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Lekkas D, Yom-Tov E, Heinz MV, Gyorda JA, Nguyen T, Barr PJ, Jacobson NC. The Trajectories of Online Mental Health Information Seeking: Modeling Search Behavior Before and After Completion of Self-report Screens. COMPUTERS IN HUMAN BEHAVIOR 2024; 157:108267. [PMID: 38774307 PMCID: PMC11105786 DOI: 10.1016/j.chb.2024.108267] [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] [Indexed: 05/24/2024]
Abstract
There is an appreciable mental health treatment gap in the United States. Efforts to bridge this gap and improve resource accessibility have led to the provision of online, clinically-validated tools for mental health self-assessment. In theory, these screens serve as an invaluable component of information-seeking, representing the preparative and action-oriented stages of this process while altering or reinforcing the search content and language of individuals as they engage with information online. Accordingly, this work investigated the association of screen completion with mental health-related search behaviors. Three-year internet search histories from N=7,572 Microsoft Bing users were paired with their respective depression, anxiety, bipolar disorder, or psychosis online screen completion and sociodemographic data available through Mental Health America. Data was transformed into network representations to model queries as discrete steps with probabilities and times-to-transition from one search type to another. Search data subsequent to screen completion was also modeled using Markov chains to simulate likelihood trajectories of different search types through time. Differences in querying dynamics relative to screen completion were observed, with searches involving treatment, diagnosis, suicidal ideation, and suicidal intent commonly emerging as the highest probability behavioral information seeking endpoints. Moreover, results pointed to the association of low risk states of psychopathology with transitions to extreme clinical outcomes (i.e., active suicidal intent). Future research is required to draw definitive conclusions regarding causal relationships between screens and search behavior.
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Affiliation(s)
- Damien Lekkas
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States
| | - Elad Yom-Tov
- Microsoft Research Israel, Herzeliya, Israel
- Faculty of Industrial Engineering and Management, Technion - Israel Institute of Technology, Haifa, Israel
| | - Michael V Heinz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Joseph A. Gyorda
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States
| | | | - Paul J. Barr
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- The Dartmouth Institute of Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Nicholas C. Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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Bisby MA, Jones MP, Staples L, Dear B, Titov N. Measurement of Daily Actions Associated With Mental Health Using the Things You Do Questionnaire-15-Item: Questionnaire Development and Validation Study. JMIR Form Res 2024; 8:e57804. [PMID: 39038286 DOI: 10.2196/57804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND A large number of modifiable and measurable daily actions are thought to impact mental health. The "Things You Do" refers to 5 types of daily actions that have been associated with mental health: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections. Previous studies have reported the psychometric properties of the Things You Do Questionnaire (TYDQ)-21-item (TYDQ21). The 21-item version, however, has an uneven distribution of items across the 5 aforementioned factors and may be lengthy to administer on a regular basis. OBJECTIVE This study aimed to develop and evaluate a brief version of the TYDQ. To accomplish this, we identified the top 10 and 15 items on the TYDQ21 and then evaluated the performance of the 10-item and 15-item versions of the TYDQ in community and treatment-seeking samples. METHODS Using confirmatory factor analysis, the top 2 or 3 items were used to develop the 10-item and 15-item versions, respectively. Model fit, reliability, and validity were examined for both versions in 2 samples: a survey of community adults (n=6070) and adults who completed an assessment at a digital psychology service (n=14,878). Treatment responsivity was examined in a subgroup of participants (n=448). RESULTS Parallel analysis supported the 5-factor structure of the TYDQ. The brief (10-item and 15-item) versions were associated with better model fit than the 21-item version, as revealed by its comparative fit index, root-mean-square error of approximation, and Tucker-Lewis index. Configural, metric, and scalar invariance were supported. The 15-item version explained more variance in the 21-item scores than the 10-item version. Internal consistency was appropriate (eg, the 15-item version had a Cronbach α of >0.90 in both samples) and there were no marked differences between how the brief versions correlated with validated measures of depression or anxiety symptoms. The measure was responsive to treatment. CONCLUSIONS The 15-item version is appropriate for use as a brief measure of daily actions associated with mental health while balancing brevity and clinical utility. Further research is encouraged to replicate our psychometric evaluation in other settings (eg, face-to-face services). TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613000407796; https://tinyurl.com/2s67a6ps.
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Affiliation(s)
- Madelyne A Bisby
- MindSpot Clinic, MQ Health, Macquarie University, Macquarie Park, Australia
- School of Psychological Sciences, Macquarie University, Macquarie Park, Australia
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, Macquarie Park, Australia
| | - Lauren Staples
- MindSpot Clinic, MQ Health, Macquarie University, Macquarie Park, Australia
| | - Blake Dear
- MindSpot Clinic, MQ Health, Macquarie University, Macquarie Park, Australia
- School of Psychological Sciences, Macquarie University, Macquarie Park, Australia
| | - Nickolai Titov
- MindSpot Clinic, MQ Health, Macquarie University, Macquarie Park, Australia
- School of Psychological Sciences, Macquarie University, Macquarie Park, Australia
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Connolly Gibbons MB, Duong L, Chiu RY, Crits-Christoph P, Gallop R, Mandell D, Barg O, Newman CF, Brown LA, Oquendo MA. A cohort study of engagement in telehealth psychotherapy versus in-person services. Psychother Res 2024:1-11. [PMID: 39034438 DOI: 10.1080/10503307.2024.2375231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Although telehealth psychotherapies have been studied for over 20 years, mental health services remained largely delivered in person until the COVID-19 pandemic forced clinics to reconsider the utility of telehealth psychotherapy. This study aims to compare patient engagement in in-person versus telehealth services in outpatient psychotherapy for mood and anxiety disorders. METHOD A cohort investigation was conducted, using a propensity score matched sample, extracted from an electronic health record (EHR) to compare engagement in psychotherapy for 762 patients who used in-person services before the pandemic to a cohort of 762 patients who used telehealth psychotherapy after the onset of COVID-19. The authors compared cohorts on initial engagement in psychotherapy services following an initial intake, number of psychotherapy sessions attended, and the rate of missed sessions. RESULTS There was a 26% increase in the total number of individual psychotherapy sessions attended when the clinics transitioned to telehealth services (p < .001). In addition, patients who received telehealth psychotherapy were five times more likely to not cancel or miss any scheduled sessions (p < .001). CONCLUSION These results indicate that telehealth services may result in improved treatment engagement for outpatient centers focused on brief evidence-based psychotherapies for mood and anxiety disorders.
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Affiliation(s)
| | - Lang Duong
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rachel Y Chiu
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Paul Crits-Christoph
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
| | - David Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Olga Barg
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Cory F Newman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lily A Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Baldofski S, Scheider J, Kohls E, Klemm SL, Koenig J, Bauer S, Moessner M, Kaess M, Eschenbeck H, Lehner L, Becker K, Krämer J, Diestelkamp S, Thomasius R, Rummel-Kluge C. Intentions and barriers to help-seeking in adolescents and young adults differing in depression severity: cross-sectional results from a school-based mental health project. Child Adolesc Psychiatry Ment Health 2024; 18:84. [PMID: 39010111 PMCID: PMC11251315 DOI: 10.1186/s13034-024-00775-3] [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: 05/29/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Mental health problems, such as depression, have a high prevalence in young people. However, the majority of youths suffering from depression do not seek professional help. This study aimed to compare help-seeking behavior, intentions and perceived barriers between youthswith different levels of depressive symptoms. METHODS This cross-sectional study is part of a large-scale, multi-center project. Participants were n = 9509 youths who were recruited in German schools and completed a baseline screening questionnaire. Based on their depressive symptoms, youths were allocated to the following three subgroups: (a) without depressive symptoms, (b) with subclinical symptoms, (c) with clinical symptoms (measured by PHQ-A). Quantitative analyses compared previous help-seeking behavior, help-seeking intentions and perceived barriers (Barriers questionnaire) between these subgroups. An additional exploratory qualitative content analysis examined text answers on other perceived barriers to help-seeking. RESULTS Participants were mostly female (n = 5575, 58.6%) and 12 to 24 years old (M = 15.09, SD 2.37). Participants with different levels of depressive symptoms differed significantly in help-seeking behavior, intentions and perceived barriers. Specifically, participants with clinical depressive symptoms reported more previous help-seeking, but lower intentions to seek help compared to participants without symptoms (all p < 0.05). Participants with subclinical depressive symptoms reported a similar frequency of previous help-seeking, but higher intentions to seek help compared to participants without symptoms (all p < 0.05). Perception of barriers was different across subgroups: participants with clinical and subclinical depressive symptoms perceived the majority of barriers such as stigma, difficulties in accessibility, and family-related barriers as more relevant than participants without depressive symptoms. Across all subgroups, participants frequently mentioned intrapersonal reasons, a high need for autonomy, and a lack of mental health literacy as barriers to help-seeking. CONCLUSIONS Youths with higher levels of depressive symptoms are more reluctant to seek professional help and perceive higher barriers. This underlines the need for effective and low-threshold interventions to tackle barriers, increase help-seeking, and lower depressive symptoms in adolescents and young adults differing in depression severity. TRIAL REGISTRATION DRKS00014685.
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Affiliation(s)
- Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Jelena Scheider
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig University, Leipzig, Germany
| | - Sarah-Lena Klemm
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Bauer
- Centre for Psychosocial Medicine, Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim/Heidelberg/Ulm, Mannheim, Germany
| | - Markus Moessner
- Centre for Psychosocial Medicine, Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Heike Eschenbeck
- Department of Psychology, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Laya Lehner
- Department of Psychology, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Jennifer Krämer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the Philipps-University Marburg, Marburg, Germany
| | - Silke Diestelkamp
- German Center for Addiction Research in Childhood and Adolescence, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Thomasius
- German Center for Addiction Research in Childhood and Adolescence, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany.
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig University, Leipzig, Germany.
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Yamashita Y, Yamamoto T. Effect of virtual reality self-counseling with the intimate other avatar. Sci Rep 2024; 14:15417. [PMID: 38965334 PMCID: PMC11224315 DOI: 10.1038/s41598-024-65661-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
Virtual reality self-counseling (VR-SC) is considered an effective approach for addressing mental health problems. Previous studies have shown the effectiveness of VR-SC using Sigmund Freud's avatar as the counselor. However, considering that virtual reality (VR) enables embodied perspective-taking of another person, VR-SC using the avatar of a person who cares about the participant (an intimate person), such as a family member or friend, is considered effective because it could create warm attitudes toward the participants themselves. In this study, 60 undergraduate and graduate students were split into three conditions: VR-SC with intimate persons, VR-SC with Freud, and a control group. The intervention effects were then compared. The results showed that VR-SC with an intimate person was the most effective in improving anxiety symptoms. These results may be attributed to accepting and affirming oneself from the perspective of the intimate person's avatar and counseling oneself. This study is significant in that it is the first to conduct VR-SC with the avatar of an intimate person and compare the effects with Freud's avatar. More importantly, it showed that the same VR-SC method could have different effects depending on the avatar of the counseling partner.
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Affiliation(s)
- Yuko Yamashita
- Graduate School of Sciences and Technology for Innovation, Tokushima University, Tokushima, Japan.
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Tetsuya Yamamoto
- Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Tokushima, Japan
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Field AE, Ziobrowski HN, Eddy KT, Sonneville KR, Richmond TK. Who gets treated for an eating disorder? Implications for inference based on clinical populations. BMC Public Health 2024; 24:1758. [PMID: 38956563 PMCID: PMC11218409 DOI: 10.1186/s12889-024-19283-2] [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: 06/06/2023] [Accepted: 06/26/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The minority of people with an eating disorder receive treatment. Little is known about predictors of receiving treatment. METHODS Using data from the Growing Up Today Study we identified correlates of receiving treatment for an eating disorder among the 1237 U.S. women who answered questions on treatment history in 2013 and reported meeting criteria for subthreshold eating disorder in ≥ 1 year between 1996 and 2013. Logistic regression models using generalized estimating equations were used to estimate the relative odds of receiving treatment. RESULTS Approximately 11% of the women reported receiving treatment for an eating disorder. Independent of type of eating disorder, those who had received a diagnosis of depression or anxiety were more likely (odds ratio (OR) = 3.05 95% confidence interval (CI) 1.87-4.97) to receive treatment for an eating disorder. Women with obesity were approximately 85% less likely to receive treatment (OR = 0.13, 95% CI 0.04-0.46) regardless of their type of eating disorder or history of depression of anxiety diagnosis. CONCLUSIONS Most women meeting criteria for an eating disorder do not receive treatment. Women with BED or obesity are the least likely to receive treatment.
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Affiliation(s)
- Alison E Field
- Department of Epidemiology, Brown University School of Public Health, Box G-S121-2, Providence, RI, 02912, USA
| | - Hannah N Ziobrowski
- Department of Epidemiology, Brown University School of Public Health, Box G-S121-2, Providence, RI, 02912, USA.
| | - Kamryn T Eddy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Tracy K Richmond
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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Kohl F, Schröder UB, Stegmann R, Wegewitz U, Hander N, Hansmann M, Angerer P, Erim Y, Hondong S, Kröger C, Mulfinger N, Waldman T, Herrmann K, Weber J. [Implementation of psychotherapeutic consultation at work (PT-A): expectations, announcement, and use : Results of the friaa-study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:796-805. [PMID: 38896150 PMCID: PMC11230975 DOI: 10.1007/s00103-024-03909-2] [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: 12/20/2023] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Psychotherapeutic consultation at work (PT-A) offers easily accessible, short-term support for employees experiencing psychological stress. The aim of the study was to evaluate aspects of the implementation regarding announcement, access, and use of the PT‑A. METHODS The study was conducted as part of a randomized controlled trial (RCT) called "Early Intervention in the Workplace". Forty-six company actors answered a questionnaire about how the companies announced the PT‑A to their employees, the barriers in the announcement of the PT‑A, and the beneficial factors of using the PT‑A. The access routes of the 550 participating employees were used from the baseline data of the RCT. Seven company actors were qualitatively interviewed about their expectations of the PT‑A and 22 participants of the RCT were interviewed about their experiences accessing and using the PT‑A. RESULTS The company actors hoped that the PT‑A would have an impact on all levels of prevention. Most companies announced the PT‑A centrally (e.g., flyers and intranet) as well as through individual recommendations (e.g., through the company's social counselling and occupational health professionals). Employees appreciated the opportunity to participate anonymously in the central announcement. Advantages of the supportive access were seen in the accessibility of employees without treatment experience, employees with high levels of suffering, and employees who have not yet recognized their own need for treatment. DISCUSSION The results suggest that it is useful to announce the PT‑A centrally to all employees but also to recommend it personally to affected employees. By using both methods, different PT‑A target groups can be reached and the advantages of anonymous participation are retained.
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Affiliation(s)
- Fiona Kohl
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Centre for Health and Society, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Ute B Schröder
- FG 3.5 "Evidenzbasierte Arbeitsmedizin, Betriebliches Gesundheitsmanagement", BAuA - Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Berlin, Deutschland.
| | - Ralf Stegmann
- FG 3.5 "Evidenzbasierte Arbeitsmedizin, Betriebliches Gesundheitsmanagement", BAuA - Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Berlin, Deutschland
| | - Uta Wegewitz
- FG 3.5 "Evidenzbasierte Arbeitsmedizin, Betriebliches Gesundheitsmanagement", BAuA - Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Berlin, Deutschland
| | - Nicole Hander
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Marieke Hansmann
- Abteilung Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim, Hildesheim, Deutschland
| | - Peter Angerer
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Centre for Health and Society, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Yesim Erim
- Psychosomatische und Psychotherapeutische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Sinja Hondong
- Psychosomatische und Psychotherapeutische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Christoph Kröger
- Abteilung Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Hildesheim, Hildesheim, Deutschland
| | - Nadine Mulfinger
- Klinik für Psychiatrie und Psychotherapie II, Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Tamara Waldman
- Klinik für Psychiatrie und Psychotherapie II, Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Kristin Herrmann
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Jeannette Weber
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Centre for Health and Society, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Horwitz AG, Mills ED, Sen S, Bohnert ASB. Comparative Effectiveness of Three Digital Interventions for Adults Seeking Psychiatric Services: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2422115. [PMID: 39023893 PMCID: PMC11258584 DOI: 10.1001/jamanetworkopen.2024.22115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/14/2024] [Indexed: 07/20/2024] Open
Abstract
Importance There is a substantial gap between demand for and availability of mental health services. Digital mental health interventions (DMHIs) are promising tools for bridging this gap, yet little is known about their comparative effectiveness. Objective To assess whether patients randomized to a cognitive behavioral therapy (CBT)-based or mindfulness-based DMHI had greater improvements in mental health symptoms than patients randomized to the enhanced personalized feedback (EPF)-only DMHI. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted between May 13, 2020, and December 12, 2022, with follow-up at 6 weeks. Adult patients of outpatient psychiatry services across various clinics within the University of Michigan Health System with a scheduled or recent outpatient psychiatry appointment were recruited. Eligible patients were randomized to an intervention arm. All analyses followed the intent-to-treat principle. Interventions Participants were randomized to 1 of 5 intervention arms: (1) EPF only; (2) Silvercloud only, a mobile application designed to deliver CBT strategies; (3) Silvercloud plus EPF; (4) Headspace only, a mobile application designed to train users in mindfulness practices; and (5) Headspace plus EPF. Main Outcomes and Measures The primary outcome was change in depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9; score range: 0-27, with higher scores indicating greater depression symptoms). Secondary outcomes included changes in anxiety, suicidality, and substance use symptoms. Results A total of 2079 participants (mean [SD] age, 36.8 [14.3] years; 1423 self-identified as women [68.4%]) completed the baseline survey. The baseline mean (SD) PHQ-9 score was 12.7 (6.4) and significantly decreased for all 5 intervention arms at 6 weeks (from -2.1 [95% CI, -2.6 to -1.7] to -2.9 [95% CI, -3.4 to -2.4]; n = 1885). The magnitude of change was not significantly different across the 5 arms (F4,1879 = 1.19; P = .31). Additionally, the groups did not differ in decrease in anxiety or substance use symptoms. However, the Headspace arms reported significantly greater improvements on a suicidality measure subscale compared with the Silvercloud arms (mean difference in mean change = 0.63; 95% CI, 0.20-1.06; P = .004). Conclusions and Relevance This randomized clinical trial found decreases in depression and anxiety symptoms across all DMHIs and minimal evidence that specific applications were better than others. The findings suggest that DMHIs may provide support for patients during waiting list-related delays in care. Trial Registration ClinicalTrials.gov Identifier: NCT04342494.
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Affiliation(s)
- Adam G. Horwitz
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Elizabeth D. Mills
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Srijan Sen
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
- Molecular and Behavioral Neuroscience Institute, University of Michigan Medical School, Ann Arbor
| | - Amy S. B. Bohnert
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
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9
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Bisby MA, Barrett V, Staples LG, Nielssen O, Dear BF, Titov N. Things You Do: A randomized controlled trial of an unguided ultra-brief intervention to reduce symptoms of depression and anxiety. J Anxiety Disord 2024; 105:102882. [PMID: 38850775 DOI: 10.1016/j.janxdis.2024.102882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/05/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
The 'Things You Do' encompass five types of actions that are strongly associated with good mental health: Healthy Thinking, Meaningful Activities, Goals and Plans, Healthy Habits, and Social Connections. Ultra-brief interventions which increase how often people perform these actions may decrease depression and anxiety. A two-arm randomized controlled trial (N = 349) compared an unguided ultra-brief intervention based on the 'Things You Do' against a waitlist control. The intervention included one online module, two practice guides, and four weeks of daily text messages. The primary timepoint was 5-weeks post-baseline. The intervention resulted in moderate reductions in depression (d = 0.51) and anxiety (d = 0.55) alongside moderate increases in the frequency of Things You Do actions (d = 0.54), compared to controls. No significant change in number of days out of role or life satisfaction were observed. Treatment completion was high (92 %), most participants reported being satisfied with the treatment (66 %), and improvements were maintained at 3-month follow-up. This study demonstrated that an automated ultra-brief 'Things You Do' intervention resulted in clinically significant reductions in depression and anxiety. Ultra-brief interventions may provide a scalable solution to support individuals who are unlikely to engage in longer forms of psychological treatment.
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Affiliation(s)
- Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, MQ Health, Macquarie University, Australia.
| | | | | | - Olav Nielssen
- MindSpot Clinic, MQ Health, Macquarie University, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, MQ Health, Macquarie University, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, MQ Health, Macquarie University, Australia
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10
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Nelson BW, Peiper NC, Aschbacher K, Forman-Hoffman VL. Evidence-Based Therapist-Supported Digital Mental Health Intervention for Patients Experiencing Medical Multimorbidity: A Retrospective Cohort Intent-to-Treat Study. Psychosom Med 2024; 86:547-554. [PMID: 38718176 DOI: 10.1097/psy.0000000000001319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Multimorbidity or the co-occurrence of multiple health conditions is increasing globally and is associated with significant psychological complications. It is unclear whether digital mental health (DMH) interventions for patients experiencing multimorbidity are effective, particularly given that this patient population faces more treatment resistance. The goal of the current study was to examine the impact of smartphone-delivered DMH interventions for patients presenting with elevated internalizing symptoms that have reported multiple lifetime medical conditions. METHODS This preregistered (see https://osf.io/vh2et/ ) retrospective cohort intent-to-treat study with 2819 patients enrolled in a therapist-supported DMH intervention examined the associations between medical multimorbidity (MMB) and mental health outcomes. RESULTS Results indicated that more MMB was significantly associated with greater presenting mental health symptom severity. MMB did not have a deleterious influence on depressive symptom trajectories across treatment, although having one medical condition was associated with a steeper decrease in anxiety symptoms compared to patients with no medical conditions. Finally, MMB was not associated with time to dropout, but was associated with higher dropout and was differentially associated with fewer beneficial treatment outcomes, although this is likely attributable to higher presenting symptom severity, rather than lesser symptom reductions during treatment. CONCLUSIONS Overall, the Meru Health Program was associated with large effect size decreases in depressive and anxiety symptoms regardless of the number of MMB. Future DMH treatments and research might investigate tailored barrier reduction and extended treatment lengths for patients experiencing MMB to allow for greater treatment dose to reduce symptoms below clinical outcome thresholds.
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Affiliation(s)
- Benjamin W Nelson
- From the Meru Health Inc. (Nelson, Peiper, Aschbacher, Forman-Hoffman), San Mateo, California; Department of Psychology and Neuroscience (Nelson), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology and Population Health (Peiper), University of Louisville, Louisville, Kentucky; and Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Aschbacher), University of California San Francisco, San Francisco, California
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11
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Hartmann S, Timm C, Barnow S, Rubel JA, Lalk C, Pruessner L. Web-Based Cognitive Behavioral Treatment for Bulimia Nervosa: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2419019. [PMID: 38958978 PMCID: PMC11223002 DOI: 10.1001/jamanetworkopen.2024.19019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/26/2024] [Indexed: 07/04/2024] Open
Abstract
Importance Despite the existence of effective treatments, many individuals with bulimia nervosa (BN) do not receive evidence-based therapies. Integrating digital interventions into routine care might reach more patients and reduce the clinical burden of BN. Objective To evaluate the effectiveness of a web-based cognitive behavioral self-help intervention for individuals with BN. Design, Setting, and Participants A 2-group randomized clinical trial without follow-up was conducted between February 2, 2021, and July 9, 2022, in Germany. Participants aged between 18 and 65 years who met the diagnostic criteria for BN were enrolled online via self-referral. Data analyses were conducted from October 24, 2022, to December 23, 2023. Interventions A web-based cognitive behavioral self-help intervention including 12 weekly modules was compared with a waiting-list control group only having access to routine care. Main Outcomes and Measures The primary outcome was the change in the number of bulimic episodes between baseline and posttreatment. Secondary outcomes included changes in global eating disorder symptoms, clinical impairment, well-being, work capacity, comorbid symptoms, self-esteem, and emotion regulation complemented by weekly measures and ecological momentary assessment. Intention-to-treat analyses were performed. Results Participants (N = 154; mean [SD] age, 29.6 [8.6] years; 149 [96.8%] female) receiving the web-based intervention demonstrated a significantly greater decrease in bulimic episodes compared with the control group (Cohen d = -0.48; 95% CI, -0.75 to -0.20; P < .001), representing a significant change in binge-eating episodes (Cohen d = -0.61; 95% CI, -0.89 to -0.33; P < .001), but not in compensatory behaviors (Cohen d = -0.25; 95% CI, -0.51 to 0.02; P = .21). The intervention was superior in improving global eating disorder symptoms (Cohen d = -0.61; 95% CI, -0.89 to -0.32; P < .001) and clinical impairment (Cohen d = -0.62; 95% CI, -0.92 to -0.33; P < .001). No significant effects were found for well-being (Cohen d = -0.08; 95% CI, -0.37 to 0.22; P > .99) and work capacity (Cohen d = -0.01; 95% CI, -0.68 to 0.66; P = .99). Exploratory analyses indicated significant changes in self-esteem and emotion regulation difficulties, but not in comorbid symptoms. Conclusions and Relevance In this randomized clinical trial, a web-based cognitive behavioral self-help intervention effectively decreased eating disorder symptoms and illness-related burden in individuals with BN, underlining the potential of digital interventions to complement established treatments. Trial Registration ClinicalTrials.gov Identifier: NCT04876196.
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Affiliation(s)
| | - Christina Timm
- Department of Psychology, Heidelberg University, Germany
| | - Sven Barnow
- Department of Psychology, Heidelberg University, Germany
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12
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Chin P, Gorman F, Beck F, Russell BR, Stephan KE, Harrison OK. A systematic review of brief respiratory, embodiment, cognitive, and mindfulness interventions to reduce state anxiety. Front Psychol 2024; 15:1412928. [PMID: 38933581 PMCID: PMC11203600 DOI: 10.3389/fpsyg.2024.1412928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Anxiety is one of the most prevalent mental health conditions worldwide, and psychotherapeutic techniques can be employed to help manage and mitigate symptoms. While the available therapies are numerous, key strategies often involve cognitive and/or embodiment techniques. Within body-centered methods, breathing-oriented approaches are particularly prevalent, using either attention towards or active control of breathing. As the perception of body states (i.e., interoception) is thought to be an integral component of emotion generation, these embodiment and breathing techniques may be key in addressing the miscommunication between the brain and body that is thought to exist with anxiety. Therefore, we conducted a systematic review and meta-analysis to assess the effects of acute administration of psychological interventions for state anxiety. Results This systematic review was conducted in accordance with the PRISMA statement and registered prospectively in PROSPERO. A literature search for randomized controlled trials was conducted in PubMed, PsycINFO, and Scopus. We considered interventions that focused on cognitive, embodiment or breathing strategies, or a combination of these techniques. Twelve studies met our inclusion criteria, and study characteristics, quality and effect sizes were assessed. A single cognitive study was found to produce a moderate reduction in state anxiety, while moderate to large effects were found across studies assessing embodiment practices. In contrast, studies which utilized breathing-based interventions alone produced inconsistent results, with both attention towards and active control of breathing producing large to no effects depending on the technique employed. Finally, consistent moderate effects were found with combination techniques that involved passive attention (e.g., towards cognitions, body and/or breathing), with active combination techniques producing inconsistent results. Discussion While study numbers are limited regarding brief interventions, cognitive and embodiment techniques are consistently helpful for reducing state anxiety, while breathing-based exercises need to consider the specific technique employed, and how successful this may be for each individual. Furthermore, combined practices such as mindfulness can also be successful, although care must be taken when introducing an active change to one or more elements. PROSPERO Systematic Review Registration Number CRD42024507585 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024507585.
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Affiliation(s)
- Phoebe Chin
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Faye Gorman
- Department of Psychology, University of Otago, Dunedin, New Zealand
- Ngāpuhi, New Zealand
- Ngāti Kahu, New Zealand
| | - Fraser Beck
- Ngāi Tahu, New Zealand
- Optimal Health Model Ltd., Glenorchy, New Zealand
| | | | - Klaas E. Stephan
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland
| | - Olivia K. Harrison
- Department of Psychology, University of Otago, Dunedin, New Zealand
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland
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13
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Myers AL, Hill J, Fortuna KL. Barriers and Facilitators to Accessing and Utilizing Medicaid Smartphone Services: Perspectives of Peer Support Specialists and Patients with a Diagnosis of a Serious Mental Illness. Community Ment Health J 2024:10.1007/s10597-024-01290-7. [PMID: 38856868 DOI: 10.1007/s10597-024-01290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/28/2024] [Indexed: 06/11/2024]
Abstract
Access to smartphone and data plan services may impact levels of connection and opportunities for health management for patients with a diagnosis of a serious mental illness. Such smartphone-based services provide opportunities that extend the reach of physical and mental health care programs. The purpose of this study was to explore barriers and facilitators faced by individuals with mental health challenges when accessing Medicaid SafeLink smartphones and data plans. Interview guides were developed using the Consolidated Framework for Implementation Research. Individual semi-structured interviews were conducted to collect qualitative data on 18 participants' experiences with SafeLink services. Two main themes were identified- barriers and facilitators. Sub-themes included monthly data limits, followed by account management (barriers), opportunities for safety, and connection (facilitators). Massachusetts SafeLink policies provide individuals with an opportunity for smartphone ownership. However, results imply that expanding the current policy's usage limits may provide additional opportunities for connection and access to health services.
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Affiliation(s)
- Amanda L Myers
- Heller School for Social Policy and Management at Brandeis University, 415 South St, Waltham, MA, 02453, USA.
| | - Julia Hill
- Geisel School of Medicine , Dartmouth, Lebanon, NH, 03766, USA
| | - Karen L Fortuna
- Geisel School of Medicine , Dartmouth, Lebanon, NH, 03766, USA
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14
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Basile VT, Newton-John T, Wootton BM. Treatment histories, barriers, and preferences for individuals with symptoms of generalized anxiety disorder. J Clin Psychol 2024; 80:1286-1305. [PMID: 38384113 DOI: 10.1002/jclp.23665] [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: 12/22/2021] [Revised: 11/20/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
Generalized anxiety disorder (GAD) is a prevalent and chronic mental health condition, associated with considerable individual and economic burden. Despite the availability of effective treatments, many individuals do not access support. The current study explores treatment histories, barriers to help-seeking, and cognitive behavioral therapy (CBT) treatment preferences for individuals with clinically significant GAD symptoms. The utility of Health Belief Model (HBM) in predicting help-seeking is also examined. A cross-sectional design with 127 participants (Mage = 29.17; SD = 11.86; 80.3% female) was used. Sixty-two percent of participants reported previously seeking psychological treatment, and approximately 28% received CBT in the first instance. The most influential treatment barriers were a desire to solve the problem on one's own (M = 1.96, SD = 0.96), followed by affordability (M = 1.75, SD = 1.15) and feeling embarrassed or ashamed (M = 1.75, SD = 1.06). The most preferred treatment modes were in-person individual treatment (M = 7.59, SD = 2.86) followed by remote treatment via videoconferencing (M = 4.31, SD = 3.55). Approximately 38% of the variance in intention to seek treatment was associated with the HBM variables, with perceived benefit of treatment being the strongest predictor. Results have the potential to inform mental health service delivery by reducing treatment barriers and aligning public health campaigns with benefits of psychological treatments.
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Affiliation(s)
- Vesna Trenoska Basile
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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15
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Magid K, Sagui-Henson SJ, Sweet CC, Smith BJ, Chamberlain CEW, Levens SM. The Impact of Digital Mental Health Services on Loneliness and Mental Health: Results from a Prospective, Observational Study. Int J Behav Med 2024; 31:468-478. [PMID: 37488324 PMCID: PMC11106110 DOI: 10.1007/s12529-023-10204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Loneliness has increased since the COVID-19 pandemic and negatively impacts mental health. This study examined relationships between loneliness and mental health among adults using a digital mental health platform. METHODS A purposive sample of 919 participants (97% response rate) who were newly enrolled in the platform completed a survey on loneliness, depression, anxiety, well-being, stress, social support, and comorbidities at baseline and 3 months. Platform engagement was tracked during this period. We examined baseline differences between lonely and non-lonely participants; associations between loneliness, mental health symptoms, and comorbidities; and changes in loneliness and mental health through engagement in any form of care. RESULTS At baseline, 57.8% of the sample were categorized as lonely. Loneliness was associated with younger age, fewer years of education, and the presence of a comorbidity (p values < .05). Baseline loneliness was associated with greater depression, anxiety, and stress and lower well-being and social support (ps < .001). The percentage of lonely participants decreased at follow-up (57.6% to 52.9%, p = .03). Those who improved in loneliness improved in mental health symptoms, well-being, and social support (ps < .001). Lonely participants who engaged in any form of care reported a greater reduction in loneliness than those who did not engage (p = .04). CONCLUSIONS This study confirms previous findings of the high prevalence of loneliness among adults and risk factors for increased loneliness. Findings highlight the potential of digital platforms to reach lonely individuals and alleviate loneliness through remote mental health support.
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Affiliation(s)
- Kirby Magid
- University of North Carolina at Charlotte, NC, Charlotte, USA
- Modern Health, San Francisco, CA, USA
| | | | | | | | | | - Sara M Levens
- University of North Carolina at Charlotte, NC, Charlotte, USA
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16
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Abrahams AB, Beckenstrom AC, Browning M, Dias R, Goodwin GM, Gorwood P, Kingslake J, Morriss R, Reif A, Ruhé HG, Simon J, Dawson GR. Exploring the incidence of inadequate response to antidepressants in the primary care of depression. Eur Neuropsychopharmacol 2024; 83:61-70. [PMID: 38678794 DOI: 10.1016/j.euroneuro.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
Data from the UK suggests 13-55 % of depression patients experience some level of treatment resistance. However, little is known about how physicians manage inadequate response to antidepressants in primary care. This study aimed to explore the incidence of inadequate response to antidepressants in UK primary care. One-hundred-eighty-four medication-free patients with low mood initiated antidepressant treatment and monitored severity of depression symptoms, using the QIDS-SR16, for 48 weeks. Medication changes, visits to healthcare providers, and health-related quality of life were also recorded. Patients were classified into one of four response types based on their QIDS scores at three study timepoints: persistent inadequate responders (<50 % reduction in baseline QIDS at all timepoints), successful responders (≥50 % reduction in baseline QIDS at all timepoints), slow responders (≥50 % reduction in QIDS at week 48, despite earlier inadequate responses), and relapse (initial ≥50 % reduction in baseline QIDS, but inadequate response by week 48). Forty-eight weeks after initiating treatment 47 % of patients continued to experience symptoms of depression (QIDS >5), and 20 % of patients had a persistent inadequate response. Regardless of treatment response, 96 % (n = 176) of patients did not visit their primary care physician over the 40-week follow-up period. These results suggest that despite receiving treatment, a considerable proportion of patients with low mood remain unwell and fail to recover. Monitoring depression symptoms remotely can enable physicians to identify inadequate responders, allowing patients to be reassessed or referred to secondary services, likely improving patients' quality of life and reducing the socioeconomic impacts of chronic mental illness.
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Affiliation(s)
| | | | - Michael Browning
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Trust, Oxford, UK
| | - Rebecca Dias
- P1vital Products Ltd, Howbery Park, Wallingford, Oxfordshire, UK
| | | | - Philip Gorwood
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 75014 Paris, France; GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, F-75014 Paris, France
| | | | - Richard Morriss
- Academic Unit of Mental Health and Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Reif
- Goethe University Frankfurt, University Hospital, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Frankfurt, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Henricus G Ruhé
- Department of Psychiatry, Radboudumc, Reinier Postlaan 4, 6525 GC, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Kapittelweg 29, 6525 EN, Nijmegen, Netherlands
| | - Judit Simon
- Department of Psychiatry, University of Oxford, UK; Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria
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17
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Rief W, Asmundson GJG, Bryant RA, Clark DM, Ehlers A, Holmes EA, McNally RJ, Neufeld CB, Wilhelm S, Jaroszewski AC, Berg M, Haberkamp A, Hofmann SG. The future of psychological treatments: The Marburg Declaration. Clin Psychol Rev 2024; 110:102417. [PMID: 38688158 DOI: 10.1016/j.cpr.2024.102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024]
Abstract
Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These problems require those in our field to rethink some of our basic models of mental disorders and their treatments, and question how research and practice in clinical psychology should progress. To answer these questions, a group of experts of clinical psychology convened at a Think-Tank in Marburg, Germany, in August 2022 to review the evidence and analyze barriers for current and future developments. After this event, an overview of the current state-of-the-art was drafted and suggestions for improvements and specific recommendations for research and practice were integrated. Recommendations arising from our meeting cover further improving psychological interventions through translational approaches, improving clinical research methodology, bridging the gap between more nomothetic (group-oriented) studies and idiographic (person-centered) decisions, using network approaches in addition to selecting single mechanisms to embrace the complexity of clinical reality, making use of scalable digital options for assessments and interventions, improving the training and education of future psychotherapists, and accepting the societal responsibilities that clinical psychology has in improving national and global health care. The objective of the Marburg Declaration is to stimulate a significant change regarding our understanding of mental disorders and their treatments, with the aim to trigger a new era of evidence-based psychological interventions.
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Affiliation(s)
- Winfried Rief
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany.
| | | | - Richard A Bryant
- University of New South Wales, School of Psychology, Sydney, New South Wales, Australia
| | - David M Clark
- University of Oxford, Department of Experimental Psychology, Oxford, UK
| | - Anke Ehlers
- University of Oxford, Department of Experimental Psychology, Oxford, UK
| | - Emily A Holmes
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Solna, Sweden
| | | | - Carmem B Neufeld
- University of São Paulo, Department of Psychology, Ribeirão Preto, SP, Brazil
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard School of Medicine, Boston, USA
| | - Adam C Jaroszewski
- Massachusetts General Hospital and Harvard School of Medicine, Boston, USA
| | - Max Berg
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany
| | - Anke Haberkamp
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany
| | - Stefan G Hofmann
- Philipps-University of Marburg, Department of Psychology, Translational Clinical Psychology Group, Marburg, Germany
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18
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Cortright MK, Bluhm R, Achtyes ED, McCright A, Cabrera LY. Perceived Barriers to Using Neurostimulation: A National Survey of Psychiatrists, Patients, Caregivers, and the General Public. J ECT 2024; 40:111-117. [PMID: 38265758 PMCID: PMC11136602 DOI: 10.1097/yct.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Neurostimulation interventions often face heightened barriers limiting patient access. The objective of this study is to examine different stakeholders' perceived barriers to using different neurostimulation interventions for depression. METHODS We administered national surveys with an embedded experiment to 4 nationwide samples of psychiatrists (n = 505), people diagnosed with depression (n = 1050), caregivers of people with depression (n = 1026), and members of the general public (n = 1022). We randomly assigned respondents to 1 of 8 conditions using a full factorial experimental design: 4 neurostimulation modalities (electroconvulsive therapy [ECT], repetitive transcranial magnetic stimulation [rTMS], deep brain stimulation [DBS], or adaptive brain implants [ABIs]) by 2 depression severity levels (moderate or severe). We asked participants to rank from a list what they perceived as the top 3 barriers to using their assigned intervention. We analyzed the data with analysis of variance and logistic regression. RESULTS Nonclinicians most frequently reported "limited evidence of the treatment's effectiveness" and "lack of understanding of intervention" as their top 2 most important practical barriers to using ECT and TMS, respectively. Compared with nonclinicians, psychiatrists were more likely to identify "stigma about treatment" for ECT and "lack of insurance coverage" for TMS as the most important barriers. CONCLUSIONS Overall, psychiatrists' perceptions of the most important barriers to using neurostimulation interventions were significantly different than those of nonclinicians. Perceived barriers were significantly different for implantable DBS and ABI) versus nonimplantable (rTMS and ECT) neurostimulation interventions. Better understanding of how these barriers vary by neurostimulation and stakeholder group could help us address structural and attitudinal barriers to effective use of these interventions.
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Affiliation(s)
| | - Robyn Bluhm
- Michigan State University, Lyman Briggs and Philosophy
| | | | | | - Laura Y. Cabrera
- Pennsylvania State University; Department of Engineering and Mechanics and Rock Ethics Institute
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19
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Lazic A, Tilford JM, Davis VP, Brown CC. Association of copayments with healthcare utilization and expenditures among Medicaid enrollees with a substance use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209314. [PMID: 38369244 PMCID: PMC11090739 DOI: 10.1016/j.josat.2024.209314] [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] [Received: 08/22/2023] [Revised: 01/04/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The purpose of this study was to examine the association between copayments and healthcare utilization and expenditures among Medicaid enrollees with substance use disorders. METHODS This study used claims data (2020-2021) from a private insurer participating in Arkansas's Medicaid expansion. We compared service utilization and expenditures for enrollees in different Medicaid program structures with varying copayments. Enrollees with incomes above 100 % FPL (N = 10,240) had copayments for substance use treatment services while enrollees below 100 % FPL (N = 2478) did not. Demographic, diagnostic, utilization, and cost information came from claims and enrollment information. The study identified substance use and clinical comorbidities using claims from July through December 2020 and evaluated utilization and costs in 2021. Generalized linear models (GLM) estimated outcomes using single equation and two-part modeling. A gamma distribution and log link were used to model expenditures, and negative binomial models were used to model utilization. A falsification test comparing behavioral health telemedicine utilization, which had no cost sharing in either group, assessed whether differences in the groups may be responsible for observed findings. RESULTS Substance use enrollees with copayments were less likely to have a substance use or behavioral health outpatient (-0.04 PP adjusted; p = 0.001) or inpatient visit (-0.04 PP; p = 0.001) relative to their counterparts without copayments, equal to a 17 % reduction in substance use or behavioral health outpatient services and a nearly 50 % reduction in inpatient visits. The reduced utilization among enrollees with a copayment was associated with a significant reduction in total expenses ($954; p = 0.001) and expenses related to substance use or behavioral health services ($532; p = 0.001). For enrollees with at least one behavioral health visit, there were no differences in outpatient or inpatient utilization or expenditures between enrollees with and without copayments. Copayments had no association with non-behavioral health or telemedicine services where neither group had cost sharing. CONCLUSION Copayments serve as an initial barrier to substance use treatment, but are not associated with the amount of healthcare utilization conditional on using services. Policy makers and insurers should consider the role of copayments for treatment services among enrollees with substance use disorders in Medicaid programs.
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Affiliation(s)
- Antonije Lazic
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
| | - J Mick Tilford
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA
| | - Victor P Davis
- Actuarial Services & Enterprise Underwriting, Arkansas Blue Cross Blue Shield, Little Rock, AR 72201, USA
| | - Clare C Brown
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Science, Little Rock, AR 72205, USA.
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20
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Abo-Rass F, Abu-Kaf S, Nakash O, Braun-Lewensohn O. Mental health literacy as a barrier and facilitator for service use: Qualitative inquiry among Palestinian Bedouins in Israel. Int J Soc Psychiatry 2024; 70:689-699. [PMID: 38279598 DOI: 10.1177/00207640231223433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Mental health literacy (MHL) has been related to health behaviors and outcomes. However, studies examining MHL as a barrier and facilitator to service use are limited, especially among minority groups. AIMS This study examined MHL as a barrier and facilitator to mental health service use among the Palestinian Bedouin minority in Israel. METHODS Twenty-five Bedouins (15 women) from southern Israel participated in semi-structured, in-depth interviews. The participants were recruited by publishing an ad on social media about the study, then through a snowball technique. The data were analyzed thematically using ATLAS.ti.9, and the intercoder reliability was 92%. RESULTS We identified four major themes in the interviews: (1) MHL as a barrier to service use, due to lack of knowledge about professionals in the field, mental health services, or reasons and risk factors for mental health problems; (2) traditional attitudes that acted as barriers to service use, including a preference for informal treatment, a lack of faith in mental health treatment, aversion to discussing private feelings, and the perception that mental health is a luxury; (3) MHL as a facilitator to service use by enabling accurate identification of mental distress and suggesting practical avenues for seeking help; and (4) ways to improve MHL that should be culturally sensitive and under the government agencies' responsibility. CONCLUSIONS Interventions aimed at increasing the use of mental health services among Bedouins and reducing racial/ethnic disparities should increase knowledge in culturally adapted ways, especially regarding professionals and services, and change negative attitudes such as mental health treatment as ineffective or bonus.
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Affiliation(s)
- Fareeda Abo-Rass
- School for Social Work, Smith College, Northampton, Massachusetts, USA
| | - Sarah Abu-Kaf
- Conflict Management and Resolution Program, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ora Nakash
- School for Social Work, Smith College, Northampton, Massachusetts, USA
| | - Orna Braun-Lewensohn
- Conflict Management and Resolution Program, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Knauer J, Baumeister H, Schmitt A, Terhorst Y. Acceptance of smart sensing, its determinants, and the efficacy of an acceptance-facilitating intervention in people with diabetes: results from a randomized controlled trial. Front Digit Health 2024; 6:1352762. [PMID: 38863954 PMCID: PMC11165071 DOI: 10.3389/fdgth.2024.1352762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/06/2024] [Indexed: 06/13/2024] Open
Abstract
Background Mental health problems are prevalent among people with diabetes, yet often under-diagnosed. Smart sensing, utilizing passively collected digital markers through digital devices, is an innovative diagnostic approach that can support mental health screening and intervention. However, the acceptance of this technology remains unclear. Grounded on the Unified Theory of Acceptance and Use of Technology (UTAUT), this study aimed to investigate (1) the acceptance of smart sensing in a diabetes sample, (2) the determinants of acceptance, and (3) the effectiveness of an acceptance facilitating intervention (AFI). Methods A total of N = 132 participants with diabetes were randomized to an intervention group (IG) or a control group (CG). The IG received a video-based AFI on smart sensing and the CG received an educational video on mindfulness. Acceptance and its potential determinants were assessed through an online questionnaire as a single post-measurement. The self-reported behavioral intention, interest in using a smart sensing application and installation of a smart sensing application were assessed as outcomes. The data were analyzed using latent structural equation modeling and t-tests. Results The acceptance of smart sensing at baseline was average (M = 12.64, SD = 4.24) with 27.8% showing low, 40.3% moderate, and 31.9% high acceptance. Performance expectancy (γ = 0.64, p < 0.001), social influence (γ = 0.23, p = .032) and trust (γ = 0.27, p = .040) were identified as potential determinants of acceptance, explaining 84% of the variance. SEM model fit was acceptable (RMSEA = 0.073, SRMR = 0.059). The intervention did not significantly impact acceptance (γ = 0.25, 95%-CI: -0.16-0.65, p = .233), interest (OR = 0.76, 95% CI: 0.38-1.52, p = .445) or app installation rates (OR = 1.13, 95% CI: 0.47-2.73, p = .777). Discussion The high variance in acceptance supports a need for acceptance facilitating procedures. The analyzed model supported performance expectancy, social influence, and trust as potential determinants of smart sensing acceptance; perceived benefit was the most influential factor towards acceptance. The AFI was not significant. Future research should further explore factors contributing to smart sensing acceptance and address implementation barriers.
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Affiliation(s)
- Johannes Knauer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany
| | - Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - Yannik Terhorst
- Department of Psychological Methods and Assessment, Ludwigs-Maximilian University Munich, Munich, Germany
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22
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Gal G, Lourie J, Roe D, Gelkopf M, Khatib A, Shadmi E. Comparing outcomes of psychiatric rehabilitation between ethnic-religious groups in Israel. Transcult Psychiatry 2024:13634615241250205. [PMID: 38766846 DOI: 10.1177/13634615241250205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Psychiatric rehabilitation for people with severe mental illness (SMI) has many documented benefits, but less is known about cultural related aspects. To date, no comparison of psychiatric rehabilitation outcomes between Israeli Jews and Israeli Arabs has been carried out. Thus, the purpose of the present study was to compare the outcome measures of Israeli Arabs and Israeli Jews consuming psychiatric rehabilitation services. As part of the Israeli Psychiatric Rehabilitation Reported Outcome Measurement project (PR-ROM), a cross-sectional study comparing different ethnic-religious groups was performed. Data is based on 6,751 pairs of psychiatric rehabilitation consumers and their service providers. The consumers filled questionnaires on quality of life (QoL) and functioning, and their providers completed mirroring instruments. The findings revealed that QoL and functioning ratings were lower among Muslim Arabs compared to Jews on both consumers' and providers' ratings. Among Muslim Arabs, differences in outcomes according to the service's location were indicated. The observed differences between Israeli Arabs and Israeli Jews with SMI in the PR-ROM point to the need for culturally adapted rehabilitation services that take into account how cultural differences may affect the benefits of such services.
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Affiliation(s)
- Gilad Gal
- School of Psychology, The Academic College of Tel Aviv-Yaffo, Israel
| | - Joseph Lourie
- School of Psychology, The Academic College of Tel Aviv-Yaffo, Israel
| | - David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Anwar Khatib
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
- Department of Social Work, Zefat Academic College, Israel
| | - Efrat Shadmi
- The Cheryl Spencer Nursing Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
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23
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Qiu L, Xu H, Li Y, Zhao Y, Yang Q. Gender differences in attitudes towards psychological help-seeking among chinese medical students: a comparative analysis. BMC Public Health 2024; 24:1314. [PMID: 38750484 PMCID: PMC11095043 DOI: 10.1186/s12889-024-18826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/10/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Medical students are known to be at a greater risk of psychological disorders compared to the general population. However, their rate of help-seeking behavior is low. The purpose of this study was to explore the influencing factors of attitudes towards psychological help-seeking among Chinese medical students and to examine its gender differences. METHODS A total of 3,453 medical students from three medical colleges in Hainan Province, China, completed anonymous questionnaires that included socio-demographic attributes, the Family APGAR Index, the General Health Questionnaire (GHQ-20), and the Attitudes Towards Seeking Professional Psychological Help Short Form (ATSPPH-SF). Associations between predictor variables and attitudes towards help-seeking were explored using multivariate linear regression, and regression models with interaction terms were employed to test gender difference. RESULTS The mean score on ATSPPH-SF Scale was 15.04 ± 3.45, with males scoring significantly lower than females (14.34 vs. 15.64, P < 0.0001). For both male and female groups, psych knowledge, mental health status, family function and help-seeking utility perception significantly influenced attitudes toward psychological help-seeking. Furthermore, having more than once psycho-help experiences was positively correlated with women's attitudes. Significant interactions were found between gender and mental health status. CONCLUSION Attitude towards seeking psychological help was relatively negative among Chinese medical students. The implementation of interventions should take into account the at-risk population, especially the males and individuals with poor mental health.
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Affiliation(s)
- Lei Qiu
- School of Public Health, Hainan Medical University, Hainan, People's Republic of China
| | - Hengyi Xu
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, People's Republic of China
| | - Yingqi Li
- School of Public Health, Hainan Medical University, Hainan, People's Republic of China
| | - Yonghui Zhao
- School of Management, Hainan Medical University, Hainan, People's Republic of China
| | - Qin Yang
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China.
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Lang C, Weisel KK, Saur S, Fuhrmann LM, Schoenleber A, Reichl D, Enewoldsen N, Steins-Loeber S, Berking M. Support after return to alcohol use: a mixed-methods study on how abstinence motivation and app use change after return to alcohol use in an app-based aftercare intervention for individuals with alcohol use disorder. Addict Sci Clin Pract 2024; 19:35. [PMID: 38711152 PMCID: PMC11071226 DOI: 10.1186/s13722-024-00457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation. METHODS Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data. RESULTS Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24-96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants' reported use behavior. CONCLUSIONS The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether. TRIAL REGISTRATION The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).
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Affiliation(s)
- Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Lukas M Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Antonie Schoenleber
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
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25
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Mak WWS, Tong ACY, Fu ACM, Leung IWY, Jung OHC, Watkins ER, Lui WWS. Efficacy of Internet-based rumination-focused cognitive behavioral therapy and mindfulness-based intervention with guided support in reducing risks of depression and anxiety: A randomized controlled trial. Appl Psychol Health Well Being 2024; 16:696-722. [PMID: 38073271 DOI: 10.1111/aphw.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 05/02/2024]
Abstract
Rumination and worry are common risk factors of depression and anxiety. Internet-based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety. This three-arm randomized controlled trial compared the efficacy of Internet-based rumination-focused cognitive behavioral therapy (RFCBT), mindfulness-based intervention (MBI), and psychoeducation (EDU) control among 256 at-risk individuals. Participants' levels of rumination, worry, depressive, and anxiety symptoms were assessed at post-intervention (6 weeks), 3-month, and 9-month follow-ups. Linear mixed model analysis results showed similar levels of improvement in all outcomes across the three conditions. Changes in rumination differed comparing RFCBT and MBI, where a significant reduction in rumination was noted at a 3-month follow-up among participants in RFCBT, and no significant long-term effect among participants in MBI was noted at a 9-month follow-up. All three conditions showed similar reductions in risks and symptoms, implying that the two active interventions were not superior to EDU control. The high attrition at follow-ups suggested a need to exercise caution when interpreting the findings. Future studies should tease apart placebo effect and identify ways to improve adherence.
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Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alan C Y Tong
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Amanda C M Fu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ivy W Y Leung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Olivia H C Jung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Wacy W S Lui
- Center for Personal Growth and Crisis Intervention of the Corporate Clinical Psychology Services, Hospital Authority, Ma Tau Wai, Hong Kong
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Zhang L, Chen Y, Li Q, Zhang J, Zhou Y. Barriers and Facilitators to Medical Help-seeking in Rural Patients with Mental Illness: A Qualitative Meta-synthesis. Asian Nurs Res (Korean Soc Nurs Sci) 2024; 18:203-214. [PMID: 38704085 DOI: 10.1016/j.anr.2024.04.010] [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: 11/29/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE Numerous barriers hinder individuals with mental illness from seeking medical assistance in rural regions, yet a comprehensive understanding of these challenges remains elusive. This meta-synthesis aims to understand the barriers and facilitators in medical help-seeking among rural individuals with mental illness. METHODS We systematically searched seven databases [PubMed, CINAHL, Medline (OVID), PsycINFO (OVID), Cochrane, Embase, and ProQuest] in May 2023 and included the studies if they reported the barriers or/and facilitators to seek healthcare in rural patients with mental illness. We conducted hand search and citation search on Google Scholar for literature supplements. Thematic analysis was employed. RESULTS The study included 27 articles reporting on the barriers and facilitators to seeking medical help in this population from 2007 to 2023. We ultimately identified themes at three levels: navigating the terrain of vulnerability and empowerment (the individual with mental illness), navigating the terrain of external environment (the external environment) and connectivity within the healthcare ecosystem for mental health (the health service system). CONCLUSIONS We must design more effective strategies to improve mental healthcare access for rural patients, considering cultural nuances and health service utilization patterns. This requires a multi-level approach, tailored to the unique needs of diverse populations.
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Affiliation(s)
- Linghui Zhang
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yubin Chen
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qi Li
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiayuan Zhang
- Department of Nursing, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yuqiu Zhou
- Department of Medicine, Huzhou University, Huzhou, Zhejiang, China.
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Moore K, Uriegas NA, Emerson DM, Winkelmann ZK, Harriell K, Torres-McGehee TM. Barriers To and Attitudes Toward Seeking Mental Health Services Among Collegiate Marching Band Artists. J Athl Train 2024; 59:506-513. [PMID: 38243734 PMCID: PMC11127682 DOI: 10.4085/1062-6050-0368.23] [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] [Indexed: 01/21/2024]
Abstract
CONTEXT Marching band (MB) artists experience stressors influencing their physical, mental, and emotional health warranting medical support, and they face challenges similar to those of other college students and athletes. Mental health illnesses exist in collegiate and MB settings, but barriers affect access to treatment. OBJECTIVES To examine MB artists' perceived barriers to and attitudes toward seeking care from mental health professionals. The secondary aim was to explore barriers to and attitudes about seeking mental health counseling between genders and history of pursuing mental health counseling. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS A total of 534 MB artists (women = 312, men = 222; age = 19.7 ± 1.4 years). MAIN OUTCOME MEASURE(S) Participants completed surveys on demographics and past medical history along with the Barriers to Help Seeking Checklist, the Attitudes Toward Seeking Professional Psychological Help-Short Form Scale (ATSPPH-SF), and the Mental Help Seeking Attitudes Scale (MHSAS). Descriptive statistics were calculated to assess demographic data. Cross-tabulations and χ2 statistics were used to evaluate individual barriers (Barriers to Help Seeking Checklist) between genders. Scales were scored 1 to 7 and 10 to 30 on the MHSAS and ATSPPH-SF, respectively. A 1-way analysis of variance measured differences in the total mean score on the ATSPPH-SF between genders. RESULTS The highest barrier reported was lack of time to seek services (69.1%; n = 369), followed by 47.6% (n = 254) for services not available during my free time. Average scores were 4.0 ± 0.4 on the MHSAS (indicating neutral attitudes toward seeking help) and 17.97 ± 5.48 on the ATSPPH-SF (indicating slightly positive attitudes to seeking help). No differences were seen for the total mean scores on the MHSAS and ATSPPH-SF between genders. CONCLUSIONS Marching band artists' barriers to and attitudes toward mental health care influenced their ability to seek care in times of need and demonstrated some similarities to those of collegiate athletes. Awareness of the obstacles MB artists face in receiving mental health care will assist health care providers in advocating for improved care in this setting.
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Affiliation(s)
- Kenya Moore
- Department of Exercise Science, University of South Carolina, Columbia
| | - Nancy A. Uriegas
- Department of Exercise Science, University of South Carolina, Columbia
| | - Dawn M. Emerson
- Department of Exercise Science, University of South Carolina, Columbia
| | | | - Kysha Harriell
- Department of Kinesiology & Sport Sciences, University of Miami, Coral Gables, FL
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McCabe JE, Henderson L, Davila RC, Segre LS. Improving Maternal Depression Screening in the Neonatal Intensive Care Unit. MCN Am J Matern Child Nurs 2024; 49:145-150. [PMID: 38679825 DOI: 10.1097/nmc.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
PURPOSE To examine whether self-perceived benefits of mental health treatment differed between mothers of babies in the neonatal intensive care unit with and without a positive screen for depression based on their Edinburgh Postnatal Depression score. STUDY DESIGN AND METHODS Mothers were recruited in person pre-COVID-19 pandemic, and via phone call and online advertisement during the pandemic. Mothers completed a 10-item depression scale and whether they believed they would benefit from mental health treatment. A chi-square test determined the difference in perceived benefit between mothers who screened positively for depression and those who did not. RESULTS This secondary analysis included 205 mothers, with an average age of 29. Of the 68 mothers who screened positively for depression, 12 believed that would not benefit from mental health intervention. Of the 137 who screened negatively for depression, 18 believed they would benefit from mental health intervention. Mothers who screened negatively for depression were significantly less likely to believe they would benefit from mental health intervention. CLINICAL IMPLICATIONS Depression screening scales offer guidance on which mothers to flag for follow-up, but neither on how a mother will respond nor how to effectively approach a mother about her mental health. Nurses can improve identification and follow-up of depressed mothers in the neonatal intensive care unit by asking mothers about their perceived need for mental health treatment.
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Shakya P, Sood M, Mathur R, Prajapati N, Patil V. Pathways to care and barriers in treatment among patients with Dissociative disorders. Asian J Psychiatr 2024; 95:104000. [PMID: 38507864 DOI: 10.1016/j.ajp.2024.104000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Dissociative disorder patients often present with sudden and embarrassing symptoms, and it is difficult for the patient and care giver to understand initially, recognize the need for help and reach for appropriate treatment timely. This can result in high risk of engaging in dangerous behaviors such as self-harm and suicidal acts, impaired global functioning, and poor quality of life. Knowledge about the types of barriers which are there in treatment seeking, can help in planning strategies for their removal and to facilitate the treatment process. METHODS Cross-sectional study among patients (n=133) with Dissociative disorders which were recruited from January 2023 to June 2023 in a tertiary care hospital. Pathways to care and barriers in treatment for Dissociative disorders were assessed by interviewing patients using semi-structured proforma. The Dissociative Experience Scale and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)) were used to assess disease severity and impact of illness on various domains of life respectively. Group comparison was made to assess differences in social- clinical profile of patients choosing different modalities of treatment. RESULTS 133 patients of Dissociative disorders with mean age 29.6±9.2, showed their first-choice of help seeking from general practitioner/ neurologist (40.6%), traditional faith healers (35.3%), psychiatrist (18.1%) and 5.2% preferred alternative treatments. This trend changed with 2nd and 3rd contact of help seeking with greater preference for psychiatrist in their 2nd (n=45, 33.8%) and 3rd (n=69, 51.8%) contact. The median duration of untreated illness was 56 weeks (IQR 24-182 weeks). Social-clinical profile of patients varied with their choice of treatment, having lower education level (P = 0.013), longer duration of untreated illness (p=0.003), more severity of symptoms (p=0.032) and greater disability scores(p=0.002) in patients whose first treatment choice was traditional faith healers. More than 70% patients faced availability barriers, stigma, unawareness about mental illness and influence of others in treatment of choice as barriers in initiating and continuing treatment. CONCLUSION Patients with Dissociative disorders seek treatment from a multitude of healthcare providers including traditional faith healers, general physicians, and alternative medicine practitioners before reaching psychiatrist and undergoes various barriers in treatment. There is need to implement necessary measures for sensitization and awareness about Dissociative disorders to prevent prolonged and undue delays in initiation of appropriate management.
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Affiliation(s)
- Pooja Shakya
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Rahul Mathur
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Nisha Prajapati
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Vaibhav Patil
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
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Abouzeid N, Lal S. The role of sociodemographic factors on the acceptability of digital mental health care: A scoping review protocol. PLoS One 2024; 19:e0301886. [PMID: 38669278 PMCID: PMC11051634 DOI: 10.1371/journal.pone.0301886] [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: 09/22/2023] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Many individuals experiencing mental health complications face barriers when attempting to access services. To bridge this care gap, digital mental health innovations (DMHI) have proven to be valuable additions to in-person care by enhancing access to care. An important aspect to consider when evaluating the utility of DMHI is perceived acceptability. However, it is unclear whether diverse sociodemographic groups differ in their degree of perceived acceptability of DMHI. OBJECTIVE This scoping review aims to synthesize evidence on the role of sociodemographic factors (e.g., age, gender) in the perceived acceptability of DMHI among individuals seeking mental health care. METHODS Guided by the JBI Manual of Evidence Synthesis, chapter on Scoping Review, a search strategy developed according to the PCC framework will be implemented in MEDLINE and then adapted to four electronic databases (i.e., CINAHL, MEDLINE, PsycINFO, and EMBASE). The study selection strategy will be piloted by two reviewers on subsets of 30 articles until agreement among reviewers reaches 90%, after which one reviewer will complete the remaining screening of titles and abstracts. The full-text screening, data extraction strategy, and charting tool will be completed by one reviewer and then validated by a second member of the team. Main findings will be presented using tables and figures. EXPECTED CONTRIBUTIONS This scoping review will examine the extent to which sociodemographic factors have been considered in the digital mental health literature. Also, the proposed review may help determine whether certain populations have been associated with a lower level of acceptability within the context of digital mental health care. This investigation aims to favor equitable access to DMHI among diverse populations.
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Affiliation(s)
- Nagi Abouzeid
- School of Rehabilitation, University of Montréal, Montréal, Québec, Canada
- Youth Mental Health and Technology Lab, University of Montréal Hospital Research Centre, Montréal, Québec, Canada
| | - Shalini Lal
- School of Rehabilitation, University of Montréal, Montréal, Québec, Canada
- Youth Mental Health and Technology Lab, University of Montréal Hospital Research Centre, Montréal, Québec, Canada
- Douglas Research Centre, Montréal, Québec, Canada
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Lemmer D, Moessner M, Arnaud N, Baumeister H, Mutter A, Klemm SL, König E, Plener P, Rummel-Kluge C, Thomasius R, Kaess M, Bauer S. The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial. J Med Internet Res 2024; 26:e54478. [PMID: 38656779 PMCID: PMC11079770 DOI: 10.2196/54478] [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: 11/13/2023] [Revised: 12/22/2023] [Accepted: 03/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. OBJECTIVE This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. METHODS This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. RESULTS No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. CONCLUSIONS Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. TRIAL REGISTRATION German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110.
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Affiliation(s)
- Diana Lemmer
- Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Agnes Mutter
- Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sarah-Lena Klemm
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Elisa König
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Rainer Thomasius
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Ruprecht-Karls University Heidelberg, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner site Mannheim/Heidelberg/Ulm, Heidelberg, Germany
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Rottstädt F, Becker E, Wilz G, Croy I, Baumeister H, Terhorst Y. Enhancing the acceptance of smart sensing in psychotherapy patients: findings from a randomized controlled trial. Front Digit Health 2024; 6:1335776. [PMID: 38698889 PMCID: PMC11063245 DOI: 10.3389/fdgth.2024.1335776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Objective Smart sensing has the potential to make psychotherapeutic treatments more effective. It involves the passive analysis and collection of data generated by digital devices. However, acceptance of smart sensing among psychotherapy patients remains unclear. Based on the unified theory of acceptance and use of technology (UTAUT), this study investigated (1) the acceptance toward smart sensing in a sample of psychotherapy patients (2) the effectiveness of an acceptance facilitating intervention (AFI) and (3) the determinants of acceptance. Methods Patients (N = 116) were randomly assigned to a control group (CG) or intervention group (IG). The IG received a video AFI on smart sensing, and the CG a control video. An online questionnaire was used to assess acceptance of smart sensing, performance expectancy, effort expectancy, facilitating conditions and social influence. The intervention effects of the AFI on acceptance were investigated. The determinants of acceptance were analyzed with structural equation modeling (SEM). Results The IG showed a moderate level of acceptance (M = 3.16, SD = 0.97), while the CG showed a low level (M = 2.76, SD = 1.0). The increase in acceptance showed a moderate effect in the intervention group (p < .05, d = 0.4). For the IG, performance expectancy (M = 3.92, SD = 0.7), effort expectancy (M = 3.90, SD = 0.98) as well as facilitating conditions (M = 3.91, SD = 0.93) achieved high levels. Performance expectancy (γ = 0.63, p < .001) and effort expectancy (γ = 0.36, p < .001) were identified as the core determinants of acceptance explaining 71.1% of its variance. The fit indices supported the model's validity (CFI = .95, TLI = .93, RMSEA = .08). Discussion The low acceptance in the CG suggests that enhancing the acceptance should be considered, potentially increasing the use and adherence to the technology. The current AFI was effective in doing so and is thus a promising approach. The IG also showed significantly higher performance expectancy and social influence and, in general, a strong expression of the UTAUT factors. The results support the applicability of the UTAUT in the context of smart sensing in a clinical sample, as the included predictors were able to explain a great amount of the variance of acceptance.
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Affiliation(s)
- Fabian Rottstädt
- Department of Clinical Psychology, Friedrich Schiller University of Jena, Jena, Germany
- DZPG (German Center for Mental Health), Partner Site Halle-Jena-Magdeburg, Jena, Germany
| | - Eduard Becker
- Department of Clinical Psychology, Friedrich Schiller University of Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Clinical-Psychological Intervention, Friedrich Schiller University of Jena, Jena, Germany
| | - Ilona Croy
- Department of Clinical Psychology, Friedrich Schiller University of Jena, Jena, Germany
- DZPG (German Center for Mental Health), Partner Site Halle-Jena-Magdeburg, Jena, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
- DZPG (German Center for Mental Health), Partner Site Mannheim-Ulm-Heidelberg, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
- DZPG (German Center for Mental Health), Partner Site Mannheim-Ulm-Heidelberg, Ulm, Germany
- Department of Psychological Methods and Assessment, Ludwigs-Maximilian University Munich, Munich, Germany
- DZPG (German Center for Mental Health), Partner Site München, Munich, Germany
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Billian J, Imfeld L, Roth CB, Moeller J, Lang UE, Huber CG. Patient-reported experience measures (PREMs) in outpatient psychiatry - is there an association to perceived discrimination and devaluation? Front Psychiatry 2024; 15:1378487. [PMID: 38699444 PMCID: PMC11064698 DOI: 10.3389/fpsyt.2024.1378487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Patient-Reported Experience Measures (PREMs) are gaining significance in the field of psychiatry, with patient satisfaction being a key measure. However, it is unclear if patient satisfaction in psychiatry is influenced by variables outside the treatment setting. This brief report thus examines the possible impact of perceived discrimination and devaluation (PDD) on patient satisfaction in the psychiatric outpatient setting. Data from 1,126 individuals who were undergoing or had recently completed treatment at 15 outpatient centers of the Psychiatric University Clinic in Basel, Switzerland, was analyzed. Patient satisfaction was assessed using the Münsterlingen Patient Satisfaction Questionnaire (MüPF), and perceived stigma was measured with the Perceived Discrimination Devaluation Scale. The results revealed a positive small effect size relationship between MüPF and PDD, suggesting that patients who perceived less stigma report higher treatment satisfaction. This relationship may affect most ratings, with the total MüPF score remaining relatively robust against this potential influence. Linear regression analysis indicated that a one-unit increase in PDD score could lead to a maximum change of 1.8 points on the 7-point Likert scale for the MüPF item correlating highest with PDD and 0.4 points on the total MüPF score. These findings highlight the importance of considering perceived stigma when evaluating patient satisfaction with psychiatric outpatient treatment. Future research should investigate associations between stigma, patient satisfaction, treatment outcome, as well as other external factors that may influence patient satisfaction in psychiatric settings.
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Affiliation(s)
- Janina Billian
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Lukas Imfeld
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Institute for Evaluation Research, Basel, Universitäre Psychiatrische Kliniken (UPK) Basel, University of Basel, Basel, Switzerland
| | - Carl B. Roth
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
| | - Julian Moeller
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Undine E. Lang
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
| | - Christian G. Huber
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
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Bradford A, Meyer AND, Khan S, Giardina TD, Singh H. Diagnostic error in mental health: a review. BMJ Qual Saf 2024:bmjqs-2023-016996. [PMID: 38575311 DOI: 10.1136/bmjqs-2023-016996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
Diagnostic errors are associated with patient harm and suboptimal outcomes. Despite national scientific efforts to advance definition, measurement and interventions for diagnostic error, diagnosis in mental health is not well represented in this ongoing work. We aimed to summarise the current state of research on diagnostic errors in mental health and identify opportunities to align future research with the emerging science of diagnostic safety. We review conceptual considerations for defining and measuring diagnostic error, the application of these concepts to mental health settings, and the methods and subject matter focus of recent studies of diagnostic error in mental health. We found that diagnostic error is well understood to be a problem in mental healthcare. Although few studies used clear definitions or frameworks for understanding diagnostic error in mental health, several studies of missed, wrong, delayed and disparate diagnosis of common mental disorders have identified various avenues for future research and development. Nevertheless, a lack of clear consensus on how to conceptualise, define and measure errors in diagnosis will pose a barrier to advancement. Further research should focus on identifying preventable missed opportunities in the diagnosis of mental disorders, which may uncover generalisable opportunities for improvement.
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Affiliation(s)
- Andrea Bradford
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Ashley N D Meyer
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Sundas Khan
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Traber D Giardina
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Hardeep Singh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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Billian J, Imfeld L, Roth CB, Moeller J, Lang UE, Huber CG. Treatment-seeking threshold and accessibility of psychiatric outpatient services in Switzerland: the relationship with stigma and self-esteem. Front Psychiatry 2024; 15:1377971. [PMID: 38680786 PMCID: PMC11045997 DOI: 10.3389/fpsyt.2024.1377971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Perceived stigmatization and low self-esteem are linked to poorer mental health outcomes, but their impact on treatment-seeking thresholds and the importance of outpatient service location remain unclear. The study included 525 outpatients of the University Psychiatric Clinic (UPK) Basel, Switzerland, of whom 346 were treated at inner city services and 179 at services located on the main site of the UPK at the outer city limits. Perceived discrimination and devaluation (PDD), self-esteem (SE), treatment-seeking threshold (TST), and accessibility were measured via a self-reported questionnaire. The PDD consisted of 12 items evaluating beliefs about the level of stigma towards individuals with mental illness in the general population on a 5-point Likert scale. SE, TST and accessibility were assessed through single-item 7-point Likert scales. PDD and SE were positively correlated (p < 0.001), suggesting that lower perceived stigma was linked to higher self-esteem, and were not associated with TST. The relationship between PDD and SE remained consistent after controlling for age, gender, and nationality. Age was negatively correlated with TST (p = 0.022), while gender did not significantly influence any of the variables. There was little variation regarding PDD, with emergencies at the site of the psychiatric clinic and substance use disorder (SUD) patients reporting higher levels of stigmatization. Emergency patients and those with SUD and personality disorder reported the lowest SE ratings. TST showed a broad range and was highest for emergency services and transcultural psychiatry patients. Differences in accessibility were mainly linked to the location, with outpatient service users in the inner city reporting better accessibility (p < 0.001) and higher SE (p = 0.009). In comparison to patients using services with planned contacts only, patients in emergency settings differed by higher TST (p = 0.018) and better ratings of accessibility (p = 0.004). In conclusion, there was a relevant amount of stigmatization, impaired self-esteem, and, for some outpatient services, high thresholds to seek treatment. Future research should explore other factors influencing TST. The findings highlight the need to address stigmatization and accessibility when planning mental health services.
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Affiliation(s)
- Janina Billian
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Lukas Imfeld
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Institute for Evaluation Research, Universitäre Psychiatrische Kliniken (UPK) Basel, University of Basel, Basel, Switzerland
| | - Carl B. Roth
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
| | - Julian Moeller
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Undine E. Lang
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
| | - Christian G. Huber
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
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Lin G, Werner K, Alqunaiebet A, Hamza MM, Alkanhal N, Alsukait RF, Alruwaily A, Rakic S, Cetinkaya V, Herbst CH, Lin TK. The cost-effectiveness of school-based interventions for chronic diseases: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:26. [PMID: 38605333 PMCID: PMC11008027 DOI: 10.1186/s12962-024-00511-w] [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: 01/07/2023] [Accepted: 01/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Chronic diseases, or non-communicable diseases (NCD), are conditions of long duration and often influenced and contributed by complex interactions of several variables, including genetic, physiological, environmental, and behavioral factors. These conditions contribute to death, disability, and subsequent health care costs. Primary and secondary school settings provide an opportunity to deliver relatively low cost and effective interventions to improve public health outcomes. However, there lacks systematic evidence on the cost-effectiveness of these interventions. METHODS We systematically searched four databases (PubMed/Medline, Cochrane, Embase, and Web of Science) for published studies on the cost-effectiveness of chronic-disease interventions in school settings. Studies were eligible for inclusion if they assessed interventions of any chronic or non-communicable disease, were conducted in a school setting, undertook a full cost-effectiveness analysis and were available in English, Spanish, or French. RESULTS Our review identified 1029 articles during our initial search of the databases, and after screening, 33 studies were included in our final analysis. The most used effectiveness outcome measures were summary effectiveness units such as quality-adjusted life years (QALYs) (22 articles; 67%) or disability-adjusted life years (DALYs) (4 articles; 12%). The most common health condition for which an intervention targets is overweight and obesity. Almost all school-based interventions were found to be cost-effective (30 articles; 81%). CONCLUSION Our review found evidence to support a number of cost-effective school-based interventions targeting NCDs focused on vaccination, routine physical activity, and supplement delivery interventions. Conversely, many classroom-based cognitive behavioral therapy for mental health and certain multi-component interventions for obesity were not found to be cost-effective.
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Affiliation(s)
- George Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Kalin Werner
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | | | - Mariam M Hamza
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Norah Alkanhal
- Saudi Public Health Authority, Riyadh, KSA, Saudi Arabia
| | - Reem F Alsukait
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Severin Rakic
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Volkan Cetinkaya
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Tracy Kuo Lin
- Institute for Health & Aging, Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA.
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Wilhelm S, Bernstein EE, Bentley KH, Snorrason I, Hoeppner SS, Klare D, Greenberg JL, Weingarden H, McCoy TH, Harrison O. Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone App-Led Cognitive Behavioral Therapy for Depression Under Therapist Supervision: Open Trial. JMIR Ment Health 2024; 11:e53998. [PMID: 38592771 DOI: 10.2196/53998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Major depressive disorder affects approximately 1 in 5 adults during their lifetime and is the leading cause of disability worldwide. Yet, a minority receive adequate treatment due to person-level (eg, geographical distance to providers) and systems-level (eg, shortage of trained providers) barriers. Digital tools could improve this treatment gap by reducing the time and frequency of therapy sessions needed for effective treatment through the provision of flexible, automated support. OBJECTIVE This study aimed to examine the feasibility, acceptability, and preliminary clinical effect of Mindset for Depression, a deployment-ready 8-week smartphone-based cognitive behavioral therapy (CBT) supported by brief teletherapy appointments with a therapist. METHODS This 8-week, single-arm open trial tested the Mindset for Depression app when combined with 8 brief (16-25 minutes) video conferencing visits with a licensed doctoral-level CBT therapist (n=28 participants). The app offers flexible, accessible psychoeducation, CBT skills practice, and support to patients as well as clinician guidance to promote sustained engagement, monitor safety, and tailor treatment to individual patient needs. To increase accessibility and thus generalizability, all study procedures were conducted remotely. Feasibility and acceptability were assessed via attrition, patient expectations and feedback, and treatment utilization. The primary clinical outcome measure was the clinician-rated Hamilton Depression Rating Scale, administered at pretreatment, midpoint, and posttreatment. Secondary measures of functional impairment and quality of life as well as maintenance of gains (3-month follow-up) were also collected. RESULTS Treatment credibility (week 4), expectancy (week 4), and satisfaction (week 8) were moderate to high, and attrition was low (n=2, 7%). Participants self-reported using the app or practicing (either on or off the app) the CBT skills taught in the app for a median of 50 (IQR 30-60; week 4) or 60 (IQR 30-90; week 8) minutes per week; participants accessed the app on an average 36.8 (SD 10.0) days and completed a median of 7 of 8 (IQR 6-8) steps by the week 8 assessment. The app was rated positively across domains of engagement, functionality, aesthetics, and information. Participants' depression severity scores decreased from an average Hamilton Depression Rating Scale score indicating moderate depression (mean 19.1, SD 5.0) at baseline to a week 8 mean score indicating mild depression (mean 10.8, SD 6.1; d=1.47; P<.001). Improvement was also observed for functional impairment and quality of life. Gains were maintained at 3-month follow-up. CONCLUSIONS The results show that Mindset for Depression is a feasible and acceptable treatment option for individuals with major depressive disorder. This smartphone-led treatment holds promise to be an efficacious, scalable, and cost-effective treatment option. The next steps include testing Mindset for Depression in a fully powered randomized controlled trial and real-world clinical settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05386329; https://clinicaltrials.gov/study/NCT05386329?term=NCT05386329.
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Affiliation(s)
- Sabine Wilhelm
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Emily E Bernstein
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kate H Bentley
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ivar Snorrason
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Susanne S Hoeppner
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Dalton Klare
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jennifer L Greenberg
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Hilary Weingarden
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Thomas H McCoy
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Titov N, Dear BF, Nielssen O, Barrett V, Kayrouz R, Staples LG. A pilot study examining whether restricting and resuming specific actions systematically changes symptoms of depression and anxiety. A series of N-of-1 trials. Behav Res Ther 2024; 177:104536. [PMID: 38598899 DOI: 10.1016/j.brat.2024.104536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
Anxiety and depressive disorders are highly prevalent and a leading cause of disability. Understanding how symptoms develop could lead to new preventive and clinical interventions. This pilot study examined whether systematically restricting specific behaviours (target actions) associated with good psychological health would increase psychological symptoms in healthy participants, and whether resuming those actions would reduce symptoms to baseline levels. Twelve adults participated in a series of N-of-1 trials comprising baseline (A), restriction (B) and recovery (C) phases. Outcomes were assessed weekly using measures of depression (PHQ-9), anxiety (GAD-7), and a validated 15-item measure of target actions (Big 5). Symptoms of depression and anxiety increased significantly from Phase A to Phase B and returned to baseline by the end of Phase C. Increased symptoms during Phase B were only observed in participants who restricted actions by more than 25%. Symptom increases were evident within 2 weeks of restriction, but most participants appeared to take longer to recover to baseline levels. This study demonstrates that reducing the frequency of specific actions may increase symptoms of anxiety and depression, which is reversed when those actions are resumed. This contributes to our understanding of the aetiology, maintenance, and recovery from depression, anxiety, and possibly other disorders.
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Affiliation(s)
- Nickolai Titov
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Blake F Dear
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Olav Nielssen
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Victoria Barrett
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Rony Kayrouz
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Lauren G Staples
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
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Wilhelm M, Bauer S, Feldhege J, Wolf M, Moessner M. Alleviating the burden of depression: a simulation study on the impact of mental health services. Epidemiol Psychiatr Sci 2024; 33:e19. [PMID: 38563188 PMCID: PMC11022261 DOI: 10.1017/s204579602400012x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/21/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS Depressive disorders are ranked as the single leading cause of disability worldwide. Despite immense efforts, there is no evidence of a global reduction in the disease burden in recent decades. The aim of the study was to determine the public health impact of the current service system (status quo), to quantify its effects on the depression-related disease burden and to identify the most promising strategies for improving healthcare for depression on the population level. METHODS A Markov model was developed to quantify the impact of current services for depression (including prevention, treatment and aftercare interventions) on the total disease burden and to investigate the potential of alternative scenarios (e.g., improved reach or improved treatment effectiveness). Parameter settings were derived from epidemiological information and treatment data from the literature. Based on the model parameters, 10,000,000 individual lives were simulated for each of the models, based on monthly transition rates between dichotomous health states (healthy vs. diseased). Outcome (depression-related disease burden) was operationalized as the proportion of months spent in depression. RESULTS The current healthcare system alleviates about 9.5% (95% confidence interval [CI]: 9.2%-9.7%) of the total disease burden related to depression. Chronic cases cause the majority (83.2%) of depression-related burden. From a public health perspective, improving the reach of services holds the largest potential: Maximum dissemination of prevention (26.9%; CI: 26.7%-27.1%) and treatment (26.5%; CI: 26.3%-26.7%) would result in significant improvements on the population level. CONCLUSIONS The results confirm an urgent need for action in healthcare for depression. Extending the reach of services is not only more promising but also probably more achievable than increasing their effectiveness. Currently, the system fails to address the prevention and treatment of chronic cases. The large proportion of the disease burden associated with chronic courses highlights the need for improved treatment policies and clinical strategies for this group (e.g., disease management and adaptive or personalized interventions). The model complements the existing literature by providing a new perspective on the depression-related disease burden and the complex interactions between healthcare services and the lifetime course.
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Affiliation(s)
- M. Wilhelm
- Center for Psychotherapy Research, Heidelberg University Hospital, Heidelberg, Germany
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner site Mannheim/Heidelberg/Ulm, Germany
| | - S. Bauer
- Center for Psychotherapy Research, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Mental Health (DZPG), Partner site Mannheim/Heidelberg/Ulm, Germany
| | - J. Feldhege
- Asklepios Science & Research, Research Institute, Hamburg, Germany
| | - M. Wolf
- Department of Psychology, University of Zurich, Zürich, Switzerland
| | - M. Moessner
- Center for Psychotherapy Research, Heidelberg University Hospital, Heidelberg, Germany
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Renwick L, Pedley R, Johnson I, Bell V, Lovell K, Bee P, Brooks H. Mental health literacy in children and adolescents in low- and middle-income countries: a mixed studies systematic review and narrative synthesis. Eur Child Adolesc Psychiatry 2024; 33:961-985. [PMID: 35570227 PMCID: PMC11032284 DOI: 10.1007/s00787-022-01997-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 04/23/2022] [Indexed: 12/12/2022]
Abstract
Mental illnesses are the leading cause of disease burden among children and young people (CYP) globally. Low- and middle-income countries (LMIC) are disproportionately affected. Enhancing mental health literacy (MHL) is one way to combat low levels of help-seeking and effective treatment receipt. We aimed to synthesis evidence about knowledge, beliefs and attitudes of CYP in LMICs about mental illnesses, their treatments and outcomes, evaluating factors that can enhance or impede help-seeking to inform context-specific and developmentally appropriate understandings of MHL. Eight bibliographic databases were searched from inception to July 2020: PsycInfo, EMBASE, Medline (OVID), Scopus, ASSIA (ProQuest), SSCI, SCI (Web of Science) CINAHL PLUS, Social Sciences full text (EBSCO). 58 papers (41 quantitative, 13 qualitative, 4 mixed methods) representing 52 separate studies comprising 36,429 participants with a mean age of 15.3 [10.4-17.4], were appraised and synthesized using narrative synthesis methods. Low levels of recognition and knowledge about mental health problems and illnesses, pervasive levels of stigma and low confidence in professional healthcare services, even when considered a valid treatment option were dominant themes. CYP cited the value of traditional healers and social networks for seeking help. Several important areas were under-researched including the link between specific stigma types and active help-seeking and research is needed to understand more fully the interplay between knowledge, beliefs and attitudes across varied cultural settings. Greater exploration of social networks and the value of collaboration with traditional healers is consistent with promising, yet understudied, areas of community-based MHL interventions combining education and social contact.
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Affiliation(s)
- Laoise Renwick
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, School of Health Sciences, University of Manchester, Room 6.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, School of Health Sciences, University of Manchester, Room 6.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Isobel Johnson
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, School of Health Sciences, University of Manchester, Room 6.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Vicky Bell
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, School of Health Sciences, University of Manchester, Room 6.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, School of Health Sciences, University of Manchester, Room 6.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, School of Health Sciences, University of Manchester, Room 6.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, Faculty of Medicine, Biology and Health, School of Health Sciences, University of Manchester, Room 6.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
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Limenih G, MacDougall A, Wedlake M, Nouvet E. Depression and Global Mental Health in the Global South: A Critical Analysis of Policy and Discourse. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:95-107. [PMID: 38105446 PMCID: PMC10955781 DOI: 10.1177/27551938231220230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/09/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023]
Abstract
Over the past two decades, depression has become a prominent global public health concern, especially in low- and middle-income countries (LMICs). The World Health Organization (WHO) and the Movement for Global Mental Health have developed international guidelines to improve mental health services globally, prioritizing LMICs. These efforts hold promise for advancing care and treatment for depression and other mental, neurological, and substance abuse disorders in LMICs. The intervention guides, such as the WHO's mhGAP-Intervention Guides, are evidence-based tools and guidelines to help detect, diagnose, and manage the most common mental disorders. Using the Global South as an empirical site, this article draws on Foucauldian critical discourse and document analysis methods to explore how these international intervention guides operate as part of knowledge-power processes that inscribe and materialize in the world in some forms rather than others. It is proposed that these international guidelines shape the global discourse about depression through their (re)production of biopolitical assumptions and impacts, governmentality, and "conditions of possibility." The article uses empirical data to show nuance, complexity, and multi-dimensionality where binary thinking sometimes dominates, and to make links across arguments for and against global mental health. The article concludes by identifying several resistive discourses and suggesting reconceptualizing the treatment gap for common mental disorders.
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Affiliation(s)
- Gojjam Limenih
- School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Arlene MacDougall
- Department of Pyschiatry, Western University Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Marnie Wedlake
- School of Health Studies, Western University, London, ON, Canada
| | - Elysee Nouvet
- School of Health Studies, Western University, London, ON, Canada
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Beukema L, de Winter AF, Korevaar EL, Hofstra J, Reijneveld SA. Investigating the use of support in secondary school: the role of self-reliance and stigma towards help-seeking. J Ment Health 2024; 33:227-235. [PMID: 35502838 PMCID: PMC11147454 DOI: 10.1080/09638237.2022.2069720] [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: 11/01/2021] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
Purpose: Adolescents are the least likely to seek help for their mental health problems. School may be an important route to improve early recognition of adolescents with mental health problems in need for support, but little is known about the barriers to school support.Materials and methods: Data were collected in a longitudinal cohort study of Dutch adolescents (age 12-16) in secondary school (n = 956). We assessed the relation between level of psychosocial problems at the beginning of the school year (T1) and the support used in school at the end of that school year (T2), whether the willingness to talk to others (measured at T1) mediates this relation, and whether stigma towards help-seeking (T1) moderates this mediation.Results: Adolescents with more psychosocial problems were more likely to use support in school and were less willing to talk to others about their problems, but the willingness to talk to others was not a mediator. Stigma moderated the relationship between psychosocial problems and willingness to talk to others.Conclusions: Most adolescents with psychosocial problems get support in Dutch secondary school regardless of their willingness to talk to others about their problems. However, perceiving stigma towards help-seeking makes it less likely for someone to talk about their problems.
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Affiliation(s)
- L. Beukema
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A. F. de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E. L. Korevaar
- Department of Rehabilitation, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - J. Hofstra
- Department of Rehabilitation, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - S. A. Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Gomes KD, Collette TL, Schlenk M, Judkins J, Sanchez-Cardona I, Channer B, Ross P, Fredrick G, Moore BA. Posttraumatic Stress Disorder, Suicidal ideation, and Stress: The Moderating Role of Dysfunctional and Recovery Cognitions. Arch Suicide Res 2024; 28:569-584. [PMID: 37073774 DOI: 10.1080/13811118.2023.2199798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Trauma and stressor-related behavioral health conditions are prevalent in military populations and have become a major public health concern in recent years. Individuals who commonly report suicidal ideation often have comorbid mental health diagnoses (i.e., posttraumatic stress disorder; PTSD). However, the mechanisms associated with stress, suicidal ideation, and PTSD are unclear. METHOD The present study examined the moderating role of dysfunctional and recovery cognitions between (i) PTSD and suicidal ideation, and (ii) stress and suicidal ideation in two distinct samples. Sample 1 was composed of civilians and military personnel (N = 322). Sample 2 was composed of (N = 377) student service members and veterans (SSM/Vs). RESULTS In Study 1, we found that low recovery cognitions at higher and moderate levels of PTSD symptoms were significantly associated with increased suicidal ideation. High dysfunctional cognitions were significantly associated with suicidal ideation at higher levels of PTSD symptoms. In Study 2, we found no differences in any level of recovery cognitions at low and moderate stress levels with suicidal ideation. Higher levels of stress were associated with high dysfunctional cognitions and suicidal ideation. CONCLUSION Promoting higher levels of recovery cognitions and reducing dysfunctional cognitions are important in addressing stress, suicidal ideation, and comorbid conditions such as PTSD. Future research should focus on examining the clinical utility of the Dispositional Recovery and Dysfunction Inventory (DRDI) in other populations (i.e., firefighters and paramedics). This could contribute to efforts of suicide prevention and the promotion of the well-being of individuals experiencing suicidal ideation.
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Bisby MA, Balakumar T, Scott AJ, Titov N, Dear BF. An online therapist-guided ultra-brief treatment for depression and anxiety: a randomized controlled trial. Psychol Med 2024; 54:902-913. [PMID: 37655527 DOI: 10.1017/s003329172300260x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND There are many barriers to engaging in current psychological treatments, including time, cost, and availability. Ultra-brief treatments overcome some of these barriers by delivering therapeutic information and skills using significantly less time than standard-length treatments. We developed a therapist-guided online ultra-brief treatment for depression and anxiety and compared it to an existing 8-week, 5-lesson therapist-guided standard-length treatment and a waitlist control. METHODS In a randomized controlled trial, adults with self-reported depression or anxiety were randomized (1:1:1) to the ultra-brief treatment, standard-length treatment, or waitlist control. The primary outcomes were depression symptoms and anxiety symptoms assessed at baseline, 5-weeks later, 9-weeks later (primary timepoint), and 3-months later. The trial was prospectively registered. RESULTS Between 7 February 2022, and 16 August 2022, 242 participants were enrolled in the ultra-brief treatment (n = 85), standard-length treatment (n = 80), and waitlist control (n = 77). Participants were mostly women with an average age of 48.56 years. At 9-weeks post-baseline, participants in the ultra-brief treatment group reported significantly lower depression (between groups d = 0.41) and anxiety (d = 0.53) than the waitlist control. The ultra-brief treatment was non-inferior for anxiety at both 9-weeks and 3-months follow-up. Non-inferiority for depression was observed at 9-weeks. CONCLUSIONS The online ultra-brief treatment resulted in significant reductions in depression and anxiety that were non-inferior to a longer treatment course after 9-weeks. Remotely delivered ultra-brief treatments have the potential to provide accessible and effective care for those who cannot, or would prefer not to, access longer psychological interventions.
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Affiliation(s)
- Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Tanya Balakumar
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Amelia J Scott
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- MindSpot Clinic, MQ Health, Macquarie University, Sydney, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
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Wong VWH, Yiu EKL, Ng CH, Sarris J, Ho FYY. Unraveling the associations between unhealthy lifestyle behaviors and mental health in the general adult Chinese population: A cross-sectional study. J Affect Disord 2024; 349:583-595. [PMID: 38176449 DOI: 10.1016/j.jad.2023.12.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/24/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND This study examined the cumulative risk of unhealthy lifestyle behaviors and the associations between overall lifestyle and common mental disorders (CMDs), insomnia, stress, health-related quality of life (HRQOL), and functional impairment. Additionally, the treatment preferences for managing CMDs and insomnia were examined. METHODS A survey was conducted on 1487 Chinese Hong Kong adults, assessing their lifestyle behaviors (i.e., diet and nutrition, substance use, physical activity, stress management, restorative sleep, social support, and environmental exposures), mental health-related outcomes, and treatment preferences via a vignette. RESULTS The findings revealed significant additive relationships between the number of 'worse' lifestyle domains and the risk of all outcomes. A healthier overall lifestyle was significantly associated with reduced risks of all outcomes (AORs = 0.88 to 0.93). Having healthier practices in diet and nutrition, substance use, stress management, restorative sleep, and social support domains were significantly associated with lower risks of all outcomes (AORs = 0.93 to 0.98), except that substance use was not significantly associated with stress. Physical activity was inversely associated with only depressive symptoms (AOR = 0.98), anxiety symptoms (AOR = 0.99), and stress (AOR = 0.99). Environmental exposures were not significantly associated with functional impairment but with all other outcomes (AORs = 0.98 to 0.99). Besides, lifestyle interventions (55 %) were significantly more preferred for managing CMDs and insomnia relative to psychotherapy (35.4 %) and pharmacotherapy (9.6 %). CONCLUSIONS Our findings underscore the importance of considering lifestyle factors when managing CMDs, insomnia, stress, HRQOL, and functional impairment, with a particular emphasis on adopting a multicomponent treatment approach.
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Affiliation(s)
| | - Eric Kwok-Lun Yiu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Jerome Sarris
- Western Sydney University, NICM Health Research Institute, Westmead, NSW, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
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Bernstein EE, Wolfe EC, Huguenel BM, Wilhelm S. Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review. JMIR Mhealth Uhealth 2024; 12:e45860. [PMID: 38488834 PMCID: PMC10981024 DOI: 10.2196/45860] [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: 01/19/2023] [Revised: 09/12/2023] [Accepted: 11/30/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness. OBJECTIVE This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns. METHODS In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on. RESULTS To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area. CONCLUSIONS Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.
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Affiliation(s)
- Emily E Bernstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Emma C Wolfe
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
| | - Brynn M Huguenel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Thielecke J, Kuper P, Lehr D, Schuurmans L, Harrer M, Ebert DD, Cuijpers P, Behrendt D, Brückner H, Horvath H, Riper H, Buntrock C. Who benefits from indirect prevention and treatment of depression using an online intervention for insomnia? Results from an individual-participant data meta-analysis. Psychol Med 2024:1-14. [PMID: 38469832 DOI: 10.1017/s0033291724000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent and burdensome for individuals and society. While there are psychological interventions able to prevent and treat MDD, uptake remains low. To overcome structural and attitudinal barriers, an indirect approach of using online insomnia interventions seems promising because insomnia is less stigmatized, predicts MDD onset, is often comorbid and can outlast MDD treatment. This individual-participant-data meta-analysis evaluated the potential of the online insomnia intervention GET.ON Recovery as an indirect treatment to reduce depressive symptom severity (DSS) and potential MDD onset across a range of participant characteristics. METHODS Efficacy on depressive symptom outcomes was evaluated using multilevel regression models controlling for baseline severity. To identify potential effect moderators, clinical, sociodemographic, and work-related variables were investigated using univariable moderation and random-forest methodology before developing a multivariable decision tree. RESULTS IPD were obtained from four of seven eligible studies (N = 561); concentrating on workers with high work-stress. DSS was significantly lower in the intervention group both at post-assessment (d = -0.71 [95% CI-0.92 to -0.51]) and at follow-up (d = -0.84 [95% CI -1.11 to -0.57]). In the subsample (n = 121) without potential MDD at baseline, there were no significant group differences in onset of potential MDD. Moderation analyses revealed that effects on DSS differed significantly across baseline severity groups with effect sizes between d = -0.48 and -0.87 (post) and d = - 0.66 to -0.99 (follow-up), while no other sociodemographic, clinical, or work-related characteristics were significant moderators. CONCLUSIONS An online insomnia intervention is a promising approach to effectively reduce DSS in a preventive and treatment setting.
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Affiliation(s)
- Janika Thielecke
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Unit Healthy Living & Work, TNO (The Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | - Paula Kuper
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute for Sustainability, Education & Psychology, Leuphana University Luneburg, Luneburg, Germany
| | - Lea Schuurmans
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Mathias Harrer
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- GET.ON Institute for Online Health Trainings GmbH, Berlin, Germany
| | - David D Ebert
- Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, Netherlands
- Amsterdam Public Health, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Dörte Behrendt
- Department of Health Psychology and Applied Biological Psychology, Institute for Sustainability, Education & Psychology, Leuphana University Luneburg, Luneburg, Germany
| | - Hanna Brückner
- Department of Health Psychology and Applied Biological Psychology, Institute for Sustainability, Education & Psychology, Leuphana University Luneburg, Luneburg, Germany
| | - Hanne Horvath
- GET.ON Institute for Online Health Trainings GmbH, Berlin, Germany
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, Netherlands
- Amsterdam Public Health, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands
| | - Claudia Buntrock
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Cjuno J, Zafra-Tanaka JH, García García TDP, Taype-Rondan A. Religious leaders' perceptions of the identification and referral of people with mental health problems in a Peruvian city. PLoS One 2024; 19:e0300023. [PMID: 38451996 PMCID: PMC10919717 DOI: 10.1371/journal.pone.0300023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Religious leaders have the potential to play a significant role in the identification and referral of individuals with mental health problems. OBJECTIVE This study sought to understand the perceptions of religious leaders in regards to identifying and referring parishioners with mental health issues to healthcare professionals, in Chimbote, Peru. METHODS We performed a cross-sectional study that covered religious leaders of different religious groups in Chimbote. The leaders completed a survey that assessed their characteristics, past experiences of detecting and referring those with mental health problems to healthcare professionals, and perceptions of four clinical cases (for which we used the Clergy's Perception of Mental Illness Survey instrument). RESULTS We included 109 religious' leaders of four religious groups (11 Catholics, 70 Evangelicals, 21 Mormons, and 7 Adventists). Of these, 50.5% had received at least one request for help with mental health issues from a parishioner in the previous month, over 85% expressed a desire for training in identifying mental health problems, and 22-30% reported receiving any training. While the majority of leaders were able to correctly identify cases of depression, alcohol dependence, and drug problems, only 62% correctly classified a case of schizophrenia. Despite this, 80% stated that they would refer their parishioners to healthcare professionals. CONCLUSION Parishioners tend to consult their religious leaders regarding their mental health and approximately 80% stated they would refer such cases to a healthcare professional. However, less than one-third of the leaders had received training to detect mental health problems. These results suggest that there is a need for training programs to improve the ability of religious leaders to identify and refer individuals with mental health issues.
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Affiliation(s)
- Julio Cjuno
- Universidad Cesar Vallejo, Escuela de Medicina, Piura, Peru
| | | | | | - Alvaro Taype-Rondan
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
- EviSalud–Evidencias en Salud, Lima, Peru
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Stürner L, Ross T, Traub HJ. Elusive cases in forensic psychiatry? Exploring subgroups of schizophrenia spectrum disorder patients in Germany. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 93:101971. [PMID: 38422564 DOI: 10.1016/j.ijlp.2024.101971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The relationship between schizophrenia spectrum disorders (SSD) and criminal behaviour is a central issue in forensic psychiatry. People with mental illness face some of the same types of criminogenic factors as people without mental illness, albeit more frequently. The research question of this study is the extent to which a framework of early and late offender typology can be empirically reconstructed in a forensic psychiatric population, and whether there are any practical implications. METHOD For N = 733 patients in six different forensic hospitals in Germany, the age at first psychiatric admission and the age at first registered offence were documented, as well as a number of other patient-related characteristics. Two clustering procedures were used to investigate whether forensic psychiatric patients could be classified according to these characteristics. RESULTS A k-means cluster analysis using age at first psychiatric admission, age at first recorded offence, sociodemographic, clinical and criminological characteristics supported a 4-cluster solution. MANOVA analyses revealed further differences between the identified types. CONCLUSION This study empirically confirms some of the sub-groups of the early and late starter typology described in the literature. In particular, the "early starters", "late starters" and "first presenters" were identified, but cluster four comprises individuals not previously described in the scientific literature. Each of these classes has group-specific characteristics that may have implications for forensic treatment, post-release aftercare, and the legal system.
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Affiliation(s)
- Lukas Stürner
- Psychiatric Centre ZfP-Südwürttemberg, Weissenau, Germany; University of Ulm, Ulm, Germany.
| | - Thomas Ross
- Reichenau Psychiatric Centre, Reichenau, Germany; University of Ulm, Ulm, Germany.
| | - Hans-Joachim Traub
- Psychiatric Centre ZfP-Südwürttemberg, Weissenau, Germany; University of Ulm, Ulm, Germany.
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Beck C, Peynenburg V, Patterson T, Titov N, Dear B, Hadjistavropoulos H. Acceptability and effectiveness study of therapist-assisted internet-delivered cognitive behaviour therapy for agriculture producers. Internet Interv 2024; 35:100709. [PMID: 38298471 PMCID: PMC10828050 DOI: 10.1016/j.invent.2024.100709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Agriculture producers are less likely to seek or to receive mental health services compared to the general population. Additional research is needed to identify effective and accessible mental health interventions for this underserved population. This study used a mixed-methods approach and open trial design to examine the acceptability and effectiveness of therapist-assisted internet-delivered cognitive behaviour therapy (ICBT) supplemented with an additional agricultural resource for clients from agricultural backgrounds receiving ICBT in routine care. Clients (n = 34) participated in an online, five-lesson course that provided psychoeducation and strategies for dealing with symptoms of anxiety and depression, with weekly therapist assistance. Clients also received a tailored resource (developed with input from those with an agricultural background) providing culturally specific information and case stories pertinent to agricultural communities. Intent-to-treat analyses showed that the ICBT program was effective in reducing anxiety and depression symptoms among the agricultural population. Large within-group pre-to-post-treatment Cohen's effect sizes of d = 1.14, 95 % CI [0.41, 1.86] and d = 1.15, 95 % CI [0.42, 1.87] were found for depression and anxiety, respectively and comparable to the same program offered to the general population. Clients also experienced reductions in perceived stress and significant improvements in resiliency from pre- to post-treatment. Semi-structured interviews conducted at post-treatment with the agricultural clients (n = 31) on their experiences with ICBT identified four main themes: perceived strengths of ICBT and the tailored resource, suggestions to improve service delivery for agriculture producers, clients experienced internal and external challenges to participating in ICBT, and the positive impact of the course reached beyond the client. Very high satisfaction rates were found. These results provide support for the acceptability and effectiveness of ICBT with a tailored resource offered in routine care among agriculture producers.
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Affiliation(s)
- C.D. Beck
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - V. Peynenburg
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - T. Patterson
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - N. Titov
- eCentre Clinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - B.F. Dear
- eCentre Clinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - H.D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
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