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van Houtum LAEM, Baaré WFC, Beckmann CF, Castro-Fornieles J, Cecil CAM, Dittrich J, Ebdrup BH, Fegert JM, Havdahl A, Hillegers MHJ, Kalisch R, Kushner SA, Mansuy IM, Mežinska S, Moreno C, Muetzel RL, Neumann A, Nordentoft M, Pingault JB, Preisig M, Raballo A, Saunders J, Sprooten E, Sugranyes G, Tiemeier H, van Woerden GM, Vandeleur CL, van Haren NEM. Running in the FAMILY: understanding and predicting the intergenerational transmission of mental illness. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02423-9. [PMID: 38613677 DOI: 10.1007/s00787-024-02423-9] [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: 09/15/2023] [Accepted: 03/15/2024] [Indexed: 04/15/2024]
Abstract
Over 50% of children with a parent with severe mental illness will develop mental illness by early adulthood. However, intergenerational transmission of risk for mental illness in one's children is insufficiently considered in clinical practice, nor is it sufficiently utilised into diagnostics and care for children of ill parents. This leads to delays in diagnosing young offspring and missed opportunities for protective actions and resilience strengthening. Prior twin, family, and adoption studies suggest that the aetiology of mental illness is governed by a complex interplay of genetic and environmental factors, potentially mediated by changes in epigenetic programming and brain development. However, how these factors ultimately materialise into mental disorders remains unclear. Here, we present the FAMILY consortium, an interdisciplinary, multimodal (e.g., (epi)genetics, neuroimaging, environment, behaviour), multilevel (e.g., individual-level, family-level), and multisite study funded by a European Union Horizon-Staying-Healthy-2021 grant. FAMILY focuses on understanding and prediction of intergenerational transmission of mental illness, using genetically informed causal inference, multimodal normative prediction, and animal modelling. Moreover, FAMILY applies methods from social sciences to map social and ethical consequences of risk prediction to prepare clinical practice for future implementation. FAMILY aims to deliver: (i) new discoveries clarifying the aetiology of mental illness and the process of resilience, thereby providing new targets for prevention and intervention studies; (ii) a risk prediction model within a normative modelling framework to predict who is at risk for developing mental illness; and (iii) insight into social and ethical issues related to risk prediction to inform clinical guidelines.
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Affiliation(s)
- Lisanne A E M van Houtum
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre-Sophia, Rotterdam, The Netherlands
| | - William F C Baaré
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, Copenhagen, Denmark
| | - Christian F Beckmann
- Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, FCRB-IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Charlotte A M Cecil
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre-Sophia, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | | | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research and Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jörg M Fegert
- President European Society for Child and Adolescent Psychiatry (ESCAP), Brussels, Belgium
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Alexandra Havdahl
- PsychGen Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- PROMENTA Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre-Sophia, Rotterdam, The Netherlands
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research, Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Steven A Kushner
- Department of Psychiatry, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Isabelle M Mansuy
- Laboratory of Neuroepigenetics, Medical Faculty, Brain Research Institute, Department of Health Science and Technology of ETH, University of Zurich and Institute for Neuroscience, Zurich, Switzerland
- Zurich Neuroscience Centre, ETH and University of Zurich, Zurich, Switzerland
| | - Signe Mežinska
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Ryan L Muetzel
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre-Sophia, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Alexander Neumann
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre-Sophia, Rotterdam, The Netherlands
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jean-Baptiste Pingault
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre-Sophia, Rotterdam, The Netherlands
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Martin Preisig
- Psychiatric Epidemiology and Psychopathology Research Centre, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea Raballo
- Public Health Division, Department of Health and Social Care, Cantonal Socio-Psychiatric Organization, Repubblica e Cantone Ticino, Mendrisio, Switzerland
- Chair of Psychiatry, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - John Saunders
- Executive Director European Federation of Associations of Families of People with Mental Illness (EUFAMI), Louvain, Belgium
| | - Emma Sprooten
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, 2021SGR01319, Institut Clinic de Neurociències, Hospital Clínic de Barcelona, FCRB-IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre-Sophia, Rotterdam, The Netherlands
- Department of Social and Behavioural Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Geeske M van Woerden
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Caroline L Vandeleur
- Psychiatric Epidemiology and Psychopathology Research Centre, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Neeltje E M van Haren
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre-Sophia, Rotterdam, The Netherlands.
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Serresse L, Guerder A, Dedonder J, Nion N, Lavault S, Morélot-Panzini C, Gonzalez-Bermejo J, Benoit L, Similowski T. 'You can't feel what we feel': Multifaceted dyspnoea invisibility in advanced chronic obstructive pulmonary disease examined through interpretative phenomenological analysis. Palliat Med 2022; 36:1364-1373. [PMID: 36154535 DOI: 10.1177/02692163221118198] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND More than a symptom, dyspnoea is an existential experience shaping the lives of those afflicted, particularly when its persistence despite maximal pathophysiological treatments makes it pervasive. It is, however, insufficiently appreciated by concerned people themselves, family members, healthcare professionals and the public (dyspnoea invisibility), limiting access to appropriate care and support. AIM To provide a better understanding of dyspnoea experiences and its invisibility. DESIGN Interpretative phenomenological analysis of data collected prospectively through in-depth semi-structured interviews. SETTING/PARTICIPANTS Pulmonary rehabilitation facility of a tertiary care university hospital; 11 people (six men, five women) with severe chronic obstructive pulmonary disease (stages 3 and 4 of the 4-stage international GOLD classification) admitted for immediate post-exacerbation rehabilitation. RESULTS We identified several types of dyspnoea invisibility depending on temporality and interlocutors: (1) invisibility as a symptom to oneself; (2) invisibility as a symptom to others; (3) invisibility as an experience that cannot be shared; (4) invisibility as an experience detached from objective measurements; (5) invisibility as an experience that does not generate empathic concern. The notion of invisibility was present in all the identified experiential dimensions of dyspnoea. It was seen as worsening the burden of the disease and as self-aggravating through self-isolation and self-censorship. CONCLUSIONS The study confirmed that dyspnoea invisibility is a reality for people with advanced chronic obstructive pulmonary disease. It shows dyspnoea invisibility to be a multifaceted burden. Future research should aim at identifying individual and collective measures to overcome dyspnoea invisibility.
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Affiliation(s)
- Laure Serresse
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Fédération 'Soins Palliatifs, Accompagnement et Soins de Support', Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Antoine Guerder
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Soins de Suite et de Réadaptation Respiratoire, Département R3S, Paris, France
| | - Jonathan Dedonder
- Institute for the Analysis of Change in Contemporary and Historical Societies (IACCHOS), Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Nathalie Nion
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, Paris, France
| | - Sophie Lavault
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, Paris, France
| | - Capucine Morélot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Département R3S, Paris, France
| | - Jésus Gonzalez-Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Soins de Suite et de Réadaptation Respiratoire, Département R3S, Paris, France
| | - Laelia Benoit
- Yale School of Medicine, Child Study Center, QUALab qualitative and mixed methods lab, New Haven, CT, USA.,Inserm U1018, Team DevPsy, Maison de Solenn, Hôpital Cochin, AP-HP, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, Paris, France
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Falissard B, Benoit L, Martin A. Qualitative methods in child and adolescent psychiatry: the time has come. Eur Child Adolesc Psychiatry 2022; 31:541-544. [PMID: 35366131 PMCID: PMC8976216 DOI: 10.1007/s00787-022-01978-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Laelia Benoit
- grid.50550.350000 0001 2175 4109CESP, Université Paris-Saclay, UVSQ, AP-HP, Paris, France ,grid.47100.320000000419368710Yale School of Medicine, Yale University, New Haven, CT USA ,grid.411784.f0000 0001 0274 3893Maison de Solenn, Hôpital Cochin, AP-HP, Paris, France
| | - Andrés Martin
- grid.47100.320000000419368710Yale School of Medicine, Yale University, New Haven, CT USA
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Kurukgy JL, Bourgin J, Benoit JP, Guessoum SB, Benoit L. Implementing organicity investigations in early psychosis: Spreading expertise. PLoS One 2021; 16:e0252610. [PMID: 34111172 PMCID: PMC8191881 DOI: 10.1371/journal.pone.0252610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many medical disorders may contribute to adolescent psychoses. Although guidelines for thorough organicity investigations (OI) exist, their dissemination appears scarce in nonacademic healthcare facilities and some rare disorders remain undiagnosed, many of them presenting without easily recognized phenotypes. This study aims to understand the challenges underlying the implementation of OI in non-academic facilities by practitioners trained in expert centers. METHODS Sixteen psychiatrists working at French non-academic facilities were interviewed about their use of OI for adolescents suspected of early psychosis. Interviews were analyzed with Grounded Theory. RESULTS Organicity investigations were found to be useful in rationalizing psychiatric care for the young patient all the while building trust between the doctor and the patient's parents. They also are reassuring for psychiatrists confronted with uncertainty about psychosis onset and the consequences of a psychiatric label. However, they commonly find themselves facing the challenges of implementation alone and thus enter a renunciation pathway: from idealistic missionaries, they become torn between their professional ethics and the non-academic work culture. Ultimately, they abandon the use of OI or delegate it to expert centers. CONCLUSION Specific hindrances to OI implementation must be addressed.
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Affiliation(s)
- Jean-Luc Kurukgy
- Hôpital Delafontaine, Secteur de Psychiatrie Infanto-Juvénile, Saint-Denis, France
| | - Julie Bourgin
- Psychiatrie de l’enfant et de l’adolescent–Site Orsay, GH Nord-Essonne, Bures sur Yvette, France
| | - Jean-Pierre Benoit
- Hôpital Delafontaine, Secteur de Psychiatrie Infanto-Juvénile, Saint-Denis, France
| | - Sélim Benjamin Guessoum
- University of Paris, PCPP, Boulogne-Billancourt, France
- Child and Adolescent Department—Maison de Solenn, Hospital Cochin, Paris, France
- Paris-Saclay University, UVSQ, Inserm 1178, CESP, Team DevPsy, Villejuif, France
| | - Laelia Benoit
- Child and Adolescent Department—Maison de Solenn, Hospital Cochin, Paris, France
- Paris-Saclay University, UVSQ, Inserm 1178, CESP, Team DevPsy, Villejuif, France
- Yale School of Medicine (Child Study Center), Yale University, New Haven, CT, United States of America
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Martin R, Benoit JP, Moro MR, Benoit L. School Refusal or Truancy? A Qualitative Study of Misconceptions Among School Personnel About Absenteeism of Children From Immigrant Families. Front Psychiatry 2020; 11:202. [PMID: 32265757 PMCID: PMC7099978 DOI: 10.3389/fpsyt.2020.00202] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND School refusal is a form of school attendance problem (SAP) distinct from truancy, school withdrawal, and school exclusion; it requires specific mental health care. Schools' identification and referral to care of school refusers depends on school personnel's interpretation of the reasons for absences. Because cultural factors can induce misunderstanding of the young people's behavior and of their parents' attitudes toward school attendance, school personnel can have difficulty understanding these reasons for children with transcultural backgrounds (migrants or children of migrants). The aim of this study was to explore the experiences and opinions of school personnel, mainly teachers, related to school refusal among these students. METHODS Grounded theory methodology was used to conduct 52 qualitative interviews of school personnel in two regions of France. Their daily practices with students presenting with school refusal were addressed in general (i.e., in response to absence of all youth) and in transcultural contexts (i.e., absence of migrant children or children of migrants). This study analyzed the interviews of the 30 participants who reported working with students from transcultural backgrounds. RESULTS Many school personnel reported experiencing difficulties, ambivalence, and destabilizing feelings in situations involving immigrant families whose school culture differed from their own. Talking about culture appeared to be taboo for most participants. These situations challenged the participants' usual strategies and forced them to devise new ones to deal with these young people and their families. Although some personnel were at risk of developing exclusionary attitudes, others dealt with school refusal with both commitment and creativity. CONCLUSION The tensions experienced by these participants reveal contradictions between the French universalist ideology and the reality of daily life in schools becoming increasingly multicultural. School personnel's attitudes toward children with transcultural backgrounds presenting with school refusal can affect children's access to care and shape social inequalities. Further research should develop, implement, and assess interventions including transcultural training of school personnel, improved use of interpreters at school for migrant families, and the addition of a transcultural dimension to SAP assessment scales, especially for school refusal.
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Affiliation(s)
- Robin Martin
- Maison des Adolescents de Saint-Denis, Saint-Denis Hospital, Saint Denis, France
| | - Jean Pierre Benoit
- Maison des Adolescents de Saint-Denis, Saint-Denis Hospital, Saint Denis, France
| | - Marie Rose Moro
- Maison des Adolescents-Maison de Solenn, Hôpital Cochin, APHP, Paris, France.,University of Paris, Medical School, Faculty of Psychology, PCPP, Boulogne-Billancourt, France.,Center for Research in Epidemiology and Population Health (CESP), Paris-Sud and UVSQ Medical Schools, French National Institute of Health and Medical Research (Inserm), Team DevPsy, Villejuif, France
| | - Laelia Benoit
- Maison des Adolescents-Maison de Solenn, Hôpital Cochin, APHP, Paris, France.,University of Paris, Medical School, Faculty of Psychology, PCPP, Boulogne-Billancourt, France.,Center for Research in Epidemiology and Population Health (CESP), Paris-Sud and UVSQ Medical Schools, French National Institute of Health and Medical Research (Inserm), Team DevPsy, Villejuif, France
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Meisenzahl E, Walger P, Schmidt SJ, Koutsouleris N, Schultze-Lutter F. [Early recognition and prevention of schizophrenia and other psychoses]. DER NERVENARZT 2019; 91:10-17. [PMID: 31858162 DOI: 10.1007/s00115-019-00836-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The last two decades of clinical research have clearly demonstrated the comprehensive benefits of the early recognition and treatment of psychotic disorders. The attenuated and transient positive symptoms according to the ultrahigh risk criteria and the basic symptom criterion "Cognitive disturbances" are the main approaches for an indicated prevention. They have recently been recommended as criteria for a clinical high-risk (CHR) state of psychosis by the European Psychiatric Association (EPA) and, following these, in the German S3 guidelines for the treatment of schizophrenia by the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN); however, the efficacy of early treatment of patients with a CHR for psychoses critically depends on the development of prognostic instruments, which enable healthcare professionals to reliably identify these patients based on the individual objective risk profiles. An important goal is the treatment of functional deficits, which can be identified by an individual risk profile. The treatment of existing comorbid mental disorders, psychosocial problems and the prevention of potential future disorders also characterizes the recommendations of the EPA and DGPPN for early treatment, which favor psychotherapeutic, especially cognitive behavioral interventions over pharmacological treatment. The close interdisciplinary cross-sectoral cooperation between the disciplines of child and adolescent psychiatry, and adult psychiatry is of outstanding importance in this context.
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Affiliation(s)
- E Meisenzahl
- Klinik für Psychiatrie und Psychotherapie, medizinische Fakultät, Heinrich-Heine Universität/LVR Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Deutschland.
| | - P Walger
- Klinik für Psychiatrie und Psychotherapie, medizinische Fakultät, Heinrich-Heine Universität/LVR Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Deutschland
| | - S J Schmidt
- Abtlg. für Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Bern, Bern, Schweiz
| | - N Koutsouleris
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - F Schultze-Lutter
- Klinik für Psychiatrie und Psychotherapie, medizinische Fakultät, Heinrich-Heine Universität/LVR Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Deutschland
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Jadad AR, Jadad Garcia TM. From a Digital Bottle: A Message to Ourselves in 2039. J Med Internet Res 2019; 21:e16274. [PMID: 31682578 PMCID: PMC6858618 DOI: 10.2196/16274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 01/03/2023] Open
Abstract
We are fully aware that we could have wasted our time writing this message, as nobody might read it. Even those who read it might ignore it, and those who read and care about it might be unable to do anything. It may simply be too late. Nevertheless, this message describes the hopes we had back in 1999, imagining how the incredible digital tools whose birth we were witnessing, could change the world for the better. In 2019, when we wrote these words, we were saddened to realize that most of what we had imagined and proposed in the past 20 years could have been written the day before, without losing an iota of relevance. Whoever or whatever you might be, dear reader-a human, a sentient machine, or a hybrid-we would like you to understand that, rather than an attempt to predict the future, which probably continues to be an impossible endeavor, this message was meant to act as an invitation, regardless of when or where it is found, to engage in a conversation that has already transcended time and space, even if the issues it contains have become irrelevant.
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Affiliation(s)
- Alejandro R Jadad
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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