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Martiniuk A, Toepfer A, Lane-Brown A. A review of risks, adverse effects and mitigation strategies when delivering mental health services using telehealth. J Ment Health 2024; 33:415-438. [PMID: 36866784 DOI: 10.1080/09638237.2023.2182422] [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: 02/21/2022] [Revised: 08/31/2022] [Accepted: 01/07/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND This paper presents a scoping review of the peer-reviewed literature regarding reported risks, adverse effects and mitigation factors related to providing mental health services using telehealth. AIMS The paper aims to describe risks and risk management strategies. METHODS Publications were included if they reported upon risks, adverse events or mitigation factors experienced, hypothesised or discussed for: any population (any country, any age), service (any mental health services), intervention (telehealth), English language, 2010 to 10 July 2021, any publication type (commentary, research, policy), excluding protocol papers, and self-help tools. The following databases were searched: PsycINFO (from 2010 to 10 July 2021), MEDLINE (2010 to 10 July 2021) and the Cochrane Database from 2010 to 10 July 2021. RESULTS The search strategy resulted in 1,497 papers and after exclusions a final 55 articles were selected. Results of this scoping review are presented in terms of types of risk, risk by client population, risk by modality (eg group therapy using telehealth) and risk management. CONCLUSIONS Recommendations for future research include gathering and publishing more detailed information regarding near-miss and actual adverse events when delivering mental health assessment and care using telehealth. In clinical practice, training is required for potential adverse events, and to prevent them and reporting mechanisms in place to collate and learn from these.
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Affiliation(s)
| | - Amy Toepfer
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Amanda Lane-Brown
- Work: Clinical Psychologist, KidsRehab, Children's Hospital Westmead, South Turramurra, NSW, Australia
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Zhou C, Li H, Zhang Z, Li S, Wu S, Dai Y, Zhang X, Lai H, Zhou Q, Yang M, Zuo X, Ning J, Wu J, Zheng T, Li N, Liu L, Zou X, Liu L, Luo X, Yang J, Wang Y, Zheng L, Luo Y, Chen Y, Deng H. Effectiveness of video-based psychiatric rehabilitation for patients with early-phase schizophrenia spectrum: A randomized controlled trial. Early Interv Psychiatry 2024. [PMID: 38782736 DOI: 10.1111/eip.13556] [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: 05/21/2023] [Revised: 01/07/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
AIM This study aimed to establish a comprehensive set of recovery-oriented rehabilitation programs for individuals with schizophrenia, comparing the efficacy of video-based rehabilitation to traditional face-to-face interventions. The primary objective was to assess whether video-based rehabilitation could serve as a viable alternative for individuals with schizophrenia residing in remote areas. METHODS A randomized controlled study was used to recruit 80 patients with schizophrenia in a stable post-hospitalization stage following discharge. Participants were categorized into three groups: 24 in the control group, 21 in the face-to-face group, and 35 in the remote group. Assessment parameters included psychiatric symptoms, social skills, family function and self-stigma. RESULTS A total of 68 participants completed the program. The findings indicated significant differences (p < .05) between the control group and intervention group, particularly in the Positive and Negative Syndrome Scale (PANSS) and the Personal and Social Performance Scale (PSP). CONCLUSIONS The rehabilitation program, tailored for patients in the early phase of the schizophrenia spectrum, demonstrates both effectiveness and feasibility in enhancing clinical symptoms and social functions. Notably, interventions conducted via video proved to be equally effective as those administered face-to-face.
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Affiliation(s)
- Chunfen Zhou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Haimin Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuoqiu Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Shuiying Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Shuang Wu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Youran Dai
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiuying Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Hua Lai
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Qian Zhou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Mengshu Yang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaofeng Zuo
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Jinna Ning
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Jiaxin Wu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Tianfen Zheng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Na Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Liu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xuemin Zou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Lifang Liu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoqi Luo
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Jie Yang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Yi Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lulu Zheng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Ya Luo
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Chen
- Huaxi MR Research (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Hope Recovery and Rehabilitation Center, West China Hospital of Sichuan University, Chengdu, China
| | - Hong Deng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Shih YH, Wang JY, Chou PH, Lin KH. The effects of treatment via telemedicine interventions for patients with depression on depressive symptoms and quality of life: a systematic review and meta-ranalysis. Ann Med 2023; 55:1092-1101. [PMID: 36920229 PMCID: PMC10026747 DOI: 10.1080/07853890.2023.2187078] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Aim: The aim of this systematic review and meta-analysis was to identify, evaluate, and synthesize the evidence from studies that have investigated the treatment effect via telemedicine interventions on depressive symptoms, quality of life, and work and social functioning in patients with depression.Methods: Six electronic databases (MEDLINE [1916-2021], PubMED [1950-2021], PsycINFO [1971-2021], Scopus [2004-2021], Embase [1972-2021], and CINAHL [1937-2021]) were systematically searched in March 2021. Reference lists of identified articles were hand searched. Randomized controlled trials were included if they investigated the treatment effects via telemedicine interventions in patients who had a depression diagnosis. Quality assessment was evaluated using the critical appraisal checklists developed by the Joanna Briggs Institute.Results: Seventeen (17) trials (n = 2,394) met eligibility criteria and were included in the analysis. Eleven (11) randomized controlled trials shared common outcome measures, allowing meta-analysis. The results provided evidence that treatment via telemedicine interventions were beneficial for depressive symptoms (standardized mean difference= -0.44; 95% CI= -0.64 to -0.25; p < .001) and quality of life (standardized mean difference= 0.25, 95% CI -0.01 to 0.49, p = .04) in patients of depression. There were insufficient data for meta-analysis of work and social functioning.Conclusion: This study showed the positive effects of treatment via telemedicine interventions on depressive symptoms and quality of life in patients with depression and supported the idea for clinical practice to establish a well-organized telepsychiatry system.KEY MESSAGESTelemedicine is effective at reducing symptoms of depression.Telemedicine can improve quality of life in persons with depression.
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Affiliation(s)
- Yin-Hwa Shih
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Kuan-Han Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Moulaei K, Bahaadinbeigy K, Sharifi H. Medication adherence in patients with mental disorders: A systematic review and meta-analysis of telemedicine interventions. J Telemed Telecare 2023:1357633X231211355. [PMID: 37966845 DOI: 10.1177/1357633x231211355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Telemedicine interventions have emerged as a promising solution to improve medication adherence by providing remote support and monitoring of patients with mental disorders. This study aims to investigate the effectiveness of telemedicine interventions in enhancing medication adherence among patients with mental disorders. METHODS PubMed, Scopus, and Web of Science were searched systematically. After deleting the double-included studies, two researchers independently selected articles and extracted data using a standardized data collection form. The risk of bias in the included studies was assessed using the Mixed Methods Appraisal Tool. The intervention effects were combined using a random effects model. Standardized mean differences (Hedges's g) between the treatment and control groups were calculated. Heterogeneity variance was estimated using the Q test and I2 statistic. The analysis was performed in Stata version 17.0. RESULTS Out of the 1088 articles retrieved, nine studies were included in the analysis. Overall, telemedicine interventions demonstrated a statistically significant improvement in medication adherence among patients with mental disorders (Hedges' g = 0.25, 95% confidence interval: 0.12-0.38, p-value: < 0.01). The type of mental disorder was a significant moderator of the heterogeneity between studies (p = 0.022). CONCLUSION Telemedicine interventions have a positive impact on medication adherence in patients with mental disorders by offering remote support and monitoring. Integrating telemedicine into mental healthcare can enhance overall adherence rates, leading to improved management of mental disorders.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Faria M, Zin STP, Chestnov R, Novak AM, Lev-Ari S, Snyder M. Mental Health for All: The Case for Investing in Digital Mental Health to Improve Global Outcomes, Access, and Innovation in Low-Resource Settings. J Clin Med 2023; 12:6735. [PMID: 37959201 PMCID: PMC10649112 DOI: 10.3390/jcm12216735] [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: 08/11/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Mental health disorders are an increasing global public health concern that contribute to morbidity, mortality, disability, and healthcare costs across the world. Biomedical and psychological research has come a long way in identifying the importance of mental health and its impact on behavioral risk factors, physiological health, and overall quality of life. Despite this, access to psychological and psychiatric services remains widely unavailable and is a challenge for many healthcare systems, particularly those in developing countries. This review article highlights the strengths and opportunities brought forward by digital mental health in narrowing this divide. Further, it points to the economic and societal benefits of effectively managing mental illness, making a case for investing resources into mental healthcare as a larger priority for large non-governmental organizations and individual nations across the globe.
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Affiliation(s)
- Manuel Faria
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
- Health and Development, United Nations Development Programme, 1219 Geneva, Switzerland; (S.T.P.Z.); (R.C.)
| | - Stella Tan Pei Zin
- Health and Development, United Nations Development Programme, 1219 Geneva, Switzerland; (S.T.P.Z.); (R.C.)
| | - Roman Chestnov
- Health and Development, United Nations Development Programme, 1219 Geneva, Switzerland; (S.T.P.Z.); (R.C.)
| | - Anne Marie Novak
- Department of Health Promotion, Tel Aviv University School of Medicine, Tel Aviv 6997801, Israel;
| | - Shahar Lev-Ari
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Department of Health Promotion, Tel Aviv University School of Medicine, Tel Aviv 6997801, Israel;
| | - Michael Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA;
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Ishrat Husain M, Rodie DJ, Perivolaris A, Sanches M, Crawford A, Fitzgibbon KP, Levinson A, Geist R, Kurdyak P, Mitchell B, Oslin D, Sunderji N, Mulsant BH. A Collaborative-Care Telephone-Based Intervention for Depression, Anxiety, and at-Risk Drinking in Primary Care: The PARTNERs Randomized Clinical Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:732-744. [PMID: 36855791 PMCID: PMC10517649 DOI: 10.1177/07067437231156243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Collaborative care (CC) could improve outcomes in primary care patients with common mental conditions. We assessed the effectiveness of a transdiagnostic model of telephone-based CC (tCC) delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. METHODS PARTNERS was a pragmatic trial in 502 primary care adults presenting with depressive symptoms, anxiety symptoms, or at-risk drinking randomized to (1) usual care by primary care providers (PCPs) enhanced with the results of computer-assisted telephone-based assessments (at baseline and 4, 8, and 12 months later) (enhanced usual care [eUC]) or (2) tCC consisting of eUC plus frequent telephone coaching and psychoeducation provided by mental health technicians who also communicated to the PCP recommendations from a psychiatrist for evidence-based pharmacotherapy, psychotherapy, or, when indicated, referrals to mental health services. The primary analysis compared the change on the 9-item Patient Health Questionnaire (PHQ-9) in participants presenting with depression (n = 366) randomized to tCC versus eUC. Secondary analyses compared changes on the Generalized Anxiety Disorder-7 scale (GAD-7) in those presenting with anxiety (n = 298); or change in the number of weekly drinks in those presenting with at-risk drinking (n = 176). RESULTS There were no treatment or time×treatment effects between tCC and eUC on PHQ-9 scores for patients with depression during the 12-month follow-up. However, there was a treatment effect (tCC > eUC) on GAD-7 scores in those with anxiety and a time×treatment interaction effect on the number of weekly drinks (tCC > eUC) in those with at-risk drinking. CONCLUSION Implementing transdiagnostic tCC for common mental disorders using lay providers appears feasible in Canadian primary care. While tCC was not better than eUC for depression, there were some benefits for those with anxiety or at-risk drinking. Future studies will need to confirm whether tCC differentially benefits patients with depression, anxiety, or at-risk drinking.
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Affiliation(s)
- M. Ishrat Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David J. Rodie
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Marcos Sanches
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Andrea Levinson
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rose Geist
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - David Oslin
- Department of Psychiatry, University of Pennsylvania and the Department of Veteran Affairs, Philadelphia, PA, USA
| | - Nadiya Sunderji
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Borges do Nascimento IJ, Abdulazeem HM, Vasanthan LT, Martinez EZ, Zucoloto ML, Østengaard L, Azzopardi-Muscat N, Zapata T, Novillo-Ortiz D. The global effect of digital health technologies on health workers' competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysis. Lancet Digit Health 2023; 5:e534-e544. [PMID: 37507197 PMCID: PMC10397356 DOI: 10.1016/s2589-7500(23)00092-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/31/2023] [Accepted: 04/29/2023] [Indexed: 07/30/2023]
Abstract
Systematic reviews have quantified the effectiveness, feasibility, acceptability, and cost-effectiveness of digital health technologies (DHTs) used by health-care workers. We aimed to collate available evidence on technologies' effect on health-care workers' competencies and performance. We searched the Cochrane Database of Systematic Reviews, Embase, MEDLINE, Epistemonikos, and Scopus for reviews published from database inception to March 1, 2023. Studies assessing the effects of DHTs on the organisational, socioeconomic, clinical, and epidemiological levels within the workplace, and on health-care workers' performance parameters, were included. Data were extracted and clustered into 25 domains using vote counting based on the direction of effect. The relative frequency of occurrence (RFO) of each domain was estimated using R software. AMSTAR-2 tool was used to appraise the quality of reporting, and the Confidence in the Evidence from Reviews of Qualitative research approach developed by Grading of Recommendations Assessment, Development and Evaluation was used to analyse the certainty of evidence among included studies. The 12 794 screened reviews generated 132 eligible records for assessment. Top-ranked RFO identifiers showed associations of DHT with the enhancement of health-care workers' performance (10·9% [95% CI 5·3-22·5]), improvement of clinical practice and management (9·8% [3·9-24·2]), and improvement of care delivery and access to care (9·2% [4·1-20·9]). Our overview found that DHTs positively influence the daily practice of health-care workers in various medical specialties. However, poor reporting in crucial domains is widely prevalent in reviews of DHT, hindering our findings' generalisability and interpretation. Likewise, most of the included reviews reported substantially more data from high-income countries. Improving the reporting of future studies and focusing on low-income and middle-income countries might elucidate and answer current knowledge gaps.
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Affiliation(s)
- Israel Júnior Borges do Nascimento
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; School of Medicine and University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil; Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | | | - Edson Zangiacomi Martinez
- Department of Social Medicine-Biostatistics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Miriane Lucindo Zucoloto
- Department of Social Medicine-Biostatistics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lasse Østengaard
- Centre for Evidence-Based Medicine Odense and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; University Library of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Tomas Zapata
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
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Splinter MJ, Ikram MK, Helsper CW, Bindels PJE, de Schepper EIT, Licher S. Patient perspectives on telemedicine during the COVID-19 pandemic: a mixed-methods community-based study. BMC Health Serv Res 2023; 23:803. [PMID: 37501087 PMCID: PMC10375760 DOI: 10.1186/s12913-023-09794-w] [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: 12/29/2022] [Accepted: 07/07/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Detailed community-based perspectives on patient experiences with telemedicine are currently lacking, yet essential to assess clinical applicability of telemedicine during and beyond pandemics, alike COVID-19. The aim of this study was to expose patient perspectives on virtual compared to in-person consultations, including determinants of these preferences. METHODS We invited 5864 participants of the population-based Rotterdam Study to fill in a validated questionnaire using both close-ended and free-text questions. The questionnaire was sent on 30 July 2020, following a period of lockdowns and closures of non-essential workplaces. It assessed preferences for physician contact, healthcare utilisation, socioeconomic factors, and overall health. Those who experienced at least one virtual consultation (telephone or video call) between March 2020 and the beginning of July 2020 were asked whether those consultations were more, equally or less pleasant than in-person consultations, and to detail their experiences through free-text comments. These narrative data were examined using thematic analysis. RESULTS 4514 participants completed the questionnaire (response rate 77.0%, 58.7% women, mean age 70.8 ± 10.5 years). 1103 participants (24.4%) reported having had experience with virtual consultations. Half of these participants considered virtual consultations less pleasant than in-person consultations (N = 556; 50.4%), while 11.5% found it more pleasant. In total, we coded free-text comments of 752 participants. Prominent themes behind patient preferences for virtual or in-person consultations were lack of nonverbal communication, lack of physical examination, consultation scheduling, personal circumstances, and the presence of somatic and/or language barriers. CONCLUSIONS Based on the experiences of a large elderly patient population, we showed that preference for virtual or in-person consultations is dependent on personal and situational variety, and their interplay. Healthcare providers should consider patients' complex care needs and evaluate the potential added value of nonverbal communication and physical examination before scheduling a virtual consultation.
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Affiliation(s)
- Marije J Splinter
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charles W Helsper
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
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Hornstein S, Zantvoort K, Lueken U, Funk B, Hilbert K. Personalization strategies in digital mental health interventions: a systematic review and conceptual framework for depressive symptoms. Front Digit Health 2023; 5:1170002. [PMID: 37283721 PMCID: PMC10239832 DOI: 10.3389/fdgth.2023.1170002] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Personalization is a much-discussed approach to improve adherence and outcomes for Digital Mental Health interventions (DMHIs). Yet, major questions remain open, such as (1) what personalization is, (2) how prevalent it is in practice, and (3) what benefits it truly has. Methods We address this gap by performing a systematic literature review identifying all empirical studies on DMHIs targeting depressive symptoms in adults from 2015 to September 2022. The search in Pubmed, SCOPUS and Psycinfo led to the inclusion of 138 articles, describing 94 distinct DMHIs provided to an overall sample of approximately 24,300 individuals. Results Our investigation results in the conceptualization of personalization as purposefully designed variation between individuals in an intervention's therapeutic elements or its structure. We propose to further differentiate personalization by what is personalized (i.e., intervention content, content order, level of guidance or communication) and the underlying mechanism [i.e., user choice, provider choice, decision rules, and machine-learning (ML) based approaches]. Applying this concept, we identified personalization in 66% of the interventions for depressive symptoms, with personalized intervention content (32% of interventions) and communication with the user (30%) being particularly popular. Personalization via decision rules (48%) and user choice (36%) were the most used mechanisms, while the utilization of ML was rare (3%). Two-thirds of personalized interventions only tailored one dimension of the intervention. Discussion We conclude that future interventions could provide even more personalized experiences and especially benefit from using ML models. Finally, empirical evidence for personalization was scarce and inconclusive, making further evidence for the benefits of personalization highly needed. Systematic Review Registration Identifier: CRD42022357408.
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Affiliation(s)
- Silvan Hornstein
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kirsten Zantvoort
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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10
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Biagianti B, Foti G, Di Liberto A, Bressi C, Brambilla P. CBT-informed psychological interventions for adult patients with anxiety and depression symptoms: A narrative review of digital treatment options. J Affect Disord 2023; 325:682-694. [PMID: 36690081 DOI: 10.1016/j.jad.2023.01.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Across a range of age, educational and clinical characteristics, adults experiencing depression and anxiety already use digital technology to manage their symptoms. Although several reviews and meta-analyses indicated feasibility and efficacy for adults with depression and anxiety, digital treatments are poorly accessed and disseminated. This review illustrates potentials and limitations of interventions that specifically leveraged unique features of digital technology and were grounded in the principles of Cognitive Behavioral Therapy (CBT). METHODS This systematic review followed the PRISMA guidelines. An electronic database search was conducted in October 2021. Peer-reviewed, English-language studies were included if i) they reported data from RCTs for adults aged 18+ who engaged with CBT-informed digital interventions targeting primarily depression and anxiety; ii) they used at least PHQ-9 or GAD-7 as standardized and validated assessment self-report measures for depression and anxiety. RESULTS Findings from 35 RCTs examining 33 interventions (25 internet-based, 6 mobile-based, a2 mobile/web) are discussed. The quality of the evidence differed widely as many small-scale RCTs reported only short-term feasibility and preliminary efficacy. Effects of CBT-informed digital interventions were substantially larger when compared to waitlist than active control conditions. Greater therapeutic benefits were observed for interventions that offered clinical assistance or were used in combination with other treatments. CONCLUSIONS CBT-informed digital interventions have accumulated enough scientific evidence to be positioned today as: i) a low-intensity tool for those with subclinical levels of symptoms; ii) a first step in a stepped-care approach to service delivery iii) a low-cost, easily accessible option for targeted preventive programs.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.
| | | | | | - Cinzia Bressi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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11
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Magallón-Botaya R, Méndez-López F, Oliván-Blázquez B, Carlos Silva-Aycaguer L, Lerma-Irureta D, Bartolomé-Moreno C. Effectiveness of health literacy interventions on anxious and depressive symptomatology in primary health care: A systematic review and meta-analysis. Front Public Health 2023; 11:1007238. [PMID: 36844856 PMCID: PMC9948257 DOI: 10.3389/fpubh.2023.1007238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Background Affective disorders are a debilitating and very prevalent problem throughout the world. Often these are associated with the onset of comorbidities or a consequence of chronic diseases. Anxiety and depression are associated with poor social and personal relationships, compromised health. We aimed to synthesize evidence from studies measuring the impact of a health literacy (HL) intervention on the improvement of affective disorders. Methods For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, Web of Science, Ibecs, Cuiden, Scielo, Science Direct and Dialnet for exclusively randomized controlled trial studies (RCTs) published between 1 Jan 2011, and 31 May 2022. The search terms employed were "health literacy," "health knowledge," "anxiety," "anxiety disorder," "depression," "depressive disorder," and "adult." The risk of bias assessment was performed using the Cochrane Collaboration Revised Risk of Bias tool (RoB2). We conducted random-effects meta-analyses and explored heterogeneity using meta-regression and a stratified survey. Results Of 2,863 citations found through the initial screening, 350 records were screened by the title and abstract for their themes and relevance. Finally, nine studies complied with the inclusion criteria for the meta-analysis. 66.66% of studies (n = 6) were rated as having a low risk of bias and 33.33% (n = 3) were judged to raise some concerns. The health literacy interventions were associated with -1.378 reduction in depression and anxiety questionnaires scores [95% CI (-1.850, -0.906)]. Low mood disorder scores are associated with better mental health and wellbeing. Conclusion Our findings demonstrate that an HL intervention in relation to the symptoms associated with affective disorders improves the emotional state of patients in PHC, with a moderately positive effect in reducing depression and anxiety.
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Affiliation(s)
- Rosa Magallón-Botaya
- Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
| | - Fátima Méndez-López
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | | | - David Lerma-Irureta
- Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Cruz Bartolomé-Moreno
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
- Aragonese Healthcare Service (SALUD), Zaragoza, Spain
- Department of Family and Community Care Teaching - Sector I, Aragonese Healthcare Service, Zaragoza, Spain
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12
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Leiz M, Pfeuffer N, Rehner L, Stentzel U, van den Berg N. Telemedicine as a Tool to Improve Medicine Adherence in Patients with Affective Disorders - A Systematic Literature Review. Patient Prefer Adherence 2022; 16:3441-3463. [PMID: 36605330 PMCID: PMC9809413 DOI: 10.2147/ppa.s388106] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022] Open
Abstract
Affective disorders are a common psychological impairment. A major problem with respect to treatment is medication non-adherence. eHealth interventions are already widely used in the treatment of patients living with affective disorders. The aim of this systematic literature review is to obtain the current scientific evidence to eHealth as a tool to improve medication adherence in patients with affective disorders. A systematic search was performed across PubMed, Cochrane Library, Web of Science and PsycInfo. Studies in English and German published between 2007 and 2020 were included. The review followed the PRISMA guidelines and were performed with the CADIMA online tool. A total of 17 articles were included in this review. Eleven studies were randomized controlled trials, two were controlled clinical trials, and four had a pre-/post-design. Three different types of interventions could be identified: internet-based self-management programs (n=4), multi-faceted interventions addressing different dimensions of medication adherence (n=4), and single-faceted interventions (n=9) comprising four mobile interventions and five telehealth interventions. Eleven interventions addressed patients with (comorbid) depressions and six addressed patients with bipolar disorders. Six interventions showed a statistically significant positive effect on medication adherence. None of the studies showed a statistically significant negative effect. All interventions which had a statistically significant positive effect on medication adherence involved personal contacts between therapists and patients. All included eHealth interventions are at least as effective as control conditions and seems to be effective for patients with depression as well as with bipolar disorders. Personal contacts seem to improve the effectiveness of eHealth interventions. eHealth interventions are an effective way to improve medication adherence in patients with affective disorders. In rural or underserved regions, eHealth can supplement usual care interventions on medication adherence by expanding access. More analyses are needed in order to understand determinants for the effectiveness of eHealth interventions on medication adherence enhancement.
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Affiliation(s)
- Maren Leiz
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Nils Pfeuffer
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Laura Rehner
- Institute for Nursing Science and Interprofessional Learning, University Medicine, Greifswald, Germany
| | - Ulrike Stentzel
- Institute for Community Medicine, University Medicine, Greifswald, Germany
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13
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Bandurska E. The Voice of Patients Really Matters: Using Patient-Reported Outcomes and Experiences Measures to Assess Effectiveness of Home-Based Integrated Care-A Scoping Review of Practice. Healthcare (Basel) 2022; 11:healthcare11010098. [PMID: 36611558 PMCID: PMC9819009 DOI: 10.3390/healthcare11010098] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022] Open
Abstract
Background: The aim of the study is to analyze the prevalence of using patients’ reported outcomes measures and experiences (PROMs and PREMs) in relation to integrated care (IC). Material and methods: To select eligible studies (<10 years, full-text), PubMed was used. The general subject of the articles referring to the type of disease was indicated on the basis of a review of all full-text publications discussing the effectiveness of IC (N = 6518). The final search included MeSH headings related to outcomes measures and IC. Full-text screening resulted in including 73 articles (23 on COPD, 40 on diabetes/obesity and 10 on depression) with 93.391 participants. Results: Analysis indicated that authors used multiple outcome measures, with 54.8% of studies including at least one patient reported. PROMs were more often used than PREMs. Specific (disease or condition/dimension) outcome measures were reported more often than general, especially those dedicated to self-assessment of health in COPD and depression. PROMs and PREMs were most commonly used in studies from the USA and Netherlands. Conclusion: Using PROMS/PREMS is becoming more popular, although it is varied, both due to the place of research and type of disease.
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Affiliation(s)
- Ewa Bandurska
- Center for Competence Development, Integrated Care and e-Health, Medical University of Gdańsk, Debowa 30, 80-208 Gdansk, Poland
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14
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Xiao Z, Han X. Evaluation of the Effectiveness of Telehealth Chronic Disease Management System: A Systematic Review and Meta-Analysis (Preprint). J Med Internet Res 2022; 25:e44256. [PMID: 37103993 PMCID: PMC10176143 DOI: 10.2196/44256] [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: 11/12/2022] [Revised: 12/15/2022] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Long-term daily health monitoring and management play a more significant role in telehealth management systems nowadays, which require evaluation indicators to present patients' general health conditions and become applicable to multiple chronic diseases. OBJECTIVE This study aims to evaluate the effectiveness of subjective indicators of telehealth chronic disease management system (TCDMS). METHODS We selected Web of Science, ScienceDirect, Scopus, Cochrane library, IEEE, and Chinese National Knowledge Infrastructure and Wanfang, a Chinese medical database, and searched papers published from January 1, 2015, to July 1, 2022, regarding randomized controlled trials on the effectiveness of the telehealth system on patients with chronic diseases. The narrative review summarized the questionnaire indicators presented in the selected studies. In the meta-analysis, Mean Difference (MD) and Standardized Mean Difference (SMD) with a 95% CI were pooled depending on whether the measurements were the same. Subgroup analysis was conducted if the heterogeneity was significant, and the number of studies was sufficient. RESULTS Twenty RCTs with 4153 patients were included in the qualitative review. Seventeen different questionnaire-based outcomes were found, within which quality of life, psychological well-being (including depression, anxiety, and fatigue), self-management, self-efficacy, and medical adherence were most frequently used. Ten RCTs with 2095 patients remained in meta-analysis. Compared to usual care, telehealth system can significantly improve the quality of life (SMD 0.44; 95% CI 0.16-0.73; P=.002), whereas no significant effects were found on depression (SMD -0.25; 95% CI -0.72 to 0.23; P=.30), anxiety (SMD -0.10; 95% CI -0.27 to 0.07; P=.71), fatigue (SMD -0.36; 95% CI -1.06 to 0.34; P<.001), and self-care (SMD 0.77; 95% CI -0.28-1.81; P<.001). In the subdomains of quality of life, telehealth statistically significantly improved physical functioning (SMD 0.15; 95% CI 0.02 to 0.29; P=.03), mental functioning (SMD 0.37; 95% CI 0.13-0.60; P=.002), and social functioning (SMD 0.64; 95% CI 0.00-1.29; P=.05), while there was no difference on cognitive functioning (MD 8.31; 95% CI -7.33 to 23.95; P=.30) and role functioning (MD 5.30; 95% CI -7.80 to 18.39; P=.43). CONCLUSIONS TCDMS positively affected patients' physical, mental, and social quality of life across multiple chronic diseases. However, no significant difference was found in depression, anxiety, fatigue, and self-care. Subjective questionnaires had the potential ability to evaluate the effectiveness of long-term telehealth monitoring and management. However, further well-designed experiments are warranted to validate TCDMS's effects on subjective outcomes, especially when tested among different chronically ill groups.
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Affiliation(s)
- Ziyan Xiao
- Research Center Intelligent Equipment and Technology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong, Hong Kong
| | - Xiuping Han
- Research Center Intelligent Equipment and Technology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China
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15
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Larsen MH, Mengshoel AM, Andersen MH, Borge CR, Ahlsen B, Dahl KG, Eik H, Holmen H, Lerdal A, Mariussen KL, Thoresen L, Tschamper MK, Urstad KH, Vidnes TK, Wahl AK. "A bit of everything": Health literacy interventions in chronic conditions - a systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:2999-3016. [PMID: 35641366 DOI: 10.1016/j.pec.2022.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To systematically evaluate health literacy (HL) interventions in chronic conditions by exploring theoretical perspectives, intervention content and effectiveness. METHOD We searched MEDLINE, Cochrane, CINAHL, EMBASE, ERIC, Web of Science and PsycINFO. Standardised systematic review methods were used, and sequences informing our research question were extracted and analysed. The study includes a descriptive summary of the included papers. RESULTS We included 39 unique interventions, with diabetes and heart disease as the most targeted chronic conditions. Fifty-four percent of papers included a definition of HL, but the studies showed significant heterogeneity of theoretical underpinnings, modes, measures and content. We identified 23 HL measures, mostly assessing functional HL. The HL interventions were often more complex than the measures indicated. A significant change in HL was found in 28 studies. Study quality was generally poor. CONCLUSIONS Interventions optimizing HL appear important to improve health outcomes in chronic conditions. To ensure cumulative knowledge development of this field we need theory-based interventions, consistency in methods and more tailored and comprehensive measures to capture the interventions' complexity. PRACTICE IMPLICATIONS A more valid understanding of HL interventions and measurements is needed to reach an agreed understanding of their components and intentions.
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Affiliation(s)
- Marie H Larsen
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences-University of Oslo, Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway.
| | - Anne Marit Mengshoel
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences-University of Oslo, Oslo, Norway.
| | - Marit H Andersen
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences-University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Christine R Borge
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences-University of Oslo, Oslo, Norway; Lovisenberg Diaconal Hospital AS, Oslo, Norway.
| | - Birgitte Ahlsen
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
| | - Kari Gire Dahl
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Hedda Eik
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences-University of Oslo, Oslo, Norway; Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
| | - Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion - Oslo Metropolitan University, Norway.
| | - Anners Lerdal
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences-University of Oslo, Oslo, Norway; Lovisenberg Diaconal Hospital AS, Oslo, Norway.
| | | | - Lisbeth Thoresen
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences-University of Oslo, Oslo, Norway.
| | - Merete K Tschamper
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences-University of Oslo, Oslo, Norway; National Centre for Epilepsy, Devision of Clinical Neuroscience, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Kristin H Urstad
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Tone K Vidnes
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences-University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Astrid K Wahl
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences-University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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16
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Lin B, Yue S. The Use of Telehealth in Depression Treatment during the Crisis Caused by COVID-19. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:536-547. [PMID: 35300574 DOI: 10.1080/19371918.2022.2053631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Throughout the COVID-19 pandemic, there has been increased interest in telehealth as a means of providing care for depression. In this article, we provide an overview of telehealth utilization for the treatment of depression and provide some insight into the rapid shift made to quickly implement these telehealth services into our everyday practices due to COVID-19 personal distancing requirements. We review the application of telehealth in the treatment of depression during the COVID-19 pandemic. The multiple advantages and disadvantages of telehealth in treatment of depression are summarized through the literature, and we analyze the methods to improve the effect and quality of telehealth in depression treatment. It has been highlighted in the current research that against its proven capacity for convenience, its relative cheapness, and its ability to overcome geographic barriers, telehealth has its own shortfalls, including disparities in rural-urban infrastructure and an alleged inability to be exhaustive when intensive interventions are needed. Recommendations for the improvement of telehealth during the COVID-19 pandemic also presuppose that it is infrastructure and human resource intensive and that short-term improvements in its efficiency are largely dependent on the creativity and resourcefulness of physicians to provide custom solutions for patients.
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Affiliation(s)
- Bowen Lin
- Department of Medical Affairs, The First Afilliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Shiye Yue
- Department of Medical Affairs, The First Afilliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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17
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Degan TJ, Kelly PJ, Robinson LD, Deane FP, Smith AM. Health literacy of people living with mental illness or substance use disorders: A systematic review. Early Interv Psychiatry 2021; 15:1454-1469. [PMID: 33254279 DOI: 10.1111/eip.13090] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 09/22/2020] [Accepted: 11/14/2020] [Indexed: 02/07/2023]
Abstract
AIM Health literacy is one's ability to use cognitive and social skills to access, understand and appraise health information. Despite poor health outcomes of people living with mental illness there is limited research assessing their health literacy. This systematic review aims to synthesise research on health literacy rates, conceptualizations, and outcomes of people living with mental illness, including substance use disorders. This will provide insights into how health literacy might be targeted to reduce these health inequities. METHODS A search of published literature in multiple databases up until February 2019 was conducted. One reviewer screened the titles, abstracts and keywords of identified publications and the eligibility of all full-text publications were assessed for inclusion along with a second reviewer. Both reviewers independently rated the quality of the included studies. RESULTS Fourteen studies were included in the review. Rates and measures of health literacy varied. Low health literacy and health literacy weaknesses were identified. There is a lack of research on the relationship between health literacy and other outcomes, particularly health service engagement. CONCLUSION The review highlights the high rates of low health literacy within this population compared with general populations. Most studies used a functional health literacy measure, despite its limitations, with only a few using multidimensional measures. Overall, there is limited research examining the impact that this populations health literacy has on their recovery and how it affects them over time. The review emphasizes the importance of practitioners assessing and targeting health literacy needs when working with this population.
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Affiliation(s)
- Tayla J Degan
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Laura D Robinson
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Anna M Smith
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, Australia
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18
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Haun MW, Hoffmann M, Wildenauer A, Tönnies J, Wensing M, Szecsenyi J, Peters-Klimm F, Krisam R, Kronsteiner D, Hartmann M, Friederich HC. Health providers' experiences with mental health specialist video consultations in primary care: a qualitative study nested within a randomised feasibility trial. BMJ Open 2021; 11:e047829. [PMID: 34753752 PMCID: PMC8578962 DOI: 10.1136/bmjopen-2020-047829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Despite available effective treatments for mental health disorders, few patients in need receive even the most basic care. Integrated telepsychiatry services may be a viable option to increase access to mental healthcare. The aim of this qualitative process evaluation embedded in a randomised controlled feasibility trial was to explore health providers' experiences with a mental healthcare model integrating mental health specialist video consultations (MHSVC) and primary care. METHODS A qualitative process evaluation focusing on MHSVC in primary care was conducted. In 13 semistructured interviews, we assessed the experience of all mental health specialists, primary care physicians and medical assistants who participated in the trial. A thematic analysis, focusing on the implementation, mechanisms of impact and context, was applied to investigate the data. RESULTS Considering (1) the implementation, participants evaluated the consultations as feasible, easy to use and time saving. Concerning (2) the mechanisms of impact, the consultations were regarded as effective for patients. Providers attributed the patients' improvements to two key aspects: the familiarity of the primary care practice and the fast access to specialist mental healthcare. Mental health specialists observed trustful therapeutic alliances emerging and described their experience as comparable to same-room care. However, compared with same-room care, specialists perceived the video consultations as more challenging and sometimes more exhausting due to the additional effort required for establishing therapeutic alliances. Regarding (3) the intervention's context, shorter travel distances for patients positively affected the implementation, while technical failures, that is, poor Internet connectivity, emerged as the main barrier. CONCLUSIONS MHSVCs in primary care are feasible and successful in improving access to mental healthcare for patients. To optimise engagement and comfort of both patients and health providers, future work should focus on empirical determinants for establishing robust therapeutic alliances with patients receiving MHSVC (eg, leveraging non-verbal cues for therapeutic purposes). TRIAL REGISTRATION NUMBER DRKS00015812; Results.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Alina Wildenauer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
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19
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Hendrikx LJ, Murphy D. Supporting the Mental Health Needs of Military Partners Through the Together Webinar Program: Pilot Randomized Controlled Trial. JMIR Ment Health 2021; 8:e25622. [PMID: 34636734 PMCID: PMC8548968 DOI: 10.2196/25622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite an increased risk of psychological difficulties, there remains a lack of evidence-based support for the mental health needs of military partners. OBJECTIVE This study aims to investigate whether the Together Webinar Programme (TTP-Webinar), a 6-week structured, remote access group intervention would reduce military partners' experience of common mental health difficulties and secondary trauma symptoms. METHODS A pilot randomized controlled trial was used to compare the TTP-Webinar intervention with a waitlist control. The sample was UK treatment-seeking veterans engaged in a mental health charity. A total of 196 military partners (1 male and 195 females; aged mean 42.28, SD 10.82 years) were randomly allocated to the intervention (n=97) or waitlist (n=99) condition. Outcome measures were self-reported measures of common mental health difficulties, secondary trauma symptoms, and overall quality of life rating. RESULTS Compared with the waitlist, military partners in the TTP-Webinar had reduced common mental health difficulties (P=.02) and secondary trauma symptoms (P=.001). However, there was no difference in quality-of-life ratings (P=.06). CONCLUSIONS The results suggest that TTP-Webinar is an effective intervention to support the mental health difficulties of military partners. This study provides promising evidence that webinars may be an appropriate platform for providing group-based support. TRIAL REGISTRATION ClinicalTrials.gov NCT05013398; https://clinicaltrials.gov/ct2/show/NCT05013398.
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Affiliation(s)
| | - Dominic Murphy
- Combat Stress, Leatherhead, United Kingdom
- King's Centre for Military Health Research, King's College London, London, United Kingdom
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MacIver A, Hollinger H, Carolan C. Tele-health interventions to support self-management in adults with rheumatoid arthritis: a systematic review. Rheumatol Int 2021; 41:1399-1418. [PMID: 34132890 PMCID: PMC8245362 DOI: 10.1007/s00296-021-04907-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/29/2021] [Indexed: 11/26/2022]
Abstract
Rheumatoid arthritis (RA), a long-term auto-immune condition is a challenging condition for patients to manage. Goals of treatment include reducing pain, decreasing inflammation, and improving an individual's overall function. Increasingly technology is being utilised to support patients to self-manage their condition. The aim of this systematic narrative review was to synthesise and critically appraise published evidence concerning the effectiveness of tele-health interventions to support self-management in RA. Bibliographic databases searched from 2014 to March 2020 included MedLINE, Embase, Cochrane Library. Search strategy combined the following concepts: (1) rheumatoid arthritis, (2) tele-health interventions, and (3) self-management. Only randomised controlled trials (RCTs) involving adults with RA were included. Titles, abstracts, full-text articles were screened, any discrepancies were checked by a second reviewer. Risk of bias was assessed using Cochrane risk of bias tool and data were extracted utilising the Cochrane data collection form for RCT interventions along with the TiDier checklist. Due to high heterogeneity, results were not meta-analysed and instead data were synthesised narratively. The search identified 98 articles, seven were included. The completed RCTs varied in the nature of the interventions, duration/severity of RA, outcomes measured and effectiveness of the interventions. The completed RCTs included a total of 791 participants Disease duration was largely between 4 and 10 years and disease severity on average was moderate. There was extensive variation in intervention components, theories underpinning theories and outcomes measured. Five RCTs reported a positive effect on factors such as disease activity, medication adherence, physical activity and self-efficacy levels. This study suggests that tele-health interventions that are well-designed, tailored and multi-faceted can help to achieve positive self-management outcomes in RA. None of the studies showed evidence of harm.
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Affiliation(s)
- Alison MacIver
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
- NHS Western Isles, Stornoway, Scotland UK
| | - Hannah Hollinger
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
| | - Clare Carolan
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
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21
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Frye WS, Gardner L, Mateus JS. Utilising telemental health in a paediatric outpatient psychology clinic: Therapeutic alliance and outcomes. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Lauren Gardner
- Johns Hopkins All Children’s Hospital St Petersburg FL USA
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22
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Moriarty AS, Paton LW, Snell KIE, Riley RD, Buckman JEJ, Gilbody S, Chew-Graham CA, Ali S, Pilling S, Meader N, Phillips B, Coventry PA, Delgadillo J, Richards DA, Salisbury C, McMillan D. The development and validation of a prognostic model to PREDICT Relapse of depression in adult patients in primary care: protocol for the PREDICTR study. Diagn Progn Res 2021; 5:12. [PMID: 34215317 PMCID: PMC8254312 DOI: 10.1186/s41512-021-00101-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Most patients who present with depression are treated in primary care by general practitioners (GPs). Relapse of depression is common (at least 50% of patients treated for depression will relapse after a single episode) and leads to considerable morbidity and decreased quality of life for patients. The majority of patients will relapse within 6 months, and those with a history of relapse are more likely to relapse in the future than those with no such history. GPs see a largely undifferentiated case-mix of patients, and once patients with depression reach remission, there is limited guidance to help GPs stratify patients according to risk of relapse. We aim to develop a prognostic model to predict an individual's risk of relapse within 6-8 months of entering remission. The long-term objective is to inform the clinical management of depression after the acute phase. METHODS We will develop a prognostic model using secondary analysis of individual participant data drawn from seven RCTs and one longitudinal cohort study in primary or community care settings. We will use logistic regression to predict the outcome of relapse of depression within 6-8 months. We plan to include the following established relapse predictors in the model: residual depressive symptoms, number of previous depressive episodes, co-morbid anxiety and severity of index episode. We will use a "full model" development approach, including all available predictors. Performance statistics (optimism-adjusted C-statistic, calibration-in-the-large, calibration slope) and calibration plots (with smoothed calibration curves) will be calculated. Generalisability of predictive performance will be assessed through internal-external cross-validation. Clinical utility will be explored through net benefit analysis. DISCUSSION We will derive a statistical model to predict relapse of depression in remitted depressed patients in primary care. Assuming the model has sufficient predictive performance, we outline the next steps including independent external validation and further assessment of clinical utility and impact. STUDY REGISTRATION ClinicalTrials.gov ID: NCT04666662.
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Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences, University of York, York, England.
- Hull York Medical School, University of York, York, England.
| | - Lewis W Paton
- Department of Health Sciences, University of York, York, England
| | - Kym I E Snell
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, England
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, England
| | - Joshua E J Buckman
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, England
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, England
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, England
- Hull York Medical School, University of York, York, England
| | | | - Shehzad Ali
- Department of Health Sciences, University of York, York, England
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Stephen Pilling
- Centre for Outcomes and Research Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, England
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, England
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, England
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Jaime Delgadillo
- Department of Psychology, University of Sheffield, Sheffield, England
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, England
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway, USA
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol, England
| | - Dean McMillan
- Department of Health Sciences, University of York, York, England
- Hull York Medical School, University of York, York, England
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23
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Chattu VK, Lopes CA, Javed S, Yaya S. Fulfilling the promise of digital health interventions (DHI) to promote women's sexual, reproductive and mental health in the aftermath of COVID-19. Reprod Health 2021; 18:112. [PMID: 34088319 PMCID: PMC8177268 DOI: 10.1186/s12978-021-01168-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Vijay Kumar Chattu
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 2C4, Canada. .,Division of Occupational Medicine, Occupational Medicine Clinic, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, M5C 2C5, Canada.
| | - Claudia Abreu Lopes
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Sumbal Javed
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada.,The George Institute for Global Health, Imperial College London, London, UK
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24
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Haun MW, Tönnies J, Krisam R, Kronsteiner D, Wensing M, Szecsenyi J, Vomhof M, Icks A, Wild B, Hartmann M, Friederich HC. Mental health specialist video consultations versus treatment as usual in patients with depression or anxiety disorders in primary care: study protocol for an individually randomised superiority trial (the PROVIDE-C trial). Trials 2021; 22:327. [PMID: 33952313 PMCID: PMC8097128 DOI: 10.1186/s13063-021-05289-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/23/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Most people with mental disorders, including those with severe and chronic disorders, are treated solely by their general practitioner (GP). Nevertheless, specialised mental health care may be required for specific patients. Notably, the accessibility of mental health specialist care is mainly complicated by (a) long waiting times for an appointment with specialists, (b) long travel distances to specialists, particularly in rural and remote areas, and (c) patients' reservations about mental health specialist care (including fear of being stigmatised by seeking such care). To mitigate those barriers, technology-based integrated care models have been proposed. The purpose of this study is to examine the effectiveness and cost-effectiveness of a mental health specialist video consultations model versus treatment as usual in patients with depression or anxiety disorders in primary care. METHODS In an individually randomised, prospective, two-arm superiority trial with parallel group design, N = 320 patients with anxiety and/or depressive disorder will be recruited in general practices in Germany. The intervention includes a newly developed treatment model based on video consultations with focus on diagnostics, treatment planning, and short-term intervention by mental health specialists. We will systematically compare the effectiveness, cost-effectiveness, and adverse effects of this new model with usual care by the GP: the primary outcome is the absolute change in the mean depressive and anxiety symptom severity measured on the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) from baseline to 6 months after baseline assessment. Follow-up in both groups will be conducted by blinded outcome assessors at 6 months and 12 months after baseline. The main analysis will be based on the intention-to-treat principle. We will optimise the likelihood of treatment effectiveness by strict inclusion criteria for patients, enhanced intervention integrity, and conducting a process evaluation. DISCUSSION To the best of our knowledge, this is the first confirmatory study on a video-based, integrated care model for the treatment of anxiety and depressive disorders in GP patients in Germany. TRIAL REGISTRATION ClinicalTrials.gov, United States National Institutes of Health NCT04316572 . Prospectively registered on 20 March 2020.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany.
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University, Heidelberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
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25
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Buckman JEJ, Saunders R, Cohen ZD, Barnett P, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, Wiles N, Kessler D, Richards D, Sharp D, Brabyn S, Littlewood E, Salisbury C, White IR, Lewis G, Pilling S. The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis. Psychol Med 2021; 51:1068-1081. [PMID: 33849685 PMCID: PMC8188529 DOI: 10.1017/s0033291721001367] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/08/2021] [Accepted: 03/26/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care. METHODS We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted. RESULTS Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3-4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3-4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions. CONCLUSIONS When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.
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Affiliation(s)
- Joshua E. J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, LondonWC1E 7HB, UK
- iCope – Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, 4 St Pancras Way, LondonNW1 0PE, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, LondonWC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA90095, USA
| | - Phoebe Barnett
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, LondonWC1E 7HB, UK
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, LondonWC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, LondonWC1E 7HB, UK
| | - Robert J. DeRubeis
- Department of Psychology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, YorkYO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN37240, USA
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, SouthamptonSO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, ExeterEX4 4QG, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, BristolBS8 2BN, UK
| | - David Kessler
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - David Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, ExeterEX1 2LU, UK
| | - Deborah Sharp
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, YorkYO10 5DD, UK
| | | | - Chris Salisbury
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - Ian R. White
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, LondonWC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, LondonW1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, LondonWC1E 7HB, UK
- Camden & Islington NHS Foundation Trust, 4 St Pancras Way, LondonNW1 0PE, UK
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26
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Comparison of DASS-21, PHQ-8, and GAD-7 in a virtual behavioral health care setting. Heliyon 2021; 7:e06473. [PMID: 33817367 PMCID: PMC8010403 DOI: 10.1016/j.heliyon.2021.e06473] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Validated depression and anxiety symptom screeners are commonly used in clinical settings. How results from different brief depression and anxiety symptom assessment tools compare to each other is not well established, especially in real world healthcare settings. This study aimed to compare the Depression Anxiety Stress Scales 21 Depression scale (DASS-Depression) and Anxiety (DASS-Anxiety) scale to the Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7 (GAD-7) respectively, in a real-world virtual behavioral healthcare setting. Methods This was a retrospective comparison study of clinical data from a population of adults who completed a consultation via telephone or secure video with a licensed therapist as part of a standardized, evidence-based, virtual behavioral therapy program for individuals with comorbid medical and behavioral health conditions. The joint distributions and correlations between scores yielded by each depression and anxiety scale were assessed using descriptive and Spearman correlation statistics. Results The DASS-Depression and PHQ-8 were highly correlated (r = .71; p=<.001); the DASS-Anxiety and GAD-7 correlation was also high (r = .61; p=<.001). The PHQ-8 categorized more individuals as having above-threshold depression scores versus the DASS-Depression (71.5% vs. 43.5%; p < .001). The GAD-7 categorized more individuals as having above-threshold anxiety scores versus the DASS-Anxiety (59.0% vs. 45.0%; p < .001). Limitations This study compared results yielded by validated screeners, precluding conclusions related to the validity of screener results. Conclusions The DASS-Depression and PHQ-8 and the DASS-Anxiety and GAD-7 similarly ranked symptom severity. The PHQ-8 and GAD-7 were more likely than the DASS-21 Depression or Anxiety scales to classify individuals as having above-threshold symptom severity.
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27
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28
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Swenson I, Gates TG, Dentato MP, Kelly BL. Strengths-based behavioral telehealth with sexual and gender diverse clients at Center on Halsted. SOCIAL WORK IN HEALTH CARE 2021; 60:78-92. [PMID: 33563143 DOI: 10.1080/00981389.2021.1885561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/05/2021] [Accepted: 01/31/2021] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic necessitated an immediate response and rapid transition from traditional face-to-face behavioral health services to behavioral telehealth at an organization serving sexual and gender diverse (SGD) individuals in Chicago. In this practice innovations article, we explore the unfolding public health crisis and the impact on service delivery for SGD individuals. Using a large multi-service organization as a case study, this paper describes how key members of the staff and leadership team shifted services online as a means of responding to isolation, loneliness, and disparities in access to healthcare for Chicago SGD communities. Lessons learned and practice recommendations are presented.
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Affiliation(s)
- Ing Swenson
- Behavioral Health Department, Center on Halsted, Chicago, Illinois, USA
| | - Trevor G Gates
- School of Law and Society,University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Michael P Dentato
- School of Social Work, Loyola University Chicago, Chicago, Illinois, USA
| | - Brian L Kelly
- School of Social Work, Loyola University Chicago, Chicago, Illinois, USA
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29
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Lehner A, Nuißl K, Schlee W, Langguth B. Staying Connected: Reaching Out to Psychiatric Patients During the Covid-19 Lockdown Using an Online Blog. Front Public Health 2021; 8:592618. [PMID: 33425836 PMCID: PMC7793636 DOI: 10.3389/fpubh.2020.592618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/24/2020] [Indexed: 01/18/2023] Open
Abstract
Health systems worldwide are challenged by the coronavirus pandemic and all medical specialties have struggle to meet the conflicting requirements for virus containment on the one hand and treatment of other medical conditions on the other. This holds true also for psychiatry. Per se, psychiatric patients are highly vulnerable to suffer from social isolation and loneliness. As a result of the Covid-19 pandemic and lockdown measures, unfortunately, this vulnerability is even further increased. As a part of its pandemic risk management, the outpatient clinic of the Psychiatric District Hospital Regensburg launched an online blog as a means of assisting patients who were required to stay home. Aim of the blog was to stay by patients' side in those uncertain times by offering an online connection to their therapists, by providing important information about the pandemic situation, by offering some ideas on how to build a daily routine and how to meaningfully spend their time at home during the lockdown. We also aimed at involving patients as experts in their own affairs by inviting them to contribute to the blog's shape and content. As a result of coordinated team effort, it was possible to launch a blog within few days, and this was perceived helpful by many patients. Overall, however, patient involvement turned out to be a challenge requiring more attention in future work.
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Affiliation(s)
- Astrid Lehner
- Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Klaus Nuißl
- Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Winfried Schlee
- Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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30
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Danilewitz M, Ainsworth NJ, Bahji A, Chan P, Rabheru K. Virtual psychiatric care for older adults in the age of COVID-19: Challenges and opportunities. Int J Geriatr Psychiatry 2020; 35:1468-1469. [PMID: 32602134 PMCID: PMC7361817 DOI: 10.1002/gps.5372] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/25/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Marlon Danilewitz
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Nicholas J. Ainsworth
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Anees Bahji
- Department of PsychiatryQueen's UniversityKingstonOntarioCanada
| | - Peter Chan
- Division of Geriatric Psychiatry, Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kiran Rabheru
- Department of PsychiatryUniversity of OttawaOttawaOntarioCanada
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31
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Bhaskar S, Bradley S, Chattu VK, Adisesh A, Nurtazina A, Kyrykbayeva S, Sakhamuri S, Moguilner S, Pandya S, Schroeder S, Banach M, Ray D. Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2). Front Public Health 2020; 8:410. [PMID: 33014958 PMCID: PMC7505101 DOI: 10.3389/fpubh.2020.00410] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia.,Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,The University of New South Wales (UNSW) Medicine Sydney, South West Sydney Clinical School, Sydney, NSW, Australia
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Anil Adisesh
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Alma Nurtazina
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Saltanat Kyrykbayeva
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Sateesh Sakhamuri
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sebastian Moguilner
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Shawna Pandya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Alberta Health Services and Project PoSSUM, University of Alberta, Edmonton, AB, Canada
| | - Starr Schroeder
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Penn Medicine Lancaster General Hospital and Project PoSSUM, Lancaster, PA, United States
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.,Department of Hypertension, Medical University of Lodz, Łódz, Poland
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia.,Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
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Providers' perceptions on barriers and facilitators to prescribing naloxone for patients at risk for opioid overdose after implementation of a national academic detailing program: A qualitative assessment. Res Social Adm Pharm 2020; 16:1033-1040. [DOI: 10.1016/j.sapharm.2019.10.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 08/13/2019] [Accepted: 10/25/2019] [Indexed: 11/18/2022]
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Kumar A, Wang M, Riehm A, Yu E, Smith T, Kaplin A. An Automated Mobile Mood Tracking Technology (Mood 24/7): Validation Study. JMIR Ment Health 2020; 7:e16237. [PMID: 32432558 PMCID: PMC7270850 DOI: 10.2196/16237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/08/2020] [Accepted: 02/09/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Electronic tracking has been utilized for a variety of health conditions. Previous studies have shown that there is higher adherence to electronic methods vs paper-and-pencil tracking modalities. Electronic tracking also ensures that there are no back-filled entries, where patients have-to appear compliant-entered their responses retrospectively just before their visits with their health care provider. On the basis of the recognition of an unmet need for a Web-based automated platform to track psychiatric outcomes, Johns Hopkins University partnered with Health Central (a subsidiary of Remedy Health Media LLC) to develop Mood 24/7, an electronic, mobile, automated, SMS-based mood tracker. This is a pilot study to validate the use of Mood 24/7 in anticipation of clinical trials to demonstrate the therapeutic benefit on patients' health outcomes of utilizing digital mood-tracking technology. OBJECTIVE Mood 24/7 is an electronic mood-monitoring platform developed to accurately and efficiently track mood over time through automated daily SMS texts or emails. This study was designed to assess the accuracy and validity of Mood 24/7 in an outpatient psychiatric setting. METHODS This pilot study involved a retrospective chart review for depressed outpatients (N=9) to compare their self-reported Mood 24/7 daily mood ratings with their psychiatrist's independent clinical mood assessment at the time of the patient's visit. Their mood ratings via Mood 24/7 were collected over 36 weeks. In addition, a mixed model analysis was applied to compare the weekly Montgomery-Åsberg Depression Rating Scale (MADRS) scores with Mood 24/7 scores over an average of 3 months. RESULTS A 97.2% (315/324) digital mood reporting adherence was found over 36 weeks, and a significant correlation (r=0.86, P<.001) was observed between patients' Mood 24/7 scores and their psychiatrist's blinded clinical assessment of the patient's mood when seen in the clinic. In addition, a significant concordance (intraclass correlation of 0.69, 95% CI 0.33-0.91, P<.001) was observed in the mixed model analysis of the clinician-administered MADRS vs Mood 24/7 scores over time. CONCLUSIONS Our chart review and mixed model analyses demonstrate that Mood 24/7 is a valid instrument for convenient, simple, noninvasive, and accurate longitudinal mood assessment in the outpatient clinical setting.
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Affiliation(s)
- Anupama Kumar
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Michael Wang
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Alison Riehm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Eileen Yu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Ted Smith
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY, United States
| | - Adam Kaplin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
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Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2020; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
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Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
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Moriarty AS, Coventry PA, Hudson JL, Cook N, Fenton OJ, Bower P, Lovell K, Archer J, Clarke R, Richards DA, Dickens C, Gask L, Waheed W, Huijbregts KM, van der Feltz-Cornelis C, Ali S, Gilbody S, McMillan D. The role of relapse prevention for depression in collaborative care: A systematic review. J Affect Disord 2020; 265:618-644. [PMID: 31791677 DOI: 10.1016/j.jad.2019.11.105] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
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Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Peter A Coventry
- Department of Health Sciences and Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
| | - Joanna L Hudson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Natalie Cook
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Oliver J Fenton
- Tees, Esk and Wear Valleys NHS Foundation Trust, South and West Community Mental Health Team, Acomb Garth, 2 Oak Rise, York, YO24 4LJ, UK.
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Janine Archer
- School of Health and Society, University of Salford, Mary Seacole Building, Broad St, Frederick Road Campus, Salford, M6 6PU, UK.
| | - Rose Clarke
- Sheffield IAPT, St George's Community Health Centre, Winter Street, Sheffield, South Yorkshire, S3 7ND, UK.
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Chris Dickens
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Linda Gask
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Klaas M Huijbregts
- GGNet, Mental Health, RGC SKB Winterswijk, Beatrixpark 1, 7101 BN Winterswijk, The Netherlands.
| | | | - Shehzad Ali
- Epidemiology and Biostatistics Department, Schulich School of Medicine & Dentistry, Western University, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada; Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Simon Gilbody
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Dean McMillan
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
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Hendrikx LJ, Murphy D. Exploring the Acceptability of The Together Webinar Programme for Military Partners: A Qualitative Study. Telemed J E Health 2020; 26:1475-1482. [PMID: 32074478 DOI: 10.1089/tmj.2019.0309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Military partners appear at risk for developing psychological difficulties such as depression, generalized anxiety, and secondary trauma symptoms. Yet, evidence suggests that participants report an array of barriers that prevent them from seeking and engaging with mental health support. This includes stigma-related beliefs, work and childcare responsibilities, and distance to venue where support is offered. Introduction: The Together Webinar Programme (TTP-Webinar) was developed to increase the accessibility of mental health support for military partners. The efficacy of this program has been explored in a previous study. Materials and Methods: Data for this study were taken from 68 partners who provided qualitative feedback of the program. Thematic qualitative analysis was used to explore the views of participants about the acceptability of TTP-Webinar. Results: Four main themes were identified, namely perceived benefit, modality, general barriers, and areas for improvement. Discussion: Participants found it favorable to develop a better understanding of veterans' difficulties, to have their own difficulties normalized through sharing and discussion, and to feel part of a wider community. They also found the webinar format favorable as it increased the accessibility of support and provided them with an interactive safe platform. Conclusions: The study provides promising qualitative evidence for the use of TTP-Webinar in supporting the mental health needs of military partners.
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Affiliation(s)
| | - Dominic Murphy
- Research Department, Combat Stress, Leatherhead, United Kingdom.,King's Centre for Military Health Research, King's College London, London, United Kingdom
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Newly educated care managers' experiences of providing care for persons with stress-related mental disorders in the clinical primary care context. PLoS One 2019; 14:e0224929. [PMID: 31714951 PMCID: PMC6850534 DOI: 10.1371/journal.pone.0224929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/24/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Our aim was to explore how the care managers put the complex care manager task into practice and how they perceived their task, which was to facilitate effective, person-centred treatment for stress-related disorder concordant with evidence-based guidelines in primary care. Design This was a qualitative study using examination reports from the course for care managers. Systematic text condensation according to Malterud was used for the analysis. Setting Primary health care centres Subject Twenty-eight newly educated care managers in primary health care participated in the study. The median age was 50 (31–68) years. Twenty-seven were women and one was a man. Twenty-one were employed as nurses and seven as counsellors. Results The informants perceived the role as care manager as meaningful but at times complicated. To participate in teams and to work closely with the general practitioner was experienced as important. The co-ordinating function was emphasised as especially important, as well as the increased continuity in care. The dual role as care manager and counsellor was sometimes experienced as problematic. Conclusion The informants took advantage of the knowledge they had attained during the course. They perceived themselves as being a bridge between patients and other professionals. The result of having dual roles at the primary health care centre unexpectedly revealed difficulties for some professionals. The nurses seemed more familiar with the new way of working.
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Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2019; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 02/15/2024] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 15 RCTs met inclusion criteria. The Dep-GP database will include the 6271 participants from the 13 studies that provided IPD. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
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Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
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Senanayake B, Wickramasinghe SI, Chatfield MD, Hansen J, Edirippulige S, Smith AC. Effectiveness of text messaging interventions for the management of depression: A systematic review and meta-analysis. J Telemed Telecare 2019; 25:513-523. [DOI: 10.1177/1357633x19875852] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Depression is a leading cause of human disability. Telemedicine-based interventions using text messaging are currently being trialled for the management of community-based clients with clinical depression. However, little is known about the effectiveness of such methods. Methods We searched the databases PubMed, Embase, Informit, Cochrane Central Register of Controlled Trials, PsycINFO and Scopus for randomised controlled trials (RCTs) published between January 2000 and April 2019. Studies comparing text messaging interventions to a comparator group for patients with depression were included in the review. Articles were assessed for quality using the Joanna Briggs Institute critical appraisal checklist for RCTs. Results Nine RCTs (945 patients: 764 adults and 181 adolescents) were included in the systematic review. Five studies used text messaging as the only intervention, whilst the remaining combined text messaging with other treatment modalities such as behavioural activation or cognitive behavioural therapy. A meta-analysis was conducted on seven selected RCTs (845 patients: 664 adults and 181 adolescents). The standardised mean reduction in depression due to text messaging interventions was 0.23 (95% confidence interval: –0.02 to 0.48). There was evidence of heterogeneity in treatment effect between studies. Discussion There is marginal evidence supporting text messaging interventions as an effective treatment modality for people living with clinical depression. However, further research is needed to determine how best to utilise text-message interventions alongside other conventional forms of health services delivery.
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Affiliation(s)
| | | | - Mark D Chatfield
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Julie Hansen
- Herston Health Sciences Library, The University of Queensland, Brisbane, Australia
| | | | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- The University of Southern Denmark, Odense, Denmark
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Buckman JE, Saunders R, Cohen ZD, Clarke K, Ambler G, DeRubeis RJ, Gilbody S, Hollon SD, Kendrick T, Watkins E, White IR, Lewis G, Pilling S. What factors indicate prognosis for adults with depression in primary care? A protocol for meta-analyses of individual patient data using the Dep-GP database. Wellcome Open Res 2019; 4:69. [PMID: 31815189 PMCID: PMC6880263 DOI: 10.12688/wellcomeopenres.15225.1] [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] [Accepted: 04/05/2019] [Indexed: 02/15/2024] Open
Abstract
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: "disorder severity". In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of "disorder severity" related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) "disorder severity" which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, history of previous treatment, functional impairment and health-related quality of life. 2) To determine whether i) social support, ii) life events, iii) alcohol misuse, and iv) demographic factors (sex, age, ethnicity, marital status, employment status, level of educational attainment, and financial wellbeing) are prognostic indicators of outcomes, independent of baseline "disorder severity" and the type of treatment received. Methods: Databases were searched for randomised clinical trials (RCTs) that recruited adults seeking treatment for depression from their general practitioners and used the same diagnostic and screening instrument to measure severity at baseline - the Revised Clinical Interview Schedule; outcome measures could differ between studies. Chief investigators of all studies meeting inclusion criteria were contacted and individual patient data (IPD) were requested. Conclusions: In total 13 RCTs were found to meet inclusion criteria. The Dep-GP database was formed from the 6271 participants. This protocol outlines how these data will be analysed. Registration: PROSPERO CRD42019129512 (01/04/2019).
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Affiliation(s)
- Joshua E.J. Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Rob Saunders
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Zachary D. Cohen
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Katherine Clarke
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
| | - Gareth Ambler
- Statistical Science, University College London, London, WC1E 7HB, UK
| | - Robert J. DeRubeis
- School of Arts and Sciences, Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104-60185, USA
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, 407817, USA
| | - Tony Kendrick
- Primary Care & Population Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 5ST, UK
| | - Edward Watkins
- Department of Psychology, University of Exeter, Exeter, EX4 4QG, UK
| | - Ian R. White
- Institute of Clinical Trials and Methodology, MRC Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, London, WC1E 7HB, UK
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Massoudi B, Holvast F, Bockting CLH, Burger H, Blanker MH. The effectiveness and cost-effectiveness of e-health interventions for depression and anxiety in primary care: A systematic review and meta-analysis. J Affect Disord 2019; 245:728-743. [PMID: 30447572 DOI: 10.1016/j.jad.2018.11.050] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 09/21/2018] [Accepted: 11/03/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Psychological interventions are labor-intensive and expensive, but e-health interventions may support them in primary care. In this study, we systematically reviewed the effectiveness and cost-effectiveness of e-health interventions for depressive and anxiety symptoms and disorders in primary care. METHODS We searched MEDLINE, Cochrane library, Embase, and PsychINFO until January 2018, for randomized controlled trials of e-health interventions for depression or anxiety in primary care. Two reviewers independently screened the identified publications, extracted data, and assessed risk of bias using the Cochrane Collaboration's tool. RESULTS Out of 3617 publications, we included 14 that compared 33 treatments in 4183 participants. Overall, the methodological quality was poor to fair. The pooled effect size of e-health interventions was small (standardized mean difference = -0.19, 95%CI -0.31 to -0.06) for depression compared to control groups in the short-term, but this was maintained in the long-term (standardized mean difference = -0.22, 95%CI -0.35 to -0.09). Further analysis showed that e-health for depression had a small effect compared to care as usual and a moderate effect compared to waiting lists. One trial on anxiety showed no significant results. Four trials reported on cost-effectiveness. LIMITATIONS The trials studied different types of e-health interventions and had several risks of bias. Moreover, only one study was included for anxiety. CONCLUSIONS E-health interventions for depression have a small effect in primary care, with a moderate effect compared to waiting lists. The approach also appeared to be cost-effective for depression. However, we found no evidence for its effectiveness for anxiety.
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Affiliation(s)
- Btissame Massoudi
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
| | - Floor Holvast
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
| | - Claudi L H Bockting
- University of Utrecht, Department of Clinical Psychology, Utrecht, the Netherlands; University of Groningen, Department of Clinical Psychology, Groningen, the Netherlands.
| | - Huibert Burger
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
| | - Marco H Blanker
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
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Polhemus AM, Kadhim H, Barnes S, Zebrowski SE, Simmonds A, Masand SN, Banner J, Dupont M. Accelerating Adoption of Patient-Facing Technologies in Clinical Trials: A Pharmaceutical Industry Perspective on Opportunities and Challenges. Ther Innov Regul Sci 2018; 53:8-24. [PMID: 30373404 DOI: 10.1177/2168479018801566] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient-facing digital technologies (also called "Patient Technology" [PT]) have the potential to serve a variety of functions in clinical trials, such as capturing clinical endpoints, engaging patients, and facilitating remote study conduct. However, these technologies are not yet accepted as mainstream research tools, and the opportunities, challenges, and facilitators associated with their implementation in clinical trials have not been fully characterized. METHODS In order to understand the factors affecting PT adoption, the TransCelerate Patient Technology Initiative conducted a series of surveys, interviews, and focus groups with approximately 600 subject matter experts, including pharmaceutical company representatives, clinical trial investigators at a number of trial sites worldwide, and clinical trial participants. All interview and survey responses were blinded and aggregated by a third-party consultant and themes were extracted. RESULTS There was general consensus around the potential value of patient-facing technology as a clinical research tool, though a variety of challenges faced by each stakeholder were discussed. Detailed accounts of opportunities (improved patient experience, compliance, and engagement; clinical trial efficiencies; improved data quality and insights) and barriers (organizational and corporate cultural challenges, business-related challenges, user willingness and burden, and regulatory challenges) are reported. CONCLUSIONS While the barriers to PT adoption explored here were numerous, they were also generally consistent. A number of proposals for establishing more holistic, collaborative, and strategic approaches to PT implementation in clinical trials are discussed. Such approaches could facilitate more effective, widespread adoption of PT, and thereby a more patient-centric clinical trial paradigm.
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Affiliation(s)
- Ashley M Polhemus
- 1 MSD Global IT Innovation Center, Merck, Sharpe & Dohme Corp, Prague, Czech Republic
| | - Hassan Kadhim
- 2 IT Clinical Trial Planning & Management, Boehringer Ingelheim, Ridgefield, CT, USA
| | - Shelly Barnes
- 3 Site and Patient Solutions, UCB Biosciences Inc, Raleigh, NC, USA
| | - Susan E Zebrowski
- 4 Technology Platform Operations, Shared Solutions, Janssen Research & Development, Malvern, PA, USA
| | - Alex Simmonds
- 5 Digital Clinical, R&D IT, Bristol-Myers Squibb, New York, NY, USA
| | | | - Jaclyn Banner
- 7 Clinical Data Management, Hoffmann-La Roche Limited, Mississauga, ON, Canada
| | - Melissa Dupont
- 8 Clinical Trial Operations, Sanofi, Bridgewater, NJ, USA
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Lamb T, Pachana NA, Dissanayaka N. Update of Recent Literature on Remotely Delivered Psychotherapy Interventions for Anxiety and Depression. Telemed J E Health 2018; 25:671-677. [PMID: 30300082 DOI: 10.1089/tmj.2018.0079] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Anxiety and depression are harmful to individuals suffering from these disorders, their caregivers, and the economy. Remote delivery of psychotherapy has been established as a viable alternative to traditional in-person psychotherapy for treating anxiety and depression. However, literature comparing and evaluating the variety of remote delivery modalities of psychotherapy has not yet been integrated. This review examines the efficacy, practicality, and limitations of telephone, video, and online-administered psychotherapy for the treatment of anxiety and depression. Methods: A comprehensive literature search conducted using PubMed and PsycINFO included systematic reviews, randomized controlled trials, and cost-analysis studies focused on a remote delivery method of psychotherapy for anxiety and depression. Results: Overall, interventions delivered through telephone, video, and online modalities demonstrated good efficacy in treating anxiety and depression in general, and when presenting comorbid with other disorders. The literature also suggested that telehealth psychotherapy is accessible, convenient, and cost-effective. However, there is less evidence for video-delivered psychotherapy for anxiety and depression compared with telephone-administered and online-administered modalities. Despite this, overall, the efficacy and practical benefits of remote psychotherapy interventions in treating anxiety and depression across a diverse range of patient groups suggested that it is an appropriate alternative for those who cannot access in-person psychotherapy. Conclusions: Further research evaluating the efficacy and practical benefits of video-delivered psychotherapy for anxiety and depression is much needed for patients with limited access to in-person psychological care.
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Affiliation(s)
- Timothy Lamb
- 1School of Psychology, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- 1School of Psychology, The University of Queensland, Brisbane, Australia
| | - Nadeeka Dissanayaka
- 1School of Psychology, The University of Queensland, Brisbane, Australia.,2UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,3Department of Neurology, Royal Brisbane and Woman's Hospital, Brisbane, Australia
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Einhorn TA, Osmani FA, Sayeed Y, Karia R, Band P, Iorio R. The Role of Patient Education in Arthritis Management: The Utility of Technology. Orthop Clin North Am 2018; 49:389-396. [PMID: 30224000 DOI: 10.1016/j.ocl.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Technologies continue to shape the path of medical treatment. Orthopedic surgeons benefit from becoming more aware of how twenty-first century information technology (IT) can benefit patients. The percentage of orthopedic patients utilizing IT resources is increasing, and new IT tools are becoming utilized. These include disease-specific applications. This article highlights the opportunity for developing IT tools applicable to the growing population of patients with osteoarthritis (OA), and presents a potential solution that can facilitate the way OA education and treatment are delivered, and thereby maximize efficiency for the health care system, the physician, and the patient.
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Affiliation(s)
- Thomas A Einhorn
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, 380 2nd Avenue, New York, NY 10010, USA
| | - Feroz A Osmani
- Department of Orthopaedic Surgery, University of Illinois at Chicago, 1740 West Taylor Street, Chicago IL 60612, USA.
| | - Yousuf Sayeed
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, 380 2nd Avenue, New York, NY 10010, USA
| | - Raj Karia
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, 380 2nd Avenue, New York, NY 10010, USA
| | - Philip Band
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, 380 2nd Avenue, New York, NY 10010, USA
| | - Richard Iorio
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Disease, 380 2nd Avenue, New York, NY 10010, USA
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Black M, Hitchcock C, Bevan A, O Leary C, Clarke J, Elliott R, Watson P, LaFortune L, Rae S, Gilbody S, Kuyken W, Johnston D, Newby JM, Dalgleish T. The HARMONIC trial: study protocol for a randomised controlled feasibility trial of Shaping Healthy Minds-a modular transdiagnostic intervention for mood, stressor-related and anxiety disorders in adults. BMJ Open 2018; 8:e024546. [PMID: 30082367 PMCID: PMC6078277 DOI: 10.1136/bmjopen-2018-024546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/15/2018] [Accepted: 06/20/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Anxiety, mood and trauma-related disorders are common, affecting up to 20% of adults. Many of these individuals will experience symptoms of more than one disorder as diagnostically defined. However, most psychological treatments focus on individual disorders and are less effective for those who experience comorbid disorders. The Healthy and Resilient Mind Programme: Building Blocks for Mental Wellbeing (HARMONIC) trial introduces a novel transdiagnostic intervention (Shaping Healthy Minds (SHM)), which synthesises several evidence-based treatment techniques to address the gap in effective interventions for people with complex and comorbid difficulties. This early phase trial aims to estimate the efficacy and feasibility of the transdiagnostic intervention in preparation for a later-phase randomised controlled trial, and to explore mechanisms of change. METHODS/ANALYSIS We outline a patient-level two-arm randomised controlled trial (HARMONIC) that compares SHM to treatment-as-usual for individuals aged >18 years (n=50) with comorbid mood, anxiety, obsessive-compulsive or trauma/stressor disorders diagnoses, recruited from outpatient psychological services within the UK National Health Service (NHS). The co-primary outcomes will be 3-month follow-up scores on self-report measures of depressive symptoms, anxiety symptoms, and disability and functional impairment. Secondary outcomes include changes in symptoms linked to individual disorders. We will assess the feasibility and acceptability of SHM, the utility of proposed outcome measures, and refine the treatment manuals in preparation for a later-phase trial. ETHICS AND DISSEMINATION This trial protocol has been approved by the Health Research Authority of the NHS of the UK (East of England, Reference: 16/EE/0095). We anticipate that trial findings will inform future revisions of clinical guidelines for numerous forms of mood, anxiety and stressor-related disorders. Findings will be disseminated broadly via peer-reviewed empirical journal articles, conference presentations, clinical workshops and a trial website. TRIAL REGISTRATION NCT03143634; Pre-results.
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Affiliation(s)
- Melissa Black
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Anna Bevan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Cliodhna O Leary
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - James Clarke
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Rachel Elliott
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Louise LaFortune
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Sarah Rae
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Johnston
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
| | - Jill M Newby
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, National Health Service, Fulbourn, UK
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Atherton H, Brant H, Ziebland S, Bikker A, Campbell J, Gibson A, McKinstry B, Porqueddu T, Salisbury C. The potential of alternatives to face-to-face consultation in general practice, and the impact on different patient groups: a mixed-methods case study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06200] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BackgroundThere is international interest in the potential role of different forms of communication technology to provide an alternative to face-to-face consultations in health care. There has been considerable rhetoric about the need for general practices to offer consultations by telephone, e-mail or internet video. However, little is understood about how, under what conditions, for which patients and in what ways these approaches may offer benefits to patients and practitioners in general practice.ObjectivesOur objectives were to review existing evidence about alternatives to face-to-face consultation; conduct a scoping exercise to identify the ways in which general practices currently provide these alternatives; recruit eight general practices as case studies for focused ethnographic research, exploring how practice context, patient characteristics, type of technology and the purpose of the consultation interact to determine the impact of these alternatives; and synthesise the findings in order to develop a website resource about the implementation of alternatives to face-to-face consultations and a framework for subsequent evaluation.DesignMixed-methods case study.SettingGeneral practices in England and Scotland with varied experience of implementing alternatives to face-to-face consultations.ParticipantsPatients and practice staff.InterventionsAlternatives to face-to-face consultations include telephone consultations, e-mail, e-consultations and internet video.Main outcome measuresHow context influenced the implementation and impact of alternatives to the face-to-face consultation; the rationale for practices to introduce alternatives; the use of different forms of consultation by different patient groups; and the intended benefits/outcomes.Review methodsThe conceptual review used an approach informed by realist review, a method for synthesising research evidence regarding complex interventions.ResultsAlternatives to the face-to-face consultation are not in mainstream use in general practice, with low uptake in our case study practices. We identified the underlying rationales for the use of these alternatives and have shown that different stakeholders have different perspectives on what they hope to achieve through the use of alternatives to the face-to-face consultation. Through the observation of real-life use of different forms of alternative, we have a clearer understanding of how, under what circumstances and for which patients alternatives might have a range of intended benefits and potential unintended adverse consequences. We have also developed a framework for future evaluation.LimitationsThe low uptake of alternatives to the face-to-face consultation means that our research participants might be deemed to be early adopters. The case study approach provides an in-depth examination of a small number of sites, each using alternatives in different ways. The findings are therefore hypothesis-generating, rather than hypothesis-testing.ConclusionsThe current low uptake of alternatives, lack of clarity about purpose and limited evidence of benefit may be at odds with current policy, which encourages the use of alternatives. We have highlighted key issues for practices and policy-makers to consider and have made recommendations about priorities for further research to be conducted, before or alongside the future roll-out of alternatives to the face-to-face consultation, such as telephone consulting, e-consultation, e-mail and video consulting.Future workWe have synthesised our findings to develop a framework and recommendations about future evaluation of the use of alternatives to face-to-face consultations.Funding detailsThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Heather Brant
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annemieke Bikker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Campbell
- Collaboration for Academic Primary Care (APEx), University of Exeter, Exeter, UK
| | - Andy Gibson
- Health and Social Sciences, University of the West of England, Bristol, UK
| | - Brian McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Tania Porqueddu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
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Valdivieso B, García-Sempere A, Sanfélix-Gimeno G, Faubel R, Librero J, Soriano E, Peiró S. The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study. Med Clin (Barc) 2018; 151:308-314. [PMID: 29705155 DOI: 10.1016/j.medcli.2018.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. PATIENTS AND METHODS 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. RESULTS EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits. CONCLUSIONS Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562).
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Affiliation(s)
- Bernardo Valdivieso
- Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Anibal García-Sempere
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.
| | - Gabriel Sanfélix-Gimeno
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Raquel Faubel
- Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Julian Librero
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Navarrabiomed, Centro de Investigación Biomédica de Navarra, Pamplona, Spain
| | - Elisa Soriano
- Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Salvador Peiró
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain; Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
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Ahern E, Kinsella S, Semkovska M. Clinical efficacy and economic evaluation of online cognitive behavioral therapy for major depressive disorder: a systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2018; 18:25-41. [PMID: 29145746 DOI: 10.1080/14737167.2018.1407245] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Leading cause of disability worldwide, depression is the most prevalent mental disorder with growing societal costs. As mental health services demand often outweighs provision, accessible treatment options are needed. Our systematic review and meta-analysis evaluated the clinical efficacy and economic evidence for the use of online cognitive behavioral therapy (oCBT) as an accessible treatment solution for depression. AREAS COVERED Electronic databases were searched for controlled trials published between 2006 and 2016. Of the reviewed 3,324 studies, 29 met the criteria for inclusion in the efficacy meta-analysis. The systematic review identified five oCBT economic evaluations. Therapist-supported oCBT was equivalent to face-to-face CBT at improving depressive symptoms and superior to treatment-as-usual, waitlist control, and attention control. Depression severity, number of sessions, or support did not affect efficacy. From a healthcare provider perspective, oCBT tended to show greater costs with greater benefits in the short term, relative to comparator treatments. EXPERT COMMENTARY Although efficacious, further economic evidence is required to support the provision of oCBT as a cost-effective treatment for depression. Economic evaluations that incorporate a societal perspective will better account for direct and indirect treatment costs. Nevertheless, oCBT shows promise of effectively improving depressive symptoms, considering limited mental healthcare resources.
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Affiliation(s)
- Elayne Ahern
- a Department of Psychology , University of Limerick , Limerick , Ireland
- b Department of Economics , Kemmy Business School, University of Limerick , Limerick , Ireland
| | - Stephen Kinsella
- b Department of Economics , Kemmy Business School, University of Limerick , Limerick , Ireland
| | - Maria Semkovska
- a Department of Psychology , University of Limerick , Limerick , Ireland
- c Health Research Institute , University of Limerick , Limerick , Ireland
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Adams N, Hamilton N, Nelson EL, Smith CE. Using Telemedicine to Identify Depressive Symptomatology Rating Scale in a Home Parenteral Nutrition Population. ACTA ACUST UNITED AC 2017; 2:129-139. [PMID: 29862312 DOI: 10.1007/s41347-017-0025-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Nancy Hamilton
- Associate Professor, Department of Psychology, University of Kansas
| | - Eve-Lynn Nelson
- Professor, Pediatrics, School of Medicine, Director, KU Center for Telemedicine, University of Kansas Medical Center
| | - Carol E Smith
- Professor, School of Nursing and Preventive Medicine & Public Health, University of Kansas Medical Center
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