked to complete an online survey. Results showed that perceived psychological distress during the COVID-19 pandemic improved. In Europe, psychological support was delivered mainly in person (69.0%), while online interventions were primarily used in extra-European countries (57%). Then, only 44% of the total sample was interested in trying an online psychological intervention. Various advantages and disadvantages were defined by stakeholders: The main advantages were the reduction in geographical distances, economic reasons, and the reduction in the waiting list; The main disadvantages were problems with technology, low motivation of users, and privacy/safety reasons. These data made it possible to improve the knowledge regarding the views and attitudes that Italians have about online psychological interventions, and shed light on how to increase the uptake of digital health.
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Bell IH, Thompson A, Valentine L, Adams S, Alvarez-Jimenez M, Nicholas J. Ownership, Use of, and Interest in Digital Mental Health Technologies Among Clinicians and Young People Across a Spectrum of Clinical Care Needs: Cross-sectional Survey. JMIR Ment Health 2022; 9:e30716. [PMID: 35544295 PMCID: PMC9133993 DOI: 10.2196/30716] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/14/2021] [Accepted: 12/22/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is currently an increased interest in and acceptance of technology-enabled mental health care. To adequately harness this opportunity, it is critical that the design and development of digital mental health technologies be informed by the needs and preferences of end users. Despite young people and clinicians being the predominant users of such technologies, few studies have examined their perspectives on different digital mental health technologies. OBJECTIVE This study aims to understand the technologies that young people have access to and use in their everyday lives and what applications of these technologies they are interested in to support their mental health. The study also explores the technologies that youth mental health clinicians currently use within their practice and what applications of these technologies they are interested in to support their clients' mental health. METHODS Youth mental health service users (aged 12-25 years) from both primary and specialist services, young people from the general population (aged 16-25 years), and youth mental health clinicians completed a web-based survey exploring technology ownership, use of, and interest levels in using different digital interventions to support their mental health or that of their clients. RESULTS A total of 588 young people and 73 youth mental health clinicians completed the survey. Smartphone ownership or private access among young people within mental health services and the general population was universal (611/617, 99%), with high levels of access to computers and social media. Youth technology use was frequent, with 63.3% (387/611) using smartphones several times an hour. Clinicians reported using smartphones (61/76, 80%) and video chat (69/76, 91%) commonly in clinical practice and found them to be helpful. Approximately 50% (296/609) of the young people used mental health apps, which was significantly less than the clinicians (χ23=28.8, n=670; P<.001). Similarly, clinicians were significantly more interested in using technology for mental health support than young people (H3=55.90; P<.001), with 100% (73/73) of clinicians being at least slightly interested in technology to support mental health compared with 88% (520/591) of young people. Follow-up tests revealed no difference in interest between young people from the general population, primary mental health services, and specialist mental health services (all P>.23). Young people were most interested in web-based self-help, mobile self-help, and blended therapy. CONCLUSIONS Technology access is pervasive among young people within and outside of youth mental health services; clinicians are already using technology to support clinical care, and there is widespread interest in digital mental health technologies among these groups of end users. These findings provide important insights into the perspectives of young people and clinicians regarding the value of digital mental health interventions in supporting youth mental health.
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Affiliation(s)
- Imogen H Bell
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Andrew Thompson
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.,Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Lee Valentine
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | | | - Mario Alvarez-Jimenez
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Jennifer Nicholas
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
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Lara MA, Patiño P, Tiburcio M, Navarrete L. Satisfaction and Acceptability Ratings of a Web-Based Self-help Intervention for Depression: Retrospective Cross-sectional Study From a Resource-Limited Country. JMIR Form Res 2022; 6:e29566. [PMID: 35377324 PMCID: PMC9016498 DOI: 10.2196/29566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/25/2021] [Accepted: 12/03/2021] [Indexed: 01/27/2023] Open
Abstract
Background Web-based interventions are at an early stage in non–English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version. Objective The aim of this study is to explore participants’ satisfaction and acceptability for the second version of HDep. Methods A retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]). Results In all groups, users experienced high levels of depressive symptoms (189/191, 98.9%; Center for Epidemiological Studies Scale-Depression >16). Moderate levels of satisfaction (HPUs: mean 21.9, SD 6.7; PUs: mean 21.1, SD 5.8; range: 8-32) and acceptability (HPUs: mean 13.8, SD 3.9; PUs: mean 13.9, SD 3.2; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (odds ratio [OR] 3.4, 95% CI 1.1-10.0), whereas among PUs, older respondents (OR 1.04, 95% CI 1.01-1.08), those with paid work (OR 3.1, 95% CI 2.4-7.6), those who had not been in therapy (OR 2.42, 95% CI 1.09-5.98), and those who had not attempted suicide (OR 3.4, 95% CI 1.1-11.1) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work (OR 2.5, 95% CI 1.1-5.5), those who had not been in therapy (OR 3.1, 95% CI 1.3-7.3), those without disability (OR 2.9, 95% CI 1.3-6.6), and those who had not attempted suicide (OR 2.6, 95% CI 1.0-6.6) showed higher acceptability. Conclusions HDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative–quantitative study from a low- to middle-income, non–English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence.
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Affiliation(s)
- Ma Asunción Lara
- Department of Psychosocial Studies in Specific Population, Division of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Pamela Patiño
- Division of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Marcela Tiburcio
- Department of Social Sciences in Health, Division of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Laura Navarrete
- Department of Psychosocial Studies in Specific Population, Division of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
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Ibragimov K, Palma M, Keane G, Ousley J, Crowe M, Carreño C, Casas G, Mills C, Llosa A. Shifting to Tele-Mental Health in humanitarian and crisis settings: an evaluation of Médecins Sans Frontières experience during the COVID-19 pandemic. Confl Health 2022; 16:6. [PMID: 35164807 PMCID: PMC8845383 DOI: 10.1186/s13031-022-00437-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/01/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND 'Tele-Mental Health (MH) services,' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format. METHODS From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred. RESULTS Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure. CONCLUSION Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
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Affiliation(s)
| | - Miguel Palma
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France.
| | - Gregory Keane
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
| | - Janet Ousley
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
| | | | | | - German Casas
- Fundación Santa Fe University Hospital, Universidad de Los Andes, Bogotá, Colombia
| | - Clair Mills
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
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Lattie EG, Stiles-Shields C, Graham AK. An overview of and recommendations for more accessible digital mental health services. NATURE REVIEWS PSYCHOLOGY 2022; 1:87-100. [PMID: 38515434 PMCID: PMC10956902 DOI: 10.1038/s44159-021-00003-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 03/23/2024]
Abstract
Mental health concerns are common, and various evidence-based interventions for mental health conditions have been developed. However, many people have difficulty accessing appropriate mental health care and this has been exacerbated by the COVID-19 pandemic. Digital mental health services, such as those delivered by mobile phone or web-based platforms, offer the possibility of expanding the reach and accessibility of mental health care. To achieve this goal, digital mental health interventions and plans for their implementation must be designed with the end users in mind. In this Review, we describe the evidence base for digital mental health interventions across various diagnoses and treatment targets. Then, we explain the different formats for digital mental health intervention delivery, and offer considerations for their use across key age groups. We discuss the role that the COVID-19 pandemic has played in emphasizing the value of these interventions, and offer considerations for ensuring equity in access to digital mental health interventions among diverse populations. As healthcare providers continue to embrace the role that technology can play in broadening access to care, the design and implementation of digital mental healthcare solutions must be carefully considered to maximize their effectiveness and accessibility.
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Affiliation(s)
- Emily G. Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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Garbett KM, Craddock N, Haywood S, Nasution K, White P, Saraswati LA, Medise BE, Diedrichs PC, Williamson H. A Novel, Scalable Social Media-Based Intervention ("Warna-Warni Waktu") to Reduce Body Dissatisfaction Among Young Indonesian Women: Protocol for a Parallel Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e33596. [PMID: 35089154 PMCID: PMC8838567 DOI: 10.2196/33596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/08/2021] [Accepted: 11/30/2021] [Indexed: 01/14/2023] Open
Abstract
Background Despite the prevalence of body dissatisfaction among young Indonesian women and its consequential negative impacts, there are currently no evidence-based, culturally appropriate interventions to tackle this issue. Therefore, there is a need to develop scalable, cost-effective, and accessible interventions to improve body image among this population. Objective This paper describes the study protocol of a parallel randomized controlled trial to evaluate the effectiveness of Warna-Warni Waktu, a social media–based intervention that aims to reduce state and trait body dissatisfaction and improve mood among young Indonesian women aged 15-19 years. Methods The trial will take place online. Approximately 1800 young women from 10 cities in Indonesia, evenly split across the ages of 15-19 years, will be recruited via a local research agency’s established research panel. Participants will be randomly allocated to the intervention condition or a waitlist control condition. The intervention consists of six 5-minute videos, with each video supplemented with up to five brief interactive activities. The videos (and associated activities) will be delivered at a rate of one per day across 6 days. All participants will complete three self-report assessments: at baseline (Day 1), 1 day following the intervention (Day 9), and 1 month following the intervention (Day 36). The primary outcome will be change in trait body dissatisfaction. Secondary outcomes include change in internalization of appearance ideals, trait mood, and skin shade satisfaction. Intervention effectiveness on these outcomes will be analyzed using linear mixed models by a statistician blinded to the randomized condition. Intervention participants will also complete state measures of body satisfaction and mood before and after watching each video to assess the immediate impact of each video. This secondary analysis of state measures will be conducted at the within-group level. Results Recruitment began in October 2021, with baseline assessments underway shortly thereafter. The results of the study will be submitted for publication in 2022. Conclusions This is the first study to evaluate an eHealth intervention aimed at reducing body dissatisfaction among young Indonesian women. If effective, the intervention will be disseminated to over half a million young women in Indonesia via Facebook, Instagram, and YouTube. Trial Registration ClinicalTrials.gov NCT05023213; https://clinicaltrials.gov/ct2/show/NCT05023213 International Registered Report Identifier (IRRID) PRR1-10.2196/33596
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Affiliation(s)
- Kirsty May Garbett
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Nadia Craddock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Sharon Haywood
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, United Kingdom
| | - L Ayu Saraswati
- Department of Women, Gender, and Sexuality Studies, University of Hawaii, Manoa, HI, United States
| | | | | | | | - Phillippa C Diedrichs
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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De Witte NAJ, Joris S, Van Assche E, Van Daele T. Technological and Digital Interventions for Mental Health and Wellbeing: An Overview of Systematic Reviews. Front Digit Health 2022; 3:754337. [PMID: 35005695 PMCID: PMC8732948 DOI: 10.3389/fdgth.2021.754337] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/07/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Research increasingly shows how selective and targeted use of technology within care and welfare can have several advantages including improved quality of care and active user involvement. Purpose: The current overview of reviews aims to summarize the research on the effectiveness of technology for mental health and wellbeing. The goal is to highlight and structure the diverse combinations of technologies and interventions used so far, rather than to summarize the effectiveness of singular approaches. Methods: The current overview includes reviews published in the past five years with a focus on effectiveness of digital and technological interventions targeting mental health and wellbeing. Results: A total of 246 reviews could be included. All reviews examined the effectiveness of digital and technological interventions in the context of care and welfare. A combination of two taxonomies was created through qualitative analysis, based on the retrieved interventions and technologies in the reviews. Review classification shows a predominance of reviews on psychotherapeutic interventions using computers and smartphones. It is furthermore shown that when smartphone applications as stand-alone technology are researched, the primary focus is on self-help, and that extended reality is the most researched emerging technology to date. Conclusion: This overview of reviews shows that a wide range of interventions and technologies, with varying focus and target populations, have been studied in the field of care and wellbeing. The current overview of reviews is a first step to add structure to this rapidly changing field and may guide both researchers and clinicians in further exploring the evidence-base of particular approaches.
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Affiliation(s)
- Nele A J De Witte
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Steven Joris
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Eva Van Assche
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Tom Van Daele
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
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Karamagi HC, Ben Charif A, Ngusbrhan Kidane S, Yohanes T, Kariuki D, Titus M, Batungwanayo C, Seydi ABW, Berhane A, Nzinga J, Njuguna D, Kipruto HK, Andrews Annan E, Droti B. Investments for effective functionality of health systems towards Universal Health Coverage in Africa: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001076. [PMID: 36962623 PMCID: PMC10021830 DOI: 10.1371/journal.pgph.0001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
Abstract
The health challenges in Africa underscore the importance of effectively investing in health systems. Unfortunately, there is no information on systems investments adequate for an effective functional health system. We aimed to address this by conducting a scoping review of existing evidence following the Joanna Briggs Institute Manual for Evidence Synthesis and preregistered with the Open Science Framework (https://osf.io/bvg4z). We included any empirical research describing interventions that contributed to the functionality of health systems in Africa or any low-income or lower-middle-income regions. We searched Web of Science, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and ERIC from their inception, and hand-searched other relevant sources. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. We identified 554 unique reports describing 575 interventions, of which 495 reported evidence of effectiveness. Most interventions were undertaken in Africa (80.9%), covered multiple elements of health systems (median: 3), and focused on service delivery (77.4%) and health workforce (65.6%). Effective interventions contributed to improving single (35.6%) or multiple (64.4%) capacities of health systems: access to essential services (75.6%), quality of care (70.5%), demand for essential services (38.6%), or health systems resilience (13.5%). For example, telemedicine models which covered software (technologies) and hardware (health workers) elements were used as a strategy to address issues of access to essential services. We inventoried these effective interventions for improving health systems functionality in Africa. Further analyses could deepen understanding of how such interventions differ in their incorporation of evidence for potential scale across African countries.
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Affiliation(s)
- Humphrey Cyprian Karamagi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Solyana Ngusbrhan Kidane
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Tewelde Yohanes
- Division of Policy and Planning, Ministry of Health, Asmara, Eritrea
| | | | | | | | - Aminata Binetou-Wahebine Seydi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Araia Berhane
- Conmmunicable Diseases Control Division, Ministry of Health, Asmara, Eritrea
| | - Jacinta Nzinga
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Njuguna
- Health Economist, Ministry of Health, Nairobi, Kenya
| | - Hillary Kipchumba Kipruto
- Essential Drugs and Medicines, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Edith Andrews Annan
- Essential Drugs and Medicines, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Benson Droti
- Health Information Systems, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Congo
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Leung C, Pei J, Hudec K, Shams F, Munthali R, Vigo D. The effects of non-clinician guidance on effectiveness and process outcomes of digital mental health interventions: A systematic review and meta-analysis (Preprint). J Med Internet Res 2021; 24:e36004. [PMID: 35511463 PMCID: PMC9244656 DOI: 10.2196/36004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 01/22/2023] Open
Abstract
Background Digital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (ie, psychologists and physicians) into digital mental health interventions has become common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other nonclinicians) can help reduce costs and increase accessibility. Objective This systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of nonclinician-guided digital mental health interventions. Methods Four databases (MEDLINE, Embase, CINAHL, and PsycINFO) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals that focus on digital intervention were hand searched; gray literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane risk-of-bias tool version 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Nonclinician-guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions. Results Thirteen studies qualified for inclusion. Nonclinician-guided interventions yielded higher posttreatment effectiveness outcomes when compared to conditions involving control programs (eg, online psychoeducation and monitored attention control) or wait-list controls (k=7, Hedges g=–0.73; 95% CI –1.08 to –0.38). There were also significant differences between nonclinician-guided interventions and unguided interventions (k=6, Hedges g=–0.17; 95% CI –0.23 to –0.11). In addition, nonclinician-guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08; 95% CI –0.01 to 0.17). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualifications of the individual performing the intervention, and that the presence of a nonclinician guide improves effectiveness outcomes compared to having no guide. Nonclinician-guided interventions did not yield significantly different adherence outcomes when compared with unguided interventions (k=3, odds ratio 1.58; 95% CI 0.51 to 4.92), although a general trend of improved adherence was observed within nonclinician-guided interventions. Conclusions Integrating paraprofessionals and nonclinicians appears to improve the outcomes of digital mental health interventions, and may also enhance adherence outcomes (though this trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (ie, psychosocial support, therapeutic alliance, and technical augmentation) and their associated outcomes. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020191226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=191226
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Affiliation(s)
- Calista Leung
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Pei
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kristen Hudec
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Farhud Shams
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Munthali
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Vigo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Orsolini L, Jatchavala C, Noor IM, Ransing R, Satake Y, Shoib S, Shah B, Ullah I, Volpe U. Training and education in digital psychiatry: A perspective from Asia-Pacific region. Asia Pac Psychiatry 2021; 13:e12501. [PMID: 34873845 PMCID: PMC9285069 DOI: 10.1111/appy.12501] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Digital mental health interventions and digital psychiatry have been rapidly implemented over the past decade, particularly with the intent to offer a cost-effective solution in those circumstances in which the current mental health services and infrastructure are not able to properly accommodate the patients' needs. However, mental health workforce is often poorly theoretical/practical trained in digital psychiatry and in delivering remote consultations safely and effectively, not being common to own curricula-specific training requirements in digital psychiatry and skills. METHODS A web-based international cross-sectional survey was carried out by a working group constituted by one or two national representative(s) of each WHO South-East Asia and Western Pacific Regions (APAC), with the aim to evaluate the level of training, knowledge, experience, and perception regarding the topic of digital psychiatry in a sample constituted by medical students, psychiatry trainees, and early career psychiatrists from APAC. RESULTS An overall lack of theoretical and/or practical training on new digital tools and digital health interventions in psychiatry was observed. The level of training influences knowledge background, which, in turns, influences young professionals' perceptions and opinions regarding digital psychiatry and interventions in mental health. CONCLUSION Implementing psychiatry training programs may significantly improve the level of knowledge and use of digital tools in mental healthcare. Moreover, mental health services and infrastructures should be properly adapted to the digital era, considering the overall weak and heterogeneous technical support and equipment, issues of internet connectivity, and other administrative-related challenges observed in APAC.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | | | | | - Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Yuto Satake
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Sheikh Shoib
- Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital (JLNMH), Srinagar, Jammu and Kashmir, India
| | - Bigya Shah
- Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
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Naslund JA, Deng D. Addressing Mental Health Stigma in Low-Income and Middle-Income Countries: A New Frontier for Digital Mental Health. ETHICS, MEDICINE, AND PUBLIC HEALTH 2021; 19:100719. [PMID: 35083375 PMCID: PMC8786211 DOI: 10.1016/j.jemep.2021.100719] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND Mental health stigma is a major barrier to seeking help, and leads to poor quality of life and social withdrawal for individuals living with mental illness. These concerns are especially severe in low-income and middle-income countries (LMICs) that face a disproportionate share of the global burden of mental illnesses. With growing access to digital technologies in LMICs, there may be new opportunities to address mental health stigma. This review considers the potential for emerging digital technologies to advance efforts to challenge mental health stigma in LMICs. METHODS Promising digital strategies to reduce mental health stigma were identified through searching the peer-reviewed literature. Drawing from the Mental Illness Stigma Framework, these studies of digital strategies were grouped into three categories: 1) protest; 2) education, and 3) contact. RESULTS These three categories align with established stigma reduction programs. Digital strategies could expand the reach of or complement existing efforts. There are challenges with digital stigma reduction strategies, including the need for cultural adaptation of these programs to diverse contexts and settings, consideration of reliable measurement of mental health related stigma, and risks that digital media could perpetuate the spread of misinformation and exacerbate concerns pertaining to mental health stigma. CONCLUSION This review highlights the promise of technology for addressing mental health stigma in LMICs. This is imperative in the face of growing demand for mental health services owing to the economic and social impacts of the COVID-19 pandemic, and the increasing reliance on digital platforms among individuals in most countries.
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Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Davy Deng
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Abraham A, Jithesh A, Doraiswamy S, Al-Khawaga N, Mamtani R, Cheema S. Telemental Health Use in the COVID-19 Pandemic: A Scoping Review and Evidence Gap Mapping. Front Psychiatry 2021; 12:748069. [PMID: 34819885 PMCID: PMC8606591 DOI: 10.3389/fpsyt.2021.748069] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/15/2021] [Indexed: 01/07/2023] Open
Abstract
Background: The COVID-19 pandemic has highlighted telemedicine use for mental illness (telemental health). Objective: In the scoping review, we describe the scope and domains of telemental health during the COVID-19 pandemic from the published literature and discuss associated challenges. Methods: PubMed, EMBASE, and the World Health Organization's Global COVID-19 Database were searched up to August 23, 2020 with no restrictions on study design, language, or geographical, following an a priori protocol (https://osf.io/4dxms/). Data were synthesized using descriptive statistics from the peer-reviewed literature and the National Quality Forum's (NQF) framework for telemental health. Sentiment analysis was also used to gauge patient and healthcare provider opinion toward telemental health. Results: After screening, we identified 196 articles, predominantly from high-income countries (36.22%). Most articles were classified as commentaries (51.53%) and discussed telemental health from a management standpoint (86.22%). Conditions commonly treated with telemental health were depression, anxiety, and eating disorders. Where data were available, most articles described telemental health in a home-based setting (use of telemental health at home by patients). Overall sentiment was neutral-to-positive for the individual domains of the NQF framework. Conclusions: Our findings suggest that there was a marked growth in the uptake of telemental health during the pandemic and that telemental health is effective, safe, and will remain in use for the foreseeable future. However, more needs to be done to better understand these findings. Greater investment into human and financial resources, and research should be made by governments, global funding agencies, academia, and other stakeholders, especially in low- and middle- income countries. Uniform guidelines for licensing and credentialing, payment and insurance, and standards of care need to be developed to ensure safe and optimal telemental health delivery. Telemental health education should be incorporated into health professions curricula globally. With rapidly advancing technology and increasing acceptance of interactive online platforms amongst patients and healthcare providers, telemental health can provide sustainable mental healthcare across patient populations. Systematic Review Registration: https://osf.io/4dxms/.
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Affiliation(s)
- Amit Abraham
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Anupama Jithesh
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | | | | | - Ravinder Mamtani
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Sohaila Cheema
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
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Zhang X, Lewis S, Firth J, Chen X, Bucci S. Digital mental health in China: a systematic review. Psychol Med 2021; 51:2552-2570. [PMID: 34581263 PMCID: PMC8579156 DOI: 10.1017/s0033291721003731] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 01/24/2023]
Abstract
Mental health problems are highly prevalent in China; however, China's mental health services lack resources to deliver high-quality care to people in need. Digital mental health is a promising solution to this short-fall in view of the population's digital literacy. In this review, we aim to: (i) investigate the effectiveness, acceptability, usability, and safety of digital health technologies (DHTs) for people with mental health problems in China; (ii) critically appraise the literature; and (iii) make recommendations for future research directions. The databases MEDLINE, PsycINFO, EMBASE, Web of Science, CNKI, WANFANG, and VIP were systemically searched for English and Chinese language articles evaluating DHTs for people with mental health problems in mainland China. Eligible studies were systematically reviewed. The heterogeneity of studies included precluded a meta-analysis. In total, 39 articles were retrieved, reporting on 32 DHTs for various mental health problems. Compared with the digital mental health field in the West, the Chinese studies targeted schizophrenia and substance use disorder more often and investigated social anxiety mediated by shame and culturally specific variants, DHTs were rarely developed in a co-production approach, and methodology quality was less rigorous. To our knowledge, this is the first systematic review focused on digital mental health in the Chinese context including studies published in both English and the Chinese language. DHTs were acceptable and usable among Chinese people with mental health problems in general, similar to findings from the West. Due to heterogeneity across studies and a paucity of robust control trial research, conclusions about the efficacy of DHTs are lacking.
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Affiliation(s)
- Xiaolong Zhang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | - Xu Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Torous J, Bucci S, Bell IH, Kessing LV, Faurholt-Jepsen M, Whelan P, Carvalho AF, Keshavan M, Linardon J, Firth J. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry 2021; 20:318-335. [PMID: 34505369 PMCID: PMC8429349 DOI: 10.1002/wps.20883] [Citation(s) in RCA: 251] [Impact Index Per Article: 83.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.
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Affiliation(s)
- John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sandra Bucci
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Imogen H Bell
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lars V Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Pauline Whelan
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Matcheri Keshavan
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jake Linardon
- Deakin University, Centre for Social and Early Emotional Development and School of Psychology, Burwood, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
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Naslund JA, Karyotaki E. Reducing psychological distress and depression in humanitarian emergencies: An essential role for nonspecialists. PLoS Med 2021; 18:e1003625. [PMID: 34138878 PMCID: PMC8211261 DOI: 10.1371/journal.pmed.1003625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
John Naslund and Eirini Karyotaki discuss Mark Jordans and colleagues' accompanying research study on therapy for people with psychological distress in Nepal.
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Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Eirini Karyotaki
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Clinical, Neuro- and Development Psychology, Section Clinical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
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Araya R, Menezes PR, Claro HG, Brandt LR, Daley KL, Quayle J, Diez-Canseco F, Peters TJ, Vera Cruz D, Toyama M, Aschar S, Hidalgo-Padilla L, Martins H, Cavero V, Rocha T, Scotton G, de Almeida Lopes IF, Begale M, Mohr DC, Miranda JJ. Effect of a Digital Intervention on Depressive Symptoms in Patients With Comorbid Hypertension or Diabetes in Brazil and Peru: Two Randomized Clinical Trials. JAMA 2021; 325:1852-1862. [PMID: 33974019 PMCID: PMC8114139 DOI: 10.1001/jama.2021.4348] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
Importance Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown. Objective To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension. Design, Setting, and Participants Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in São Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018). Interventions An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n = 440 participants in 10 clusters in São Paulo; n = 217 participants in Lima) vs enhanced usual care (n = 440 participants in 10 clusters in São Paulo; n = 215 participants in Lima). Main Outcomes and Measures The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months. Results Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in São Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159/391 participants) in the digital intervention group vs 28.6% (114/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P = .001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108/205 participants) in the digital intervention group vs 34.1% (70/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P < .001). At 6-month follow-up, differences across groups were no longer statistically significant. Conclusions and Relevance In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months. Trial Registration ClinicalTrials.gov: NCT02846662 (São Paulo) and NCT03026426 (Lima).
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Affiliation(s)
- Ricardo Araya
- Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Paulo Rossi Menezes
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Heloísa Garcia Claro
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
- School of Nursing, Universidade Estadual de Campinas, Campinas, Brazil
| | - Lena R. Brandt
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kate L. Daley
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Julieta Quayle
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tim J. Peters
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Daniela Vera Cruz
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Mauricio Toyama
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Suzana Aschar
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Liliana Hidalgo-Padilla
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hellen Martins
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Victoria Cavero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Thais Rocha
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - George Scotton
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Ivan F. de Almeida Lopes
- Federal University of ABC, Engineering, Modeling and Applied Social Sciences Center (CECS), Santo André, Brazil
| | - Mark Begale
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Mitchell LM, Joshi U, Patel V, Lu C, Naslund JA. Economic Evaluations of Internet-Based Psychological Interventions for Anxiety Disorders and Depression: A Systematic Review. J Affect Disord 2021; 284:157-182. [PMID: 33601245 PMCID: PMC8008508 DOI: 10.1016/j.jad.2021.01.092] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Internet-based interventions show clinical effectiveness for treating anxiety disorders and depression and could make mental healthcare more affordable. METHODS We searched databases including PubMed; EMBASE; Cochrane Central; PsychINFO; CINAHL; EconLit; and Web of Science from January 1, 2000 to August 21, 2020. Inclusion criteria were: 1) pertained to the treatment or prevention of anxiety disorders or depression; 2) evaluated the use of an internet-delivered psychological intervention; 3) recruited participants; and 4) reported costs or cost-effectiveness. RESULTS Of the 6,069 articles identified, 33 targeted anxiety (N=13) and depression (n=20) and met final inclusion criteria. All studies were from high-income countries. The control conditions and cost components included were heterogeneous. Only eight studies reported costs of developing the intervention. Of 27 studies that made a conclusion about cost-effectiveness, 81% of interventions were cost-effective. The quality of studies included was high based on a quality assessment checklist of economic evaluations, although many studies did not include definitions of cost components or differentiate between patient-side and system-level costs. LIMITATIONS Studies varied in methodology, making conclusions about cost-effectiveness difficult. The generalizability of these results is unclear as studies were clustered in a small number of high-income countries and costs vary over time and between regions. CONCLUSIONS Internet-delivered interventions appeared to be cost-effective although control conditions and cost component reporting were variable. We propose a checklist of cost components for future cost analyses to better compare intervention costs. More research is needed to describe development costs, cost-effectiveness in low-resource settings, and cost-effectiveness of newer technologies.
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Affiliation(s)
- Lauren M Mitchell
- Department of Internal Medicine, New York Presbyterian Hospital - Weill Cornell, New York, NY, USA.
| | | | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA,Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA,Division of Global Health Equity, Brigham & Women’s Hospital, Boston, MA, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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