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Anisha SA, Sen A, Bain C. Evaluating the Potential and Pitfalls of AI-Powered Conversational Agents as Humanlike Virtual Health Carers in the Remote Management of Noncommunicable Diseases: Scoping Review. J Med Internet Res 2024; 26:e56114. [PMID: 39012688 PMCID: PMC11289576 DOI: 10.2196/56114] [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: 01/08/2024] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND The rising prevalence of noncommunicable diseases (NCDs) worldwide and the high recent mortality rates (74.4%) associated with them, especially in low- and middle-income countries, is causing a substantial global burden of disease, necessitating innovative and sustainable long-term care solutions. OBJECTIVE This scoping review aims to investigate the impact of artificial intelligence (AI)-based conversational agents (CAs)-including chatbots, voicebots, and anthropomorphic digital avatars-as human-like health caregivers in the remote management of NCDs as well as identify critical areas for future research and provide insights into how these technologies might be used effectively in health care to personalize NCD management strategies. METHODS A broad literature search was conducted in July 2023 in 6 electronic databases-Ovid MEDLINE, Embase, PsycINFO, PubMed, CINAHL, and Web of Science-using the search terms "conversational agents," "artificial intelligence," and "noncommunicable diseases," including their associated synonyms. We also manually searched gray literature using sources such as ProQuest Central, ResearchGate, ACM Digital Library, and Google Scholar. We included empirical studies published in English from January 2010 to July 2023 focusing solely on health care-oriented applications of CAs used for remote management of NCDs. The narrative synthesis approach was used to collate and summarize the relevant information extracted from the included studies. RESULTS The literature search yielded a total of 43 studies that matched the inclusion criteria. Our review unveiled four significant findings: (1) higher user acceptance and compliance with anthropomorphic and avatar-based CAs for remote care; (2) an existing gap in the development of personalized, empathetic, and contextually aware CAs for effective emotional and social interaction with users, along with limited consideration of ethical concerns such as data privacy and patient safety; (3) inadequate evidence of the efficacy of CAs in NCD self-management despite a moderate to high level of optimism among health care professionals regarding CAs' potential in remote health care; and (4) CAs primarily being used for supporting nonpharmacological interventions such as behavioral or lifestyle modifications and patient education for the self-management of NCDs. CONCLUSIONS This review makes a unique contribution to the field by not only providing a quantifiable impact analysis but also identifying the areas requiring imminent scholarly attention for the ethical, empathetic, and efficacious implementation of AI in NCD care. This serves as an academic cornerstone for future research in AI-assisted health care for NCD management. TRIAL REGISTRATION Open Science Framework; https://doi.org/10.17605/OSF.IO/GU5PX.
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Affiliation(s)
- Sadia Azmin Anisha
- Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Arkendu Sen
- Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Chris Bain
- Faculty of Information Technology, Data Future Institutes, Monash University, Clayton, Australia
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Howard M, Grant R, Schmidt M. Healthism, rural individualism and self-help: youth mental health in Northwest Tasmania. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2024:1-16. [PMID: 38946031 DOI: 10.1080/14461242.2024.2356871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/13/2024] [Indexed: 07/02/2024]
Abstract
Rural Australian youth exhibit high rates of mental ill-health, exacerbated by reduced access to mental health services. While the need for innovative solutions is well-established rural youth themselves are frequently excluded from the dialogue, creating a significant gap in evidence and the development of relevant service provision that reflects young people's lived experiences. Drawing on the concepts of individualism and healthism and research highlighting the continuing importance of relationships and trust in the lives of young people in a digital society, we aim to better understand how rural youth understand mental health and navigate mental health services and information. Using a qualitative methodology, we held 2 small focus groups with a total of 8 young people in rural Tasmania to identify aspects of rural mental healthcare that require improvement and to contribute to developing new and innovative solutions. Findings indicate that rural Tasmanian youth face numerous structural, social, and cultural barriers to positive mental health. Rural self-reliance and generational differences in attitudes towards mental health can negatively affect youths' help-seeking behaviours. Findings from this study suggest a need to combine technology-and community-based approaches creating a multi-generational approach to combat mental ill-health among rural youth.
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Affiliation(s)
- Mikaylah Howard
- School of Social Sciences, University of Tasmania, Hobart, Australia
| | - Ruby Grant
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - Merete Schmidt
- School of Social Sciences, University of Tasmania, Burnie, Australia
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Zhang Z, Hu Y, Liu S, Feng X, Yang J, Cheng LJ, Ramazanu S, Wu XV. The effectiveness of e-mental health interventions on stress, anxiety, and depression among healthcare professionals: a systematic review and meta-analysis. Syst Rev 2024; 13:144. [PMID: 38816879 PMCID: PMC11138032 DOI: 10.1186/s13643-024-02565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 05/17/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Many healthcare professionals are experiencing psychological distress. Electronic mental health (e-mental health) interventions are convenient and multifunctional. This review aimed to examine the effectiveness of e-mental health interventions in enhancing the well-being of healthcare professionals and to identify moderating factors. METHODS A comprehensive and systematic retrieval of randomized controlled trial (RCT) studies was conducted across eight databases. Population, intervention, comparison, and outcome (PICO) were used to define eligibility criteria. Stress, anxiety, and depression were included as the main outcomes. The overall effect was calculated based on the random effect model, and the effect size was presented using the standardized mean difference. The characteristics of the research design, intervention object, and intervention design were further selected as potential moderating factors for subgroup analysis. Meta-regression analyses were finally performed, incorporating intervention duration and sample size as independent variables. RESULTS A total of 20 studies were included in the systematic review, and 17 were included in the meta-analysis. A large effect on relieving stress and anxiety and a small-to-medium effect on reducing depression were observed. Subgroup analyses showed that features including mindfulness approaches, online courses, computer use, group interventions, and professional guidance were more favorable in the design of services. Meta-regression revealed that intervention duration only affected anxiety symptoms. Caution should be exercised, as some subgroups had fewer studies and higher heterogeneity. For the secondary outcomes, a large effect on emotional exhaustion and a small-to-medium effect on well-being were observed. CONCLUSION In general, e-mental health interventions significantly improve the psychological health of healthcare staff. Future high-quality, large-scale studies targeting healthcare professionals and specific intervention scenarios are warranted.
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Affiliation(s)
- Zemiao Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiandong Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhong Yang
- Xiangya School of Nursing, Central South University, Changsha, China
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sheena Ramazanu
- School of Nursing and Health Studies, The Jockey Club Institute of Healthcare (IOH), Hong Kong Metropolitan University, Hong Kong, China
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Brotherdale R, Berry K, Branitsky A, Bucci S. Co-producing digital mental health interventions: A systematic review. Digit Health 2024; 10:20552076241239172. [PMID: 38665886 PMCID: PMC11044797 DOI: 10.1177/20552076241239172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/28/2024] Open
Abstract
Objective Smartphone apps (apps) are widely recognised as promising tools for improving access to mental healthcare. However, a key challenge is the development of digital interventions that are acceptable to end users. Co-production with providers and stakeholders is increasingly positioned as the gold standard for improving uptake, engagement, and healthcare outcomes. Nevertheless, clear guidance around the process of co-production is lacking. The objectives of this review were to: (i) present an overview of the methods and approaches to co-production when designing, producing, and evaluating digital mental health interventions; and (ii) explore the barriers and facilitators affecting co-production in this context. Methods A pre-registered (CRD42023414007) systematic review was completed in accordance with The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Five databases were searched. A co-produced bespoke quality appraisal tool was developed with an expert by experience to assess the quality of the co-production methods and approaches. A narrative synthesis was conducted. Results Twenty-six studies across 24 digital mental health interventions met inclusion criteria. App interventions were rarely co-produced with end users throughout all stages of design, development, and evaluation. Co-producing digital mental health interventions added value by creating culturally sensitive and acceptable interventions. Reported challenges included resource issues exacerbated by the digital nature of the intervention, variability across stakeholder suggestions, and power imbalances between stakeholders and researchers. Conclusions Variation in approaches to co-producing digital mental health interventions is evident, with inconsistencies between stakeholder groups involved, stage of involvement, stakeholders' roles and methods employed.
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Affiliation(s)
- Rebecca Brotherdale
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison Branitsky
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Dasgupta J, Furlano JA, Bandler Z, Fittipaldi S, Canty AJ, Yasoda-Mohan A, El-Jaafary SI, Ucheagwu V, McGettrick G, de la Cruz-Góngora V, Nguyen KH, Lawlor B, Nogueira Haas A. Hope for brain health: impacting the life course and society. Front Psychol 2023; 14:1214014. [PMID: 37457094 PMCID: PMC10348811 DOI: 10.3389/fpsyg.2023.1214014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Hope is a cognitive process by which an individual can identify their personal goals and develop actionable steps to achieve results. It has the potential to positively impact people's lives by building resilience, and can be meaningfully experienced at both the individual and group level. Despite this significance, there are sizable gaps in our understanding of the neurobiology of hope. In this perspective paper, the authors discuss why further research is needed on hope and its potency to be harnessed in society as a "tool" to promote brain health across healthy and patient populations. Avenues for future research in hope and the brain are proposed. The authors conclude by identifying strategies for the possible applications of hope in brain health promotion within the areas of technology, arts, media, and education.
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Affiliation(s)
- Jayashree Dasgupta
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Samvedna Care, Gurugram, India
| | - Joyla A. Furlano
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Zach Bandler
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Sol Fittipaldi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Alison J. Canty
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Wicking Dementia Research and Education Center, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | | | - Shaimaa I. El-Jaafary
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Neurology Department, Cairo University, Cairo, Egypt
| | - Valentine Ucheagwu
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Department of Psychology, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Vanessa de la Cruz-Góngora
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Center for Evaluation and Survey Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Kim-Huong Nguyen
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Center for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Aline Nogueira Haas
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Chiang CP, Hayes D, Panagiotopoulou E. Apps targeting anorexia nervosa in young people: a systematic review of active ingredients. Transl Behav Med 2023; 13:406-417. [PMID: 36753537 PMCID: PMC10255767 DOI: 10.1093/tbm/ibad003] [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: 02/10/2023] Open
Abstract
Evaluating the presence of behavior change techniques (BCTs) in mHealth apps could be used to better understand what "active ingredients" contribute to outcomes. Despite the early onset of Anorexia Nervosa (AN) and the increasing use of mobile apps to seek mental healthcare among young people, BCTs underpinning mHealth apps targeting AN have never been systematically examined. This review systematically identified and analyzed BCTs underpinning apps targeted at reducing AN in young people in an attempt to understand their active components. Apps were searched and screened in Apple Store and Google Play. Six apps that met the inclusion criteria and were coded by trained researchers against the BCT Taxonomy V1. Overall, 22 of 93 possible BCTs were identified. The most common were "Information about health consequences," "Social support (unspecified)," and "Information about antecedents". Identified BCTs suggested potential overlaps with traditional clinical treatments for AN, such as cognitive behavioral therapy and family-based therapy. Further investigation is required to evaluate the apps' usability and effectiveness.
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Affiliation(s)
- Clara P Chiang
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Education & Training, Anna Freud National Centre for Children and Families, London, UK
| | - Daniel Hayes
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Evidence Based Practice Unit, UCL and the Anna Freud National Centre for Children and Families (AFNCCF), London, UK
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London WC1E 7HB, UK
| | - Elena Panagiotopoulou
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Education & Training, Anna Freud National Centre for Children and Families, London, UK
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Chang S, Alon N, Torous J. An exploratory analysis of the effect size of the mobile mental health Application, mindLAMP. Digit Health 2023; 9:20552076231187244. [PMID: 37434734 PMCID: PMC10331229 DOI: 10.1177/20552076231187244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023] Open
Abstract
Objectives Despite the proliferation of mobile mental health apps, evidence of their efficacy around anxiety or depression is inadequate as most studies lack appropriate control groups. Given that apps are designed to be scalable and reusable tools, insights concerning their efficacy can also be assessed uniquely through comparing different implementations of the same app. This exploratory analysis investigates the potential to report a preliminary effect size of an open-source smartphone mental health app, mindLAMP, on the reduction of anxiety and depression symptoms by comparing a control implementation of the app focused on self-assessment to an intervention implementation of the same app focused on CBT skills. Methods A total of 328 participants were eligible and completed the study under the control implementation and 156 completed the study under the intervention implementation of the mindLAMP app. Both use cases offered access to the same in-app self-assessments and therapeutic interventions. Multiple imputations were utilized to impute the missing Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 survey scores of the control implementation. Results Post hoc analysis revealed small effect sizes of Hedge's g = 0.34 for Generalized Anxiety Disorder-7 and Hedge's g = 0.21 for Patient Health Questionnaire-9 between the two groups. Conclusions mindLAMP shows promising results in improving anxiety and depression outcomes in participants. Though our results mirror the current literature in assessing mental health apps' efficacy, they remain preliminary and will be used to inform a larger, well-powered study to further elucidate the efficacy of mindLAMP.
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Affiliation(s)
- Sarah Chang
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Noy Alon
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John Torous
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Chang C, Palermo E, Deswert S, Brown A, Nuske HJ. Money can't buy happiness: A randomized controlled trial of a digital mental health app with versus without financial incentives. Digit Health 2023; 9:20552076231170693. [PMID: 37361441 PMCID: PMC10286537 DOI: 10.1177/20552076231170693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/03/2023] [Indexed: 06/28/2023] Open
Abstract
Mental health disorders are prevalent among college students and increasing in frequency and severity. However, there is a significant gap between those who need treatment and those who engage in treatment. Given the documented efficacy of financial incentives for promoting health behavior change and engagement in treatment, financial incentives may help, along with nonfinancial behavioral incentives such as motivational messaging, gamification, and loss aversion techniques. We compared brief (28-day) use of two versions of a behavioral economics-inspired digital mental health app, NeuroFlow: (1) the full app including financial incentives and nonfinancial behavioral incentives (treatment group) and (2) a version of the app with nonfinancial behavioral incentives only (control group). In our intent-to-treat analyses, in order to examine the primary outcome of app engagement, a one-way analysis of variance (ANOVA) (treatment vs. control) was conducted, and to examine the secondary outcomes (depression, anxiety, emotion dysregulation, and wellbeing), a two-way repeated measures ANOVAs (treatment vs. control × baseline vs. post-trial) were conducted. We found that there were no differences between treatment groups on app engagement or the change in the mental health/wellness outcome measures. There was a main effect of timepoint on symptoms of anxiety and emotion dysregulation, such that there were significantly lower self-reported symptoms at post-trial relative to baseline. Our results suggest that financial incentives in digital mental health apps over and above nonfinancial behavioral incentives do not have an impact on app engagement or mental health/wellness outcomes.
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Affiliation(s)
- Cheryl Chang
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Emma Palermo
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sky Deswert
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alyssa Brown
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Heather J Nuske
- Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Tarp K, Holmberg TT, Moeller AM, Lichtenstein MB. Patient and therapist experiences of using a smartphone application monitoring anxiety symptoms. Int J Qual Stud Health Well-being 2022; 17:2044981. [PMID: 35212602 PMCID: PMC8925918 DOI: 10.1080/17482631.2022.2044981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Kristine Tarp
- Research Unit for Telepsychiatry and E- The Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Trine Theresa Holmberg
- Research Unit for Telepsychiatry and E- The Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Anne Marie Moeller
- Research Unit for Telepsychiatry and E- The Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Health Promotion Research, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mia Beck Lichtenstein
- Research Unit for Telepsychiatry and E- The Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Bowles NI, Davies JN, Van Dam NT. Dose–response Relationship of Reported Lifetime Meditation Practice with Mental Health and Wellbeing: a Cross-sectional Study. Mindfulness (N Y) 2022; 13:2529-2546. [PMID: 36193220 PMCID: PMC9517970 DOI: 10.1007/s12671-022-01977-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
Objectives Meta-analyses of meditation studies have revealed mixed modest evidence of benefits across a range of outcomes. However, because this evidence-base is predominantly from brief interventions, it is unclear whether it accurately reflects how contemporary meditators practice or the dose–response relationship between amount of practice and outcome. This study sought to characterize how contemporary meditators practice, examine any possible dose–response relationships between historical practice and measures of psychological wellbeing, and explore which characteristics of practice most strongly predict favorable psychological outcomes. Methods One thousand six hundred and sixty-eight meditators (M = 1095 h practice, SD = 2365) responded to advertisements in meditation practice communities and social media. We explored associations between demographics, meditation practice characteristics, and outcomes including positive and negative affect, psychological distress, and life satisfaction in a cross-sectional study design. Results Historical meditation practice (accumulated lifetime hours) was significantly associated with favorable psychological outcomes (|r| ranging from .18 to .28). Model fit was optimized with a generalized additive model (average increase in R2 = 2.22), indicating non-linear effects. The strength of association between practice time and outcomes was generally strongest for approximately the first 500 h, before plateauing. Several practice types including Vipassana (as taught by S.N. Goenka) and cultivating practices (e.g. compassion, lovingkindness) were more strongly predictive of favorable psychological outcomes. Conclusions Benefits of meditation accrue over time in a non-linear manner, and show variation based on practice context. These results highlight the importance of understanding how the benefits of meditation accrue over longer time durations than typical standardized programs. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-022-01977-6.
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Affiliation(s)
- Nicholas I. Bowles
- Contemplative Studies Centre, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Jonathan N. Davies
- Contemplative Studies Centre, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Nicholas T. Van Dam
- Contemplative Studies Centre, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
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Zulkefly NS, Schaff ARD, Zaini NA, Mukhtar F, Norowi NM, Dahlan R, Said SM. Protocol for randomized control trial of a digital-assisted parenting intervention for promoting Malaysian children’s mental health. Front Psychol 2022; 13:928895. [PMID: 36211835 PMCID: PMC9541885 DOI: 10.3389/fpsyg.2022.928895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/31/2022] [Indexed: 12/01/2022] Open
Abstract
Background Mental illness among Malaysian children is gradually reaching a fundamentally alarming point as it persistently shows increasing trend. The existing literature on the etiologies of children’s mental illness, highlights the most common cause to be ineffective or impaired parenting. Thus, efforts to combat mental illness in children should focus on improving the quality of parenting. Documented interventional studies focusing on this issue, particularly in Malaysia, are scarce and commonly report poor treatment outcomes stemming from inconvenient face-to-face instructions. Consequently, proposing an accessible online and digital-assisted parenting program is expected to reach a larger number of parents, as it can overcome substantial barriers. Hence, this study aims to develop a universal digital-assisted preventive parenting intervention called DaPI, that aims to enhance mental health of children in Malaysia. Methods A total of 200 parents of children aged 10–14 years will be recruited and randomized into two groups either intervention or waitlist-control based on a 1:1 ratio for a duration of 8 weeks. Those in the intervention group will receive eight sessions of the DaPI program that focus mainly on parenting and children’s mental health. The primary outcome of this study will essentially focus on the changes in parent-reported parenting behavior and parental self-efficacy. The secondary outcome will be changes in children’s mental health (i.e., behavioral problems and emotional maladjustment). Assessments will be arranged pre- and post-intervention as well as at the 1-month follow-up. Analyses will be conducted using a paired t-test and multivariate analysis of covariance. Discussion The expected outcome will be the establishment of DaPI in promoting children’s mental health by targeting changes in parenting behavior and parental self-efficacy in Malaysia. Findings from this study will be beneficial for policymakers to invest in parenting programs that could provide support to parents in enhancing their child’s overall development. Clinical trial registration [www.irct.ir], identifier [IRCT20211129053207N1].
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Affiliation(s)
- Nor Sheereen Zulkefly
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- *Correspondence: Nor Sheereen Zulkefly,
| | - Anis Raihan Dzeidee Schaff
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nur Arfah Zaini
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Firdaus Mukhtar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Noris Mohd Norowi
- Department of Multimedia, Faculty of Computer Science and Information Technology, Universiti Putra Malaysia, Serdang, Malaysia
| | - Rahima Dahlan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Salmiah Md. Said
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Hudson G, Negbenose E, Neary M, Jansli SM, Schueller SM, Wykes T, Jilka S. Comparing Professional and Consumer Ratings of Mental Health Apps: Mixed Methods Study. JMIR Form Res 2022; 6:e39813. [PMID: 36149733 PMCID: PMC9547331 DOI: 10.2196/39813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background As the number of mental health apps has grown, increasing efforts have been focused on establishing quality tailored reviews. These reviews prioritize clinician and academic views rather than the views of those who use them, particularly those with lived experiences of mental health problems. Given that the COVID-19 pandemic has increased reliance on web-based and mobile mental health support, understanding the views of those with mental health conditions is of increasing importance. Objective This study aimed to understand the opinions of people with mental health problems on mental health apps and how they differ from established ratings by professionals. Methods A mixed methods study was conducted using a web-based survey administered between December 2020 and April 2021, assessing 11 mental health apps. We recruited individuals who had experienced mental health problems to download and use 3 apps for 3 days and complete a survey. The survey consisted of the One Mind PsyberGuide Consumer Review Questionnaire and 2 items from the Mobile App Rating Scale (star and recommendation ratings from 1 to 5). The consumer review questionnaire contained a series of open-ended questions, which were thematically analyzed and using a predefined protocol, converted into binary (positive or negative) ratings, and compared with app ratings by professionals and star ratings from app stores. Results We found low agreement between the participants’ and professionals’ ratings. More than half of the app ratings showed disagreement between participants and professionals (198/372, 53.2%). Compared with participants, professionals gave the apps higher star ratings (3.58 vs 4.56) and were more likely to recommend the apps to others (3.44 vs 4.39). Participants’ star ratings were weakly positively correlated with app store ratings (r=0.32, P=.01). Thematic analysis found 11 themes, including issues of user experience, ease of use and interactivity, privacy concerns, customization, and integration with daily life. Participants particularly valued certain aspects of mental health apps, which appear to be overlooked by professional reviewers. These included functions such as the ability to track and measure mental health and providing general mental health education. The cost of apps was among the most important factors for participants. Although this is already considered by professionals, this information is not always easily accessible. Conclusions As reviews on app stores and by professionals differ from those by people with lived experiences of mental health problems, these alone are not sufficient to provide people with mental health problems with the information they desire when choosing a mental health app. App rating measures must include the perspectives of mental health service users to ensure ratings represent their priorities. Additional work should be done to incorporate the features most important to mental health service users into mental health apps.
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Affiliation(s)
- Georgie Hudson
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Esther Negbenose
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Martha Neary
- Department of Psychological Science, University of California, Irvine, CA, United States
| | - Sonja M Jansli
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, CA, United States
- Department of Informatics, University of California, Irvine, CA, United States
| | - Til Wykes
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sagar Jilka
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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13
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Potential and Pitfalls of Mobile Mental Health Apps in Traditional Treatment: An Umbrella Review. J Pers Med 2022; 12:jpm12091376. [PMID: 36143161 PMCID: PMC9505389 DOI: 10.3390/jpm12091376] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 12/25/2022] Open
Abstract
While the rapid growth of mobile mental health applications has offered an avenue of support unbridled by physical distance, time, and cost, the digitalization of traditional interventions has also triggered doubts surrounding their effectiveness and safety. Given the need for a more comprehensive and up-to-date understanding of mobile mental health apps in traditional treatment, this umbrella review provides a holistic summary of their key potential and pitfalls. A total of 36 reviews published between 2014 and 2022—including systematic reviews, meta-analyses, scoping reviews, and literature reviews—were identified from the Cochrane library, Medline (via PubMed Central), and Scopus databases. The majority of results supported the key potential of apps in helping to (1) provide timely support, (2) ease the costs of mental healthcare, (3) combat stigma in help-seeking, and (4) enhance therapeutic outcomes. Our results also identified common themes of apps’ pitfalls (i.e., challenges faced by app users), including (1) user engagement issues, (2) safety issues in emergencies, (3) privacy and confidentiality breaches, and (4) the utilization of non-evidence-based approaches. We synthesize the potential and pitfalls of mental health apps provided by the reviews and outline critical avenues for future research.
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14
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Löbner M, Stein J, Luppa M, Bleckwenn M, Mehnert-Theuerkauf A, Riedel-Heller SG. What Comes after the Trial? An Observational Study of the Real-World Uptake of an E-Mental Health Intervention by General Practitioners to Reduce Depressive Symptoms in Their Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106203. [PMID: 35627739 PMCID: PMC9142114 DOI: 10.3390/ijerph19106203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023]
Abstract
Unguided and free e-mental health platforms can offer a viable treatment and self-help option for depression. This study aims to investigate, from a public health perspective, the real-world uptake, benefits, barriers, and implementation support needed by general practitioners (GPs). The study presents data from a spin-off GP survey conducted 2.5 years subsequent to a cluster-randomized trial. A total of N = 68 GPs (intervention group (IG) GPs = 38, control group (CG) GPs = 30) participated in the survey (response rate 62.4%). Data were collected via postal questionnaires. Overall, 66.2% of the GPs were female. The average age was 51.6 years (SD = 9.4), and 48.5% of the GPs indicated that they continued (IG) or started recommending (CG) the e-mental health intervention under real-world conditions beyond the trial. A number of benefits could be identified, such as ease of integration and strengthening patient activation in disease management. Future implementation support should include providing appealing informational materials and including explainer videos. Workshops, conferences, and professional journals were identified as suitable for dissemination. Social media approaches were less appealing. Measures should be taken to make it easier for health care professionals to use an intervention after the trial and to integrate it into everyday practice.
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Affiliation(s)
- Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (J.S.); (M.L.); (S.G.R.-H.)
- Correspondence: ; Tel.: +49-(0)-341-9724591
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (J.S.); (M.L.); (S.G.R.-H.)
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (J.S.); (M.L.); (S.G.R.-H.)
| | - Markus Bleckwenn
- Department of General Practice, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany;
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, 04103 Leipzig, Germany;
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (J.S.); (M.L.); (S.G.R.-H.)
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15
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McCallum M, Ho AS, Mitchell ES, May CN, Behr H, Ritschel L, Mochrie K, Michaelides A. Feasibility, Acceptability, and Preliminary Outcomes of a Cognitive Behavioral Therapy–Based Mobile Mental Well-being Program (Noom Mood): Single-Arm Prospective Cohort Study. JMIR Form Res 2022; 6:e36794. [PMID: 35436218 PMCID: PMC9055471 DOI: 10.2196/36794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence of anxiety, depression, and general distress has risen in recent years. Mobile mental health programs have been found to provide support to nonclinical populations and may overcome some of the barriers associated with traditional in-person treatment; however, researchers have voiced concerns that many publicly available mobile mental health programs lack evidence-based theoretical foundations, peer-reviewed research, and sufficient engagement from the public. Objective This study aimed to evaluate the feasibility, acceptability, and preliminary outcomes of Noom Mood, a commercial mobile cognitive behavioral therapy– and mindfulness-based program. Methods In this single-arm prospective cohort study, individuals who joined Noom Mood between August and October 2021 completed surveys at baseline and 4-week follow-up. Per-protocol analyses included those who completed both surveys (n=113), and intention-to-treat analyses included all participants (N=185). Results A majority of the sample reported that the program is easy to use, they felt confident recommending the program to a friend, and they perceived the program to be effective at improving stress and anxiety. There were significant improvements in anxiety symptoms, perceived stress, depressive feelings, emotion regulation, and optimism in both the per-protocol and intention-to-treat analyses (all P<.001). Participants reported benefiting most from learning skills (eg, breathing and cognitive reframing techniques), interacting with the program features, and gaining awareness of their emotions and thought patterns. Participants also made a number of suggestions to improve product functionality and usability. Conclusions Results suggest that Noom Mood is feasible and acceptable to participants, with promising preliminary outcomes. Future studies should build on these results to evaluate the effects of Noom Mood using more rigorous designs.
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Affiliation(s)
| | | | | | | | - Heather Behr
- Academic Research, Noom Inc, New York, NY, United States
- Department of Integrative Health, Saybrook University, Pasadena, CA, United States
| | - Lorie Ritschel
- Triangle Area Psychology Clinic, Durham, NC, United States
- School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Kirk Mochrie
- Triangle Area Psychology Clinic, Durham, NC, United States
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16
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Brown P, Prest B, Miles P, Rossi V. The development of National Safety and Quality Digital Mental Health Standards. Australas Psychiatry 2022; 30:154-157. [PMID: 34569321 DOI: 10.1177/10398562211042361] [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: 11/15/2022]
Abstract
OBJECTIVE Digital mental health services offer innovative ways for individuals to access services but are not without risk. Our objective was to develop National Safety and Quality Digital Mental Health (NSQDMH) Standards that improve the quality of digital mental health service provision and protect service users from harm. METHOD The NSQDMH Standards were developed by adapting the National Safety and Quality Health Service (NSQHS) Standards and adding components highlighted through a national consultation process as critical to the safety and quality of services. Further public consultation and pilot testing assisted in refining the NSQDMH Standards. RESULTS The NSQDMH Standards comprise three standards-Clinical and Technical Governance, Partnering with Consumers, and Model of Care-and were launched in November 2020. CONCLUSIONS The NSQDMH Standards provide a quality assurance mechanism to improve digital mental health care in Australia.
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Affiliation(s)
- Peggy Brown
- Senior Clinical Advisor, Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Ben Prest
- Project Manager, Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Paul Miles
- Program Manager, Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Vanessa Rossi
- Project Officer, Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
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17
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Lattie EG, Stiles-Shields C, Graham AK. An overview of and recommendations for more accessible digital mental health services. NATURE REVIEWS PSYCHOLOGY 2022; 1:87-100. [PMID: 38515434 PMCID: PMC10956902 DOI: 10.1038/s44159-021-00003-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 03/23/2024]
Abstract
Mental health concerns are common, and various evidence-based interventions for mental health conditions have been developed. However, many people have difficulty accessing appropriate mental health care and this has been exacerbated by the COVID-19 pandemic. Digital mental health services, such as those delivered by mobile phone or web-based platforms, offer the possibility of expanding the reach and accessibility of mental health care. To achieve this goal, digital mental health interventions and plans for their implementation must be designed with the end users in mind. In this Review, we describe the evidence base for digital mental health interventions across various diagnoses and treatment targets. Then, we explain the different formats for digital mental health intervention delivery, and offer considerations for their use across key age groups. We discuss the role that the COVID-19 pandemic has played in emphasizing the value of these interventions, and offer considerations for ensuring equity in access to digital mental health interventions among diverse populations. As healthcare providers continue to embrace the role that technology can play in broadening access to care, the design and implementation of digital mental healthcare solutions must be carefully considered to maximize their effectiveness and accessibility.
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Affiliation(s)
- Emily G. Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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18
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Torous J, Bucci S, Bell IH, Kessing LV, Faurholt-Jepsen M, Whelan P, Carvalho AF, Keshavan M, Linardon J, Firth J. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry 2021; 20:318-335. [PMID: 34505369 PMCID: PMC8429349 DOI: 10.1002/wps.20883] [Citation(s) in RCA: 251] [Impact Index Per Article: 83.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.
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Affiliation(s)
- John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sandra Bucci
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Imogen H Bell
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lars V Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Pauline Whelan
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Matcheri Keshavan
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jake Linardon
- Deakin University, Centre for Social and Early Emotional Development and School of Psychology, Burwood, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
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19
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Mata-Greve F, Johnson M, Pullmann MD, Friedman EC, Griffith Fillipo I, Comtois KA, Arean P. Mental Health and the Perceived Usability of Digital Mental Health Tools Among Essential Workers and People Unemployed Due to COVID-19: Cross-sectional Survey Study. JMIR Ment Health 2021; 8:e28360. [PMID: 34081592 PMCID: PMC8354319 DOI: 10.2196/28360] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 05/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND COVID-19 has created serious mental health consequences for essential workers or people who have become unemployed as a result of the pandemic. Digital mental health tools have the potential to address this problem in a timely and efficient manner. OBJECTIVE The purpose of this study was to document the extent of digital mental health tool (DMHT) use by essential workers and those unemployed due to COVID-19, including asking participants to rate the usability and user burden of the DMHT they used most to cope. We also explored which aspects and features of DMHTs were seen as necessary for managing stress during a pandemic by having participants design their own ideal DMHT. METHODS A total of 2000 people were recruited from an online research community (Prolific) to complete a one-time survey about mental health symptoms, DMHT use, and preferred digital mental health features. RESULTS The final sample included 1987 US residents that identified as either an essential worker or someone who was unemployed due to COVID-19. Almost three-quarters of the sample (1479/1987, 74.8%) reported clinically significant emotional distress. Only 14.2% (277/1957) of the sample used a DMHT to cope with stress associated with COVID-19. Of those who used DMHTs to cope with COVID-19, meditation apps were the most common (119/261, 45.6%). Usability was broadly in the acceptable range, although participants unemployed due to COVID-19 were less likely to report user burden with DMHTs than essential workers (t198.1=-3.89, P<.001). Individuals with emotional distress reported higher financial burden for their DMHT than nondistressed individuals (t69.0=-3.21, P=.01). When the sample was provided the option to build their own DMHT, the most desired features were a combination of mindfulness/meditation (1271/1987, 64.0%), information or education (1254/1987, 63.1%), distraction tools (1170/1987, 58.9%), symptom tracking for mood and sleep (1160/1987, 58.4%), link to mental health resources (1140/1987, 57.4%), and positive psychology (1131/1986, 56.9%). Subgroups by employment, distress, and previous DMHT use status had varied preferences. Of those who did not use a DMHT to cope with COVID-19, most indicated that they did not consider looking for such a tool to help with coping (1179/1710, 68.9%). CONCLUSIONS Despite the potential need for DMHTs, this study found that the use of such tools remains similar to prepandemic levels. This study also found that regardless of the level of distress or even past experience using an app to cope with COVID-19, it is possible to develop a COVID-19 coping app that would appeal to a majority of essential workers and unemployed persons.
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Affiliation(s)
- Felicia Mata-Greve
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness (ALACRITY) Center, University of Washington, Seattle, WA, United States
| | - Emily C Friedman
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness (ALACRITY) Center, University of Washington, Seattle, WA, United States
| | - Isabell Griffith Fillipo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Creating Technological Innovations (CREATIV) Lab, University of Washington, Seattle, WA, United States
| | - Katherine A Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Center for Suicide Prevention and Recovery, University of Washington, Seattle, WA, United States
| | - Patricia Arean
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness (ALACRITY) Center, University of Washington, Seattle, WA, United States
- Creating Technological Innovations (CREATIV) Lab, University of Washington, Seattle, WA, United States
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20
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Boucher EM, Ward HE, Stafford JL, Parks AC. Effects of a Digital Mental Health Program on Perceived Stress in Adolescents Aged 13-17 Years: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25545. [PMID: 33871377 PMCID: PMC8094018 DOI: 10.2196/25545] [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: 11/05/2020] [Revised: 02/16/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background Stress is an important transdiagnostic risk factor in adolescence and predicts a host of physical and psychological problems in adolescence and adulthood. Adolescence is also a developmental stage in which people may be more sensitive or reactive to stress. Indeed, research has shown that adolescents report high levels of stress, particularly when enrolled in school. However, adolescents report engaging in few, if any, stress management techniques. Consequently, the development of effective programs to help address adolescent stress is particularly important. To date, most stress management programs for adolescents are delivered within schools, and the evidence for such programs is mixed. Furthermore, most of these programs rely on traditional stress management techniques rather than incorporating methods to address the underlying negative cognitive processes, such as rumination, that may contribute to or exacerbate the effects of perceived stress. Objective The aim of this study is to test the short-term effects of a digital mental health program designed for adolescents aged 13-17 years on perceived stress and rumination. Methods This is a randomized controlled trial in which adolescents between the ages of 13 and 17 years, with elevated levels of perceived stress and brooding, will be randomly assigned to complete 8 weeks of a digital mental health program (Happify for Teens) or to a corresponding wait-list control group. The study will take place over 3 months, including the 8-week intervention period and 1-month postintervention follow-up. The primary outcome, perceived stress, along with secondary and exploratory outcomes (ie, brooding, optimism, sleep disturbance, and loneliness) will be assessed via self-report at baseline, 4 weeks, 8 weeks, and 12 weeks to compare changes in these outcomes across conditions. Results Recruitment is expected to begin in the second quarter of 2021, with a target sample size of 800 participants (400 per condition). Participants will begin the study as they are recruited and will finish in waves, with the first wave of data expected 8 weeks after recruitment begins and the final wave of data expected by the end of the third quarter of 2021. Conclusions Although school-based stress management programs for adolescents are common, research suggests that they may be limited in their reach and more effective for school-based stress than other types of stress. This trial will be one of the first attempts to examine the potential benefits of a digital mental health program on adolescents to address stress along with negative cognitive processes such as rumination. If successful, this would help introduce a more scalable alternative to school-based programs that offers adolescents greater privacy while also providing insight into novel ways to target adolescent mental health more generally. Trial Registration ClinicalTrials.gov NCT04567888; https://clinicaltrials.gov/ct2/show/NCT04567888 International Registered Report Identifier (IRRID) PRR1-10.2196/25545
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21
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Emerson MR, Harsh Caspari J, Notice M, Watanabe-Galloway S, Dinkel D, Kabayundo J. Mental health mobile app use: Considerations for serving underserved patients in integrated primary care settings. Gen Hosp Psychiatry 2021; 69:67-75. [PMID: 33571926 DOI: 10.1016/j.genhosppsych.2021.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Margaret R Emerson
- University of Nebraska Medical Center College of Nursing, Omaha, NE, United States of America.
| | - Jennifer Harsh Caspari
- University of Nebraska Medical Center College of Medicine, Omaha, NE, United States of America
| | - Maxine Notice
- University of Central Missouri, School of Human Service, Warrensburg, MO, United States of America
| | | | - Danae Dinkel
- University of Nebraska Omaha, School of Health & Kinesiology, Omaha, NE, United States of America
| | - Josiane Kabayundo
- University of Nebraska Medical Center College of Public Health, Omaha, NE, United States of America
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22
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Cooper D, Champion SM, Stavropoulos L, Grisham JR. How technology can enhance treatment: A scoping review of clinical interventions for anxiety and obsessive-compulsive spectrum disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61 Suppl 1:8-30. [PMID: 33570762 DOI: 10.1111/bjc.12279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/25/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Researchers are increasingly investigating how technology could be used to improve the efficacy of treatment for anxiety and obsessive-compulsive (OC) spectrum disorders. A broad range of technologies, disorders and therapeutic processes have been examined in the literature. This review summarizes the evidence for using technology in clinical interventions for anxiety and OC-spectrum disorders and highlights research gaps that should be addressed to improve the evidence base. METHODS A scoping review was conducted based on systematic searches of three databases. Broadly, the criteria included interventions that had integrated technology into clinical contexts to enhance treatment for anxiety and OC-spectrum disorders. All records were double-screened by two reviewers, and data were extracted on the characteristics of interventions, symptom outcomes, and implementation factors. RESULTS Searches returned 2,475 studies, of which 117 were eligible for inclusion in this review. Although almost all studies reported pre-post-symptom reductions, only one quarter of the controlled studies demonstrated additive effect of technology-based interventions in between-group analyses. We noted a trend in underreporting implementation factors. CONCLUSIONS Technology-based interventions can improve the efficacy of treatment for anxiety and OC-spectrum disorders, but there are challenges to achieving this goal. Based on a review of the included studies, we provide four specific recommendations to improve the quality and likelihood of success of future research projects. PRACTITIONER POINTS Technology-based adjuvants are unlikely to improve the efficacy of treatment for anxiety or OC-spectrum disorders based on their novelty or convenience alone. A subset of studies gives hope that specific innovations can improve treatment when targeting a therapeutic process that has been problematic. Clinicians seeking to improve the efficacy of their treatment should first define client-specific therapeutic factors (e.g., homework compliance) that could be leveraged, then apply a specific innovation to address this factor.
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Affiliation(s)
- David Cooper
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie M Champion
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren Stavropoulos
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica R Grisham
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
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Kellett S, Easton K, Cooper M, Millings A, Simmonds-Buckley M, Parry G. Evaluation of a Mobile App to Enhance Relational Awareness and Change During Cognitive Analytic Therapy: Mixed Methods Case Series. JMIR Ment Health 2020; 7:e19888. [PMID: 33337342 PMCID: PMC7775821 DOI: 10.2196/19888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/28/2020] [Accepted: 08/16/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There has been a lack of technological innovation regarding improving the delivery of integrative psychotherapies. This project sought to evaluate an app designed to replace previous paper-based methods supporting relational awareness and change during cognitive analytic therapy (CAT). OBJECTIVE We aimed to assess patients' and therapists' experience of using the technology (ie, the "CAT-App") and to evaluate the relationship between app usage and clinical outcome. METHODS The design was a mixed methods case series. Patients completed the Clinical Outcomes in Routine Evaluation-Outcome Measure pre- and post-CAT. Mood data plus the frequency and effectiveness of relational awareness and change were collected via the app. Therapists and patients were interviewed about their experiences using the app. RESULTS Ten patients (treated by 3 therapists) were enrolled; seven completed treatment and 4 had a reliable improvement in their mental health. App usage and mood change did not differ according to clinical outcome, but there was a statistically significant difference in app usage between completers and dropouts. The qualitative themes described by the therapists were (1) the challenge of incorporating the technology into their clinical practice and (2) the barriers and benefits of the technology. Clients' themes were (1) data protection, (2) motivation and engagement, and (3) restrictions versus flexibility. CONCLUSIONS The CAT-App is capable of supporting relational awareness and change and is an upgrade on older, paper-based formats. Further clinical evaluation is required.
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Affiliation(s)
- Stephen Kellett
- Sheffield Health & Social Care NHS Foundation Trust, University of Sheffield, Sheffield, United Kingdom
| | | | - Martin Cooper
- Sheffield Hallam University, Sheffield, United Kingdom
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Urban Emotion Sensing Beyond 'Affective Capture': Advancing Critical Interdisciplinary Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239003. [PMID: 33287188 PMCID: PMC7731212 DOI: 10.3390/ijerph17239003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022]
Abstract
The use of mobile sensor methodologies in urban analytics to study 'urban emotions' is currently outpacing the science required to rigorously interpret the data generated. Interdisciplinary research on 'urban stress' could help inform urban wellbeing policies relating to healthier commuting and alleviation of work stress. The purpose of this paper is to address-through methodological experimentation-ethical, political and conceptual issues identified by critical social scientists with regards to emotion tracking, wearables and data analytics. We aim to encourage more dialogue between the critical approach and applied environmental health research. The definition of stress is not unambiguous or neutral and is mediated by the very technologies we use for research. We outline an integrative methodology in which we combine pilot field research using biosensing technologies, a novel method for identifying 'moments of stress' in a laboratory setting, psychometric surveys and narrative interviews on workplace and commuter stress in urban environments.
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25
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Bickman L. Improving Mental Health Services: A 50-Year Journey from Randomized Experiments to Artificial Intelligence and Precision Mental Health. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:795-843. [PMID: 32715427 PMCID: PMC7382706 DOI: 10.1007/s10488-020-01065-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This conceptual paper describes the current state of mental health services, identifies critical problems, and suggests how to solve them. I focus on the potential contributions of artificial intelligence and precision mental health to improving mental health services. Toward that end, I draw upon my own research, which has changed over the last half century, to highlight the need to transform the way we conduct mental health services research. I identify exemplars from the emerging literature on artificial intelligence and precision approaches to treatment in which there is an attempt to personalize or fit the treatment to the client in order to produce more effective interventions.
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Affiliation(s)
- Leonard Bickman
- Center for Children and Families; Psychology, Academic Health Center 1, Florida International University, 11200 Southwest 8th Street, Room 140, Miami, FL, 33199, USA.
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26
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Palmer KM, Burrows V. Ethical and Safety Concerns Regarding the Use of Mental Health-Related Apps in Counseling: Considerations for Counselors. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2020; 6:137-150. [PMID: 32904690 PMCID: PMC7457894 DOI: 10.1007/s41347-020-00160-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 08/04/2020] [Accepted: 08/13/2020] [Indexed: 12/23/2022]
Abstract
Mental health-related smartphone apps (MHapps) have the potential to greatly enhance and enrich the counseling relationship, and dramatically improve the lives of clients. However, a large portion of MHapps have not been empirically researched and found to be effective. An average of 2 million apps are available in the Apple and Android stores, and users average more than 80 apps on their phones. Many of the apps lack disclaimers about the collection of user information, and there is no governing body to oversee and regulate app development and availability. This is particularly problematic with mental health-related smartphone apps, because many developers are not affiliated with mental health professionals, and many apps do not provide emergency information should a mental health emergency occur while using the app. Moreover, users are left to haphazardly make decisions about health-related apps usage without assistance. Counselors who supplement counseling with mental health-related smartphone apps could unknowingly violate their Code of Ethics by integrating apps that may jeopardize their clients' safety. The authors review literature related to mental health-related app efficacy, safety, and ethics and provide a compilation of items to consider that can be used before supplementing counseling with mental health-related apps.
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Affiliation(s)
- Kathleen M. Palmer
- University of Detroit Mercy, 4001 W. McNichols Road, Detroit, MI 48221-3038 USA
| | - Vanessa Burrows
- University of Detroit Mercy, 4001 W. McNichols Road, Detroit, MI 48221-3038 USA
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27
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Marshall JM, Dunstan DA, Bartik W. Treating Psychological Trauma in the Midst of COVID-19: The Role of Smartphone Apps. Front Public Health 2020; 8:402. [PMID: 33014955 PMCID: PMC7461952 DOI: 10.3389/fpubh.2020.00402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023] Open
Abstract
With the COVID-19 pandemic confronting health systems worldwide, medical practitioners are treating a myriad of physical symptoms that have, sadly, killed many thousands of people. There are signs that the public is also experiencing psychological trauma as they attempt to navigate their way through the COVID-19 restrictions impinging on many aspects of society. With unprecedented demand for health professionals' time, people who are unable to access face-to-face assistance are turning to smartphone apps to help them deal with symptoms of trauma. However, the evidence for smartphone apps to treat trauma is limited, and clinicians need to be aware of the limitations and unresolved issues involved in using mental health apps.
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Affiliation(s)
- Jamie M Marshall
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW, Australia
| | - Debra A Dunstan
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW, Australia
| | - Warren Bartik
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW, Australia
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28
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Marshall JM, Dunstan DA, Bartik W. Apps With Maps-Anxiety and Depression Mobile Apps With Evidence-Based Frameworks: Systematic Search of Major App Stores. JMIR Ment Health 2020; 7:e16525. [PMID: 32579127 PMCID: PMC7381031 DOI: 10.2196/16525] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/27/2020] [Accepted: 04/12/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Mobile mental health apps have become ubiquitous tools to assist people in managing symptoms of anxiety and depression. However, due to the lack of research and expert input that has accompanied the development of most apps, concerns have been raised by clinicians, researchers, and government authorities about their efficacy. OBJECTIVE This review aimed to estimate the proportion of mental health apps offering comprehensive therapeutic treatments for anxiety and/or depression available in the app stores that have been developed using evidence-based frameworks. It also aimed to estimate the proportions of specific frameworks being used in an effort to understand which frameworks are having the most influence on app developers in this area. METHODS A systematic review of the Apple App Store and Google Play store was performed to identify apps offering comprehensive therapeutic interventions that targeted anxiety and/or depression. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was adapted to guide this approach. RESULTS Of the 293 apps shortlisted as offering a therapeutic treatment for anxiety and/or depression, 162 (55.3%) mentioned an evidence-based framework in their app store descriptions. Of the 293 apps, 88 (30.0%) claimed to use cognitive behavioral therapy techniques, 46 (15.7%) claimed to use mindfulness, 27 (9.2%) claimed to use positive psychology, 10 (3.4%) claimed to use dialectical behavior therapy, 5 (1.7%) claimed to use acceptance and commitment therapy, and 20 (6.8%) claimed to use other techniques. Of the 162 apps that claimed to use a theoretical framework, only 10 (6.2%) had published evidence for their efficacy. CONCLUSIONS The current proportion of apps developed using evidence-based frameworks is unacceptably low, and those without tested frameworks may be ineffective, or worse, pose a risk of harm to users. Future research should establish what other factors work in conjunction with evidence-based frameworks to produce efficacious mental health apps.
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Affiliation(s)
- Jamie M Marshall
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Debra A Dunstan
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Warren Bartik
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, Australia
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Wright JH, Mishkind M. Computer-Assisted CBT and Mobile Apps for Depression: Assessment and Integration Into Clinical Care. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:162-168. [PMID: 33162853 DOI: 10.1176/appi.focus.20190044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A surge in the development of computer-assisted cognitive-behavioral therapy (CCBT) and mobile apps for depression has provided many tools with potential for enhancing treatment delivery. This article assesses progress in evaluation and implementation of CCBT and mobile apps for depression, with a focus on providing practical information on clinical applications. Advantage and disadvantages of these technologies are identified, outcome research is reviewed, and recommendations are made for clinical use. With increasing use of computer technology in everyday life, it is likely that clinicians and patients will pursue opportunities to employ computer tools in treatment for depression.
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Affiliation(s)
- Jesse H Wright
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky (Wright); Johnson Depression Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora (Mishkind)
| | - Matthew Mishkind
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky (Wright); Johnson Depression Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora (Mishkind)
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Challenges of Mood Disorders Care. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:205-207. [PMID: 33162860 PMCID: PMC7587890 DOI: 10.1176/appi.focus.18202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Gründahl M, Deckert J, Hein G. Three Questions to Consider Before Applying Ecological Momentary Interventions (EMI) in Psychiatry. Front Psychiatry 2020; 11:333. [PMID: 32372991 PMCID: PMC7177023 DOI: 10.3389/fpsyt.2020.00333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/02/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Marthe Gründahl
- Translational Social Neuroscience Unit, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Jürgen Deckert
- Translational Social Neuroscience Unit, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Grit Hein
- Translational Social Neuroscience Unit, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, University of Würzburg, Würzburg, Germany
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