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Walsh AEL, Naughton G, Sharpe T, Zajkowska Z, Malys M, van Heerden A, Mondelli V. A collaborative realist review of remote measurement technologies for depression in young people. Nat Hum Behav 2024; 8:480-492. [PMID: 38225410 PMCID: PMC10963268 DOI: 10.1038/s41562-023-01793-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/20/2023] [Indexed: 01/17/2024]
Abstract
Digital mental health is becoming increasingly common. This includes use of smartphones and wearables to collect data in real time during day-to-day life (remote measurement technologies, RMT). Such data could capture changes relevant to depression for use in objective screening, symptom management and relapse prevention. This approach may be particularly accessible to young people of today as the smartphone generation. However, there is limited research on how such a complex intervention would work in the real world. We conducted a collaborative realist review of RMT for depression in young people. Here we describe how, why, for whom and in what contexts RMT appear to work or not work for depression in young people and make recommendations for future research and practice. Ethical, data protection and methodological issues need to be resolved and standardized; without this, RMT may be currently best used for self-monitoring and feedback to the healthcare professional where possible, to increase emotional self-awareness, enhance the therapeutic relationship and monitor the effectiveness of other interventions.
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Affiliation(s)
- Annabel E L Walsh
- The McPin Foundation, London, UK.
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | | | - Thomas Sharpe
- Young People's Advisory Group, The McPin Foundation, London, UK
| | - Zuzanna Zajkowska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mantas Malys
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alastair van Heerden
- Centre for Community-based Research, Human and Social Capabilities Department, Human Sciences Research Council, Johannesburg, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Schwartz OS, Amminger P, Baune BT, Bedi G, Berk M, Cotton SM, Daglas-Georgiou R, Glozier N, Harrison B, Hermens DF, Jennings E, Lagopoulos J, Loo C, Mallawaarachchi S, Martin D, Phelan B, Read N, Rodgers A, Schmaal L, Somogyi AA, Thurston L, Weller A, Davey CG. The Study of Ketamine for Youth Depression (SKY-D): study protocol for a randomised controlled trial of low-dose ketamine for young people with major depressive disorder. Trials 2023; 24:686. [PMID: 37875938 PMCID: PMC10594918 DOI: 10.1186/s13063-023-07631-3] [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: 07/11/2023] [Accepted: 09/07/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Existing treatments for young people with severe depression have limited effectiveness. The aim of the Study of Ketamine for Youth Depression (SKY-D) trial is to determine whether a 4-week course of low-dose subcutaneous ketamine is an effective adjunct to treatment-as-usual in young people with major depressive disorder (MDD). METHODS SKY-D is a double-masked, randomised controlled trial funded by the Australian Government's National Health and Medical Research Council (NHMRC). Participants aged between 16 and 25 years (inclusive) with moderate-to-severe MDD will be randomised to receive either low-dose ketamine (intervention) or midazolam (active control) via subcutaneous injection once per week for 4 weeks. The primary outcome is change in depressive symptoms on the Montgomery-Åsberg Depression Rating Scale (MADRS) after 4 weeks of treatment. Further follow-up assessment will occur at 8 and 26 weeks from treatment commencement to determine whether treatment effects are sustained and to investigate safety outcomes. DISCUSSION Results from this trial will be important in determining whether low-dose subcutaneous ketamine is an effective treatment for young people with moderate-to-severe MDD. This will be the largest randomised trial to investigate the effects of ketamine to treat depression in young people. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ID: ACTRN12619000683134. Registered on May 7, 2019. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377513 .
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Affiliation(s)
- Orli S Schwartz
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.
- Orygen, Melbourne, Australia.
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - Paul Amminger
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Bernard T Baune
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Department of Psychiatry, University of Münster, Münster, Germany
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Gillinder Bedi
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Michael Berk
- Orygen, Melbourne, Australia
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Sue M Cotton
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Rothanthi Daglas-Georgiou
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Australian Research Council Centre of Excellence for Children and Families Over the Life Course, Sydney, Australia
- Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ben Harrison
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Emma Jennings
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Sunshine Coast, Australia
- Thompson Brain and Mind Healthcare, Sunshine Coast, Australia
| | - Colleen Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Black Dog Institute, Sydney, Australia
| | - Sumudu Mallawaarachchi
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Donel Martin
- Black Dog Institute, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Bethany Phelan
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nikki Read
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Lianne Schmaal
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Andrew A Somogyi
- School of Biomedicine, University of Adelaide, Adelaide, Australia
| | - Lily Thurston
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Amber Weller
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Victorian Department of Health, Melbourne, Australia
| | - Christopher G Davey
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Shin HD, Durocher K, Sequeira L, Zaheer J, Torous J, Strudwick G. Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review. BMC Health Serv Res 2023; 23:281. [PMID: 36959599 PMCID: PMC10037806 DOI: 10.1186/s12913-023-09254-5] [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: 07/29/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures. METHODS We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17-20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report. RESULTS This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration. CONCLUSION This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- School of Health, Community Service & Creative Design, Lambton College, Sarnia, Ontario, Canada
| | - Lydia Sequeira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Kasal A, Táborská R, Juríková L, Grabenhofer-Eggerth A, Pichler M, Gruber B, Tomášková H, Niederkrotenthaler T. Facilitators and barriers to implementation of suicide prevention interventions: Scoping review. Glob Ment Health (Camb) 2023; 10:e15. [PMID: 37854412 PMCID: PMC10579684 DOI: 10.1017/gmh.2023.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/12/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
We know that suicide is preventable, yet hundreds of thousands of people still die due to suicide every year. Many interventions were proven to be effective, and dozens of others showed promising results. However, translating these interventions into new settings brings several challenges. One of the crucial obstacles to success is not anticipating possible barriers to implementation nor enhancing possible benefits of factors facilitating the implementation. While we witnessed great support for suicide prevention activities globally in the past years, implementation barriers and facilitating factors are yet to be comprehensively mapped to help implementation activities worldwide. This scoping review maps current knowledge on facilitators and barriers to the implementation of suicide prevention interventions while using the Consolidated Framework for Implementation Research (CFIR) for classification. We included 64 studies. Barriers and facilitators were most commonly identified in the outer setting CFIR domain, namely in the sub-domain of patient needs and resources, which refers to the way in which these needs and resources are reflected by the reviewed interventions. The second most saturated CFIR domain for facilitators was intervention characteristics, where relative advantage, adaptability and cost of intervention sub-domains were equally represented. These sub-domains refer mostly to how the intervention is perceived by key stakeholders, to what extent it can be tailored to the implementation context and how much it costs. While intervention characteristics domain was the second most common also for barriers, the complexity sub-domain referring to high perceived difficulty of implementation was the most frequently represented. With reference to the results, we recommend adapting interventions to the needs of the target groups. Furthermore, carefully selecting the intervention to suit the target context concerning their adaptability, costs and complexity is vital for a successful implementation. Further implications for practice and research are discussed.
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Affiliation(s)
- Alexandr Kasal
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Faculty of Social Sciences, Charles University, Prague, Czech Republic
| | - Roksana Táborská
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
| | - Laura Juríková
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | | | - Michaela Pichler
- Department of Psychosocial Health, Gesundheit Österreich GmbH, Wien, Austria
| | - Beate Gruber
- Department of Psychosocial Health, Gesundheit Österreich GmbH, Wien, Austria
| | - Hana Tomášková
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
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Elzinga E, Gilissen R, Beekman A, de Beurs D. Capturing patients’ satisfaction and experiences with suicide prevention in general practice: a bridge too far? JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Fortune S, Hetrick S. Suicide risk assessments: Why are we still relying on these a decade after the evidence showed they perform poorly? Aust N Z J Psychiatry 2022; 56:1529-1534. [PMID: 35786014 DOI: 10.1177/00048674221107316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicide deaths have a profound impact on whānau and community and are a tragic loss. However, from a statistical point of view, suicide is a relatively rare event. Predicting rare events is difficult, and the implications for suicide prevention were highlighted in an important editorial in this journal more than a decade ago, yet little seems to have changed. Risk assessment that focuses on accurate prediction of suicide in real-world contexts is given a great deal of attention in mental health services, despite the fact that current scientific knowledge and best practice guidelines in this area highlight that it is unlikely to be a good basis on which to provide access to treatment. It is our view that we have a good enough understanding of the common conditions people who struggle with suicidal distress experience and energy is better directed at acting to reduce exposure to these conditions and providing treatment for those who seek it. Blueprints for successful suicide prevention exist. If we lessen the focus on prediction, we will have greater resources to focus on treatment and prevention.
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Affiliation(s)
- Sarah Fortune
- Department of Social and Community Health, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Sarah Hetrick
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.,Suicide Prevention Office, Auckland, New Zealand
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Bos FM, von Klipstein L, Emerencia AC, Veermans E, Verhage T, Snippe E, Doornbos B, Hadders-Prins G, Wichers M, Riese H. A Web-Based Application for Personalized Ecological Momentary Assessment in Psychiatric Care: User-Centered Development of the PETRA Application. JMIR Ment Health 2022; 9:e36430. [PMID: 35943762 PMCID: PMC9399881 DOI: 10.2196/36430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Smartphone self-monitoring of mood, symptoms, and contextual factors through ecological momentary assessment (EMA) provides insights into the daily lives of people undergoing psychiatric treatment. Therefore, EMA has the potential to improve their care. To integrate EMA into treatment, a clinical tool that helps clients and clinicians create personalized EMA diaries and interpret the gathered data is needed. OBJECTIVE This study aimed to develop a web-based application for personalized EMA in specialized psychiatric care in close collaboration with all stakeholders (ie, clients, clinicians, researchers, and software developers). METHODS The participants were 52 clients with mood, anxiety, and psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses). We engaged them in interviews, focus groups, and usability sessions to determine the requirements for an EMA web application and repeatedly obtained feedback on iteratively improved high-fidelity EMA web application prototypes. We used human-centered design principles to determine important requirements for the web application and designed high-fidelity prototypes that were continuously re-evaluated and adapted. RESULTS The iterative development process resulted in Personalized Treatment by Real-time Assessment (PETRA), which is a scientifically grounded web application for the integration of personalized EMA in Dutch clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, an SMS text message-based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated into electronic health record systems to ensure ease of use and sustainable integration in clinical care and adheres to privacy regulations. CONCLUSIONS PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this codevelopment process, its extensive but user-friendly personalization options, its integration into electronic health record systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care requires further research. As such, PETRA paves the way for a systematic investigation of the utility of personalized EMA for routine mental health care.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lino von Klipstein
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ando C Emerencia
- Research Support, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Erwin Veermans
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tom Verhage
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Grietje Hadders-Prins
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harriëtte Riese
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Validation of a brief tool to assess and monitor suicidal ideation: The Youth Suicide Ideation Screen (YSIS-3). J Affect Disord 2021; 295:235-242. [PMID: 34481152 DOI: 10.1016/j.jad.2021.08.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/30/2021] [Accepted: 08/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND . Suicidal ideation is common in young people. Assessment and monitoring can help to understand its dynamic nature and inform treatment planning. AIMS . The aims were to evaluate psychometric properties of a brief screening tool - the Youth Suicide Ideation Screen-3 item (YSIS-3) and determine its correlation with the Suicidal Ideation Question-Junior (SIQ-JR) and measures of depressive and anxiety symptoms a. METHOD . Cronbach's alpha (α) was used to evaluate internal consistency of the YSIS-3 in 1107 young people. Convergent validity was evaluated using network analysis based on individual item polychoric correlations. Structural equation modelling was used to understand latent constructs; pearson product moment correlations to validate the integrity of the underlying construct. and two-way mixed Intraclass Correlation Coefficient to examine longitudinal stability and Cohen's d to assess sensitivity to change. RESULTS . The YSIS-3 was found to have internal consistency, convergent validity and criteria validity almost identical to the 15-item SIQ-JR. There was a high correlation (0.91) between the latent factor underpinning YSIS-3 and SIQ-JR. The YSIS-3 was more sensitive to change among those presenting with suicidal ideation at baseline. CONCLUSIONS . The YSIS-3 is a valid measure for the assessment and monitoring of suicidal ideation, and is sensitive to change. This brief measure can contribute to regular monitoring of the presence and nature of suicidal ideation, which when included in comprehensive assessment, will inform the clinical management of those at risk of suicide.
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Rassy J, Bardon C, Dargis L, Côté LP, Corthésy-Blondin L, Mörch CM, Labelle R. Information and Communication Technology Use in Suicide Prevention: Scoping Review. J Med Internet Res 2021; 23:e25288. [PMID: 33820754 PMCID: PMC8132980 DOI: 10.2196/25288] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The use of information and communication technology (ICT) in suicide prevention has progressed rapidly over the past decade. ICT plays a major role in suicide prevention, but research on best and promising practices has been slow. OBJECTIVE This paper aims to explore the existing literature on ICT use in suicide prevention to answer the following question: what are the best and most promising ICT practices for suicide prevention? METHODS A scoping search was conducted using the following databases: PubMed, PsycINFO, Sociological Abstracts, and IEEE Xplore. These databases were searched for articles published between January 1, 2013, and December 31, 2018. The five stages of the scoping review process were as follows: identifying research questions; targeting relevant studies; selecting studies; charting data; and collating, summarizing, and reporting the results. The World Health Organization suicide prevention model was used according to the continuum of universal, selective, and indicated prevention. RESULTS Of the 3848 studies identified, 115 (2.99%) were selected. Of these, 10 regarded the use of ICT in universal suicide prevention, 53 referred to the use of ICT in selective suicide prevention, and 52 dealt with the use of ICT in indicated suicide prevention. CONCLUSIONS The use of ICT plays a major role in suicide prevention, and many promising programs were identified through this scoping review. However, large-scale evaluation studies are needed to further examine the effectiveness of these programs and strategies. In addition, safety and ethics protocols for ICT-based interventions are recommended.
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Affiliation(s)
- Jessica Rassy
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Research Center, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
- School of Nursing, Université de Sherbrooke, Longueuil, QC, Canada
- Quebec Network on Nursing Intervention Research, Montréal, QC, Canada
| | - Cécile Bardon
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Luc Dargis
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
| | - Louis-Philippe Côté
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Laurent Corthésy-Blondin
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Carl-Maria Mörch
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Algora Lab, Université de Montréal, Montréal, QC, Canada
- Mila, Quebec Artificial Intelligence Institute, Montréal, QC, Canada
| | - Réal Labelle
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Research Center, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
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Szlyk H, Tan J. The Role of Technology and the Continuum of Care for Youth Suicidality: Systematic Review. J Med Internet Res 2020; 22:e18672. [PMID: 33034568 PMCID: PMC7584980 DOI: 10.2196/18672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/26/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background Youth suicide is a global public health issue, and using technology is one strategy to increase participation in preventive interventions. However, there is minimal knowledge on how technology-enhanced interventions for youth correspond to the stages of care, from illness or risk recognition to treatment follow-up. Objective This systematic review aims to examine the efficacy of technology-enhanced youth suicide prevention and interventions across the continuum of care. Methods Four electronic databases were searched up to spring 2019 for youth suicide preventive interventions that used technology. The review was not restricted by study design and eligible studies could report outcomes on suicidality or related behaviors, such as formal treatment initiation. An adapted version of the Methodological Quality Ratings Scale was used to assess study quality. Results A total of 26 studies were identified. The findings support the emerging efficacy of technology-enhanced interventions, including a decline in suicidality and an increase in proactive behaviors. However, evidence suggests that there are gaps in the continuum of care and recent study samples do not represent the diverse identities of vulnerable youth. Conclusions The majority of identified studies were conducted in school settings and were universal interventions that aligned with the illness and risk recognition and help-seeking stages of the continuum of care. This field could be strengthened by having future studies target the stages of assessment and treatment initiation, include diverse youth demographics, and examine the varying roles of providers and technological components in emerging interventions.
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Affiliation(s)
- Hannah Szlyk
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Jia Tan
- The Brown School, Washington University in St Louis, Saint Louis, MO, United States
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Computer-Assisted Psychiatric Diagnosis. J Am Acad Child Adolesc Psychiatry 2020; 59:213-215. [PMID: 32039771 DOI: 10.1016/j.jaac.2019.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/27/2022]
Abstract
Accurate psychiatric diagnosis is critical for both sound clinical interventions and valid research methodology. Over the years, attempts to improve diagnostic reliability and accuracy led to the development of more explicit operationalized diagnostic criteria, starting with DSM-III, and subsequently fully structured and semistructured diagnostic interviews.1 As diagnostic assessment changed and with advances in technology, the use of computers soon developed in parallel to improve the reliability and validity of psychiatric diagnosis. As far back as 1968, computers were used to help clinicians formulate psychiatric diagnoses, by helping them process clinical information according to diagnostic algorithms.2 Since that time, there has been an exponential rise in the use of technology in clinical research and practice. Indeed, computers have been used both to transition diagnostic interviews from paper-and-pencil format to instruments that are clinician-administered via an electronic platform and to create self-report versions of clinician-administered diagnostic interviews. We will discuss each of these in turn.
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12
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Lavoie S, Allott K, Amminger P, Bartholomeusz C, Berger M, Breakspear M, Henders AK, Lee R, Lin A, McGorry P, Rice S, Schmaal L, Wood SJ. Harmonised collection of data in youth mental health: Towards large datasets. Aust N Z J Psychiatry 2020; 54:46-56. [PMID: 30995080 DOI: 10.1177/0004867419844322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The current international trend is to create large datasets with existing data and/or deposit newly collected data into repositories accessible to the scientific community. These practices lead to more efficient data sharing, better detection of small effects, modelling of confounders, establishment of sample generalizability and identification of differences between any given disorders. In Australia, to facilitate such data-sharing and collaborative opportunities, the Neurobiology in Youth Mental Health Partnership was created. This initiative brings together specialised researchers from around Australia to work towards a better understanding of the cross-diagnostic neurobiology of youth mental health and the translation of this knowledge into clinical practice. One of the mandates of the partnership was to develop a protocol for harmonised prospective collection of data across research centres in the field of youth mental health in order to create large datasets. METHODS Four key research modalities were identified: clinical assessments, brain imaging, neurocognitive assessment and collection of blood samples. This paper presents the consensus set of assessments/data collection that has been selected by experts in each domain. CONCLUSION The use of this core set of data will facilitate the pooling of psychopathological and neurobiological data into large datasets allowing researchers to tackle important questions requiring very large numbers. The aspiration of this transdiagnostic approach is a better understanding of the mechanisms underlying mental illnesses.
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Affiliation(s)
- Suzie Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Cali Bartholomeusz
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Maximus Berger
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Anjali K Henders
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Rico Lee
- Brain and Mental Health Research Hub, Monash University, Clayton, VIC, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Simon Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Stephen J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,School of Psychology, University of Birmingham, Birmingham, UK
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13
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Horgan A, Kelly P, Goodwin J, Behan L. Depressive Symptoms and Suicidal Ideation among Irish Undergraduate College Students. Issues Ment Health Nurs 2018; 39:575-584. [PMID: 29465285 DOI: 10.1080/01612840.2017.1422199] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined the prevalence of depressive symptoms and suicidal ideation among 220 first year undergraduate university students in Ireland. Data were collected using the Centre for Epidemiological Studies Depression Scale and the Suicidal Behaviours Questionnaire. Findings indicated that 59% of participants experienced depressive symptoms and 28.5% had suicidal ideation. Financial stress and poor relationships with both parents, increased the odds of experiencing depressive symptoms. Sexual orientation, financial stress, and poor relationships with fathers, increased the odds of experiencing suicidal ideation. Suicidal ideation was also higher in those who had sought help in the past from mental health professionals. Nurses need to be aware of the factors associated with mental ill-health in this population.
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Affiliation(s)
- Aine Horgan
- a School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork , Cork , Ireland
| | - Peter Kelly
- b School of Health Sciences, Waterford Institute of Technology , Waterford , Ireland
| | - John Goodwin
- c School of Nursing and Midwifery, University College Cork , Cork , Ireland
| | - Laura Behan
- d School of Applied Psychology, University College Cork , Ireland
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14
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Wozney L, McGrath PJ, Gehring ND, Bennett K, Huguet A, Hartling L, Dyson MP, Soleimani A, Newton AS. eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes. JMIR Ment Health 2018; 5:e48. [PMID: 29945858 PMCID: PMC6039769 DOI: 10.2196/mental.9655] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/15/2018] [Accepted: 05/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anxiety disorders and depression are frequent conditions in childhood and adolescence. eMental healthcare technologies may improve access to services, but their uptake within health systems is limited. OBJECTIVE The objective of this review was to examine and describe how the implementation of eMental healthcare technologies for anxiety disorders and depression in children and adolescents has been studied. METHODS We conducted a search of 5 electronic databases and gray literature. Eligible studies were those that assessed an eMental healthcare technology for treating or preventing anxiety or depression, included children or adolescents (<18 years), or their parents or healthcare providers and reported findings on technology implementation. The methodological quality of studies was evaluated using the Mixed Methods Appraisal Tool. Outcomes of interest were based on 8 implementation outcomes: acceptability (satisfaction with a technology), adoption (technology uptake and utilization), appropriateness ("fitness for purpose"), cost (financial impact of technology implementation), feasibility (extent to which a technology was successfully used), fidelity (implementation as intended), penetration ("spread" or "reach" of the technology), and sustainability (maintenance or integration of a technology within a healthcare service). For extracted implementation outcome data, we coded favorable ratings on measurement scales as "positive results" and unfavorable ratings on measurement scales as "negative results." Those studies that reported both positive and negative findings were coded as having "mixed results." RESULTS A total of 46 studies met the inclusion criteria, the majority of which were rated as very good to excellent in methodological quality. These studies investigated eMental healthcare technologies for anxiety (n=23), depression (n=18), or both anxiety and depression (n=5). Studies of technologies for anxiety evaluated the following: (1) acceptability (78%) reported high levels of satisfaction, (2) adoption (43%) commonly reported positive results, and (3) feasibility (43%) reported mixed results. Studies of technologies for depression evaluated the following: (1) appropriateness (56%) reported moderate helpfulness and (2) acceptability (50%) described a mix of both positive and negative findings. Studies of technologies designed to aid anxiety and depression commonly reported mixed experiences with acceptability and adoption and positive findings for appropriateness of the technologies for treatment. Across all studies, cost, fidelity, and penetration and sustainability were the least measured implementation outcomes. CONCLUSIONS Acceptability of eMental healthcare technology is high among users and is the most commonly investigated implementation outcome. Perceptions of the appropriateness and adoption of eMental healthcare technology were varied. Implementation research that identifies, evaluates, and reports on costs, sustainability, and fidelity to clinical guidelines is crucial for making high-quality eMental healthcare available to children and adolescents.
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Affiliation(s)
- Lori Wozney
- Izaak Walton Killam Centre, Centre for Research in Family Health, Halifax, NS, Canada
| | | | - Nicole D Gehring
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Bennett
- Offord Centre for Child Studies, Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada
| | - Anna Huguet
- Izaak Walton Killam Centre, Centre for Research in Family Health, Halifax, NS, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michele P Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amir Soleimani
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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15
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Hetrick SE, Robinson J, Burge E, Blandon R, Mobilio B, Rice SM, Simmons MB, Alvarez-Jimenez M, Goodrich S, Davey CG. Youth Codesign of a Mobile Phone App to Facilitate Self-Monitoring and Management of Mood Symptoms in Young People With Major Depression, Suicidal Ideation, and Self-Harm. JMIR Ment Health 2018; 5:e9. [PMID: 29362208 PMCID: PMC5801516 DOI: 10.2196/mental.9041] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/31/2017] [Accepted: 11/23/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Effective treatment of depression in young people is critical, given its prevalence, impacts, and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice. OBJECTIVE The objective of this study was to address the gap between guidelines about monitoring and real-world practice by codesigning an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician. METHODS We engaged young people aged 18 to 25 years who had experienced depression, suicidal ideation including those who self-harm, as well as clinicians in a codesign process. We used a human-centered codesign design studio methodology where young people designed the features of the app first individually and then as a group. This resulted in a minimal viable product design, represented through low-fidelity hand-drawn wireframes. Clinicians were engaged throughout the process via focus groups. RESULTS The app incorporated a mood monitoring feature with innovative design aspects that allowed customization, and was named a "well-being tracker" in response to the need for a positive approach to this function. Brief personalized interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (ie, responding in a timely manner) and will need to be addressed during the full implementation of the app into clinical services. CONCLUSIONS The potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress and increasing access to timely and evidence-based interventions are desirable outcomes. To achieve positive outcomes for young people using technology- (app) based interventions, it is critical to understand and incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians.
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Affiliation(s)
- Sarah Elisabeth Hetrick
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Jo Robinson
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Eloise Burge
- Portable, Web Innovation Company, Melbourne, Australia
| | - Ryan Blandon
- Portable, Web Innovation Company, Melbourne, Australia
| | - Bianca Mobilio
- Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Simon M Rice
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Magenta B Simmons
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | | | - Christopher G Davey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
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16
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Thabrew H, Fleming T, Hetrick S, Merry S. Co-design of eHealth Interventions With Children and Young People. Front Psychiatry 2018; 9:481. [PMID: 30405450 PMCID: PMC6200840 DOI: 10.3389/fpsyt.2018.00481] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/13/2018] [Indexed: 11/16/2022] Open
Abstract
Co-design, defined as collective creativity across the entire design process, can lead to the development of interventions that are more engaging, satisfying, and useful to potential users. However, using this methodology within the research arena requires a shift from traditional practice. Co-design of eHealth interventions with children and young people has additional challenges. This review summarizes the applied core principles of co-design and recommends techniques for undertaking co-design with children and young people. Three examples of co-design during the development of eHealth interventions (Starship Rescue, a computer game for treating anxiety in children with long-term physical conditions, a self-monitoring app for use during treatment of depression in young people, and HABITS, the development of an emotional health and substance use app, and eHealth platform for young people) are provided to illustrate the value and challenges of this contemporary process.
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Affiliation(s)
- Hiran Thabrew
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Theresa Fleming
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.,School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Sarah Hetrick
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Sally Merry
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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