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Willemsen RF, Versluis A, Aardoom JJ, Petrus AHJ, Silven AV, Chavannes NH, van Dijke A. Evaluation of completely online psychotherapy with app-support versus therapy as usual for clients with depression or anxiety disorder: A retrospective matched cohort study investigating the effectiveness, efficiency, client satisfaction, and costs. Int J Med Inform 2024; 189:105485. [PMID: 38815315 DOI: 10.1016/j.ijmedinf.2024.105485] [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: 01/25/2024] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Depressive and anxiety disorders are common mental disorders ranking among the leading causes of global disease burden. Not all clients currently benefit from therapy and clients are looking for modern ways of therapy. Online psychotherapy is a promising option for better meeting clients' needs. Recently, a new psychotherapy concept has emerged that combines videoconferencing sessions with support through a mobile application. The latter allows for ecological momentary assessments and interventions, facilitates communication between patients and therapists in between sessions through chat, and allows for incorporating feedback-informed treatment principles. MATERIAL AND METHODS The study was a retrospective observational matched cohort study, comparing online psychotherapy with Therapy As Usual (TAU) for clients with depressive or anxiety disorders. Data were obtained via questionnaires, which are part of standard clinical care. Primary outcomes included general mental functioning, and symptoms of depression and anxiety. Secondary outcomes were efficiency, client satisfaction, and therapy costs. Primary endpoints were analyzed using linear mixed models analysis, with an interaction term between time and group. Secondary outcomes were analyzed using linear regression. RESULTS Larger improvements were observed in the online compared to the TAU group for general mental functioning and depressive disorder (i.e., General mental functioning: B = -8.50, 95 CI: -15.01 - -1.97, p = 0.011; Depressive disorder: B = - 3.66, 95 % CI: -5.79 - -1.54p < 0.01). No significant differences in change over time between the two groups were observed for anxiety disorder (B = -3.64, 95 % CI: (-13.10 - 5.82) p = 0.447). The total number of sessions was significantly higher in the online psychotherapy group than in TAU (B = 3.71, p < 0.01), although clients were matched on treatment time in weeks. Treatment session duration in minutes was comparable across the groups. DISCUSSION Online psychotherapy with app support showed to be a promising alternative to TAU for depressive and anxiety disorders. More research is needed to evaluate the effectiveness, cost-effectiveness and client satisfaction of online psychotherapy compared to TAU, such as randomized controlled trials or studies multiple baseline series designs, and in-depth qualitative research.
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Affiliation(s)
- Romy Fleur Willemsen
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Anke Versluis
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Jiska Joëlle Aardoom
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Annelieke Hermina Josephina Petrus
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Anna Veronica Silven
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Niels Henrik Chavannes
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, The Netherlands, Department of Public Health and Primary Care, 2333 ZA the Netherlands.
| | - Annemiek van Dijke
- Leiden University Medical Center, The Netherlands, National eHealth Living Lab, Leiden 2333 ZA, the Netherlands; Parnassia Psychiatric Institute, The Netherlands, PsyQ online, The Hague 2553 RJ, the Netherlands.
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Reininghaus U, Schwannauer M, Barne I, Beames JR, Bonnier RA, Brenner M, Breznoščáková D, Dančík D, De Allegri M, Di Folco S, Durstewitz D, Gugel J, Hajdúk M, Heretik A, Izáková Ľ, Katreniakova Z, Kiekens G, Koppe G, Kurilla A, Marelli L, Nagyova I, Nguyen H, Pečeňák J, Schulte-Strathaus JCC, Sotomayor-Enriquez K, Uyttebroek L, Weermeijer J, Wolters M, Wensing M, Boehnke JR, Myin-Germeys I, Schick A. Strategies, processes, outcomes, and costs of implementing experience sampling-based monitoring in routine mental health care in four European countries: study protocol for the IMMERSE effectiveness-implementation study. BMC Psychiatry 2024; 24:465. [PMID: 38915006 PMCID: PMC11194943 DOI: 10.1186/s12888-024-05839-4] [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: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Recent years have seen a growing interest in the use of digital tools for delivering person-centred mental health care. Experience Sampling Methodology (ESM), a structured diary technique for capturing moment-to-moment variation in experience and behaviour in service users' daily life, reflects a particularly promising avenue for implementing a person-centred approach. While there is evidence on the effectiveness of ESM-based monitoring, uptake in routine mental health care remains limited. The overarching aim of this hybrid effectiveness-implementation study is to investigate, in detail, reach, effectiveness, adoption, implementation, and maintenance as well as contextual factors, processes, and costs of implementing ESM-based monitoring, reporting, and feedback into routine mental health care in four European countries (i.e., Belgium, Germany, Scotland, Slovakia). METHODS In this hybrid effectiveness-implementation study, a parallel-group, assessor-blind, multi-centre cluster randomized controlled trial (cRCT) will be conducted, combined with a process and economic evaluation. In the cRCT, 24 clinical units (as the cluster and unit of randomization) at eight sites in four European countries will be randomly allocated using an unbalanced 2:1 ratio to one of two conditions: (a) the experimental condition, in which participants receive a Digital Mobile Mental Health intervention (DMMH) and other implementation strategies in addition to treatment as usual (TAU) or (b) the control condition, in which service users are provided with TAU. Outcome data in service users and clinicians will be collected at four time points: at baseline (t0), 2-month post-baseline (t1), 6-month post-baseline (t2), and 12-month post-baseline (t3). The primary outcome will be patient-reported service engagement assessed with the service attachment questionnaire at 2-month post-baseline. The process and economic evaluation will provide in-depth insights into in-vivo context-mechanism-outcome configurations and economic costs of the DMMH and other implementation strategies in routine care, respectively. DISCUSSION If this trial provides evidence on reach, effectiveness, adoption, implementation and maintenance of implementing ESM-based monitoring, reporting, and feedback, it will form the basis for establishing its public health impact and has significant potential to bridge the research-to-practice gap and contribute to swifter ecological translation of digital innovations to real-world delivery in routine mental health care. TRIAL REGISTRATION ISRCTN15109760 (ISRCTN registry, date: 03/08/2022).
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Affiliation(s)
- Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- German Center for Mental Health (DZPG), partner site Mannheim-Heidelberg-Ulm, Mannheim, Germany.
| | | | - Islay Barne
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Joanne R Beames
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Rafaël A Bonnier
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Manuel Brenner
- Hector Institute for AI in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dagmar Breznoščáková
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Daniel Dančík
- Department of Psychology, Faculty of Arts, Comenius University, Bratislava, Slovakia
- Department of Psychiatry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Simona Di Folco
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Daniel Durstewitz
- Hector Institute for AI in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jessica Gugel
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michal Hajdúk
- Department of Psychology, Faculty of Arts, Comenius University, Bratislava, Slovakia
- Department of Psychiatry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Anton Heretik
- Department of Psychology, Faculty of Arts, Comenius University, Bratislava, Slovakia
| | - Ľubomíra Izáková
- Department of Psychiatry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zuzana Katreniakova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
| | - Glenn Kiekens
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Faculty of Psychology and Educational Sciences, Clinical Psychology, KU Leuven, Leuven, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Georgia Koppe
- Hector Institute for AI in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Adam Kurilla
- Department of Psychology, Faculty of Arts, Comenius University, Bratislava, Slovakia
| | - Luca Marelli
- Centre for Sociological Research, KU Leuven, Leuven, Belgium
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
| | - Hoa Nguyen
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Ján Pečeňák
- Department of Psychiatry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Julia C C Schulte-Strathaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Lotte Uyttebroek
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jeroen Weermeijer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Maria Wolters
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- School of Informatics, University of Edinburgh, Edinburgh, UK
- OFFIS Institute for Information Technology, Oldenburg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan R Boehnke
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Chapdelaine A, Vasiliadis HM, Provencher MD, Norton PJ, Roberge P. Moderators of the cost-effectiveness of transdiagnostic CBT for anxiety disorders over an 8-month time horizon using a net-benefit regression framework. BMC Health Serv Res 2023; 23:596. [PMID: 37291599 DOI: 10.1186/s12913-023-09468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/28/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Access to evidence-based psychological treatment is a concern in many parts of the globe due to government-level financial constraints and patient-level barriers. Transdiagnostic cognitive behavioural therapy (tCBT) is an effective treatment approach that uses a single protocol for anxiety disorders which could enhance the dissemination of evidence-based psychotherapy. In a context of limited resources, the study of treatment moderators can allow to identify subgroups for which the cost-effectiveness of an intervention differs, information that could impact decision-making. So far, there has been no economic evaluation of tCBT for different subpopulations. The objectives of this study, using the net-benefit regression framework, were to explore clinical and sociodemographic factors as potential moderators of the cost-effectiveness of tCBT compared to treatment-as-usual (TAU). METHODS This is a secondary data analysis of a pragmatic randomized controlled trial opposing tCBT added to TAU (n = 117) to TAU only (n = 114). Data on costs from the health system and the limited societal perspectives, as well as anxiety-free days, an effectiveness measure based on the Beck Anxiety Inventory, were collected over an 8-month time horizon and used to derive individual net-benefits. The net-benefit regression framework was used to assess moderators of the cost-effectiveness of tCBT + TAU as opposed to TAU alone. Variables of sociodemographic and clinical nature were assessed. RESULTS Results showed that the number of comorbid anxiety disorders significantly moderated the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. CONCLUSIONS The number of comorbid anxiety disorders was identified as a moderator affecting the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. More research is needed to strengthen the case of tCBT from an economic standpoint for large-scale dissemination. TRIAL REGISTRATION ClinicalTrials.gov: NCT02811458, 23/06/2016.
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Affiliation(s)
- Alexandra Chapdelaine
- PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke - Campus de Longueuil, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
| | - Martin D Provencher
- École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 All. des Bibliothèques, Québec, Québec, G1V 0A6, Canada
| | - Peter J Norton
- The Cairnmillar Institute, 391-393 Tooronga Road, Hawthorn East, Victoria, VIC, 3123, Australia
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
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Chapdelaine A, Vasiliadis HM, Provencher MD, Norton PJ, Roberge P. Cost-effectiveness of transdiagnostic group cognitive behavioural therapy for anxiety disorders v. treatment as usual: economic evaluation of a pragmatic randomized controlled trial over an 8-month time horizon using self-reported data. Psychol Med 2023; 53:1-13. [PMID: 36695038 DOI: 10.1017/s0033291722003920] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND This economic evaluation supplements a pragmatic randomized controlled trial conducted in community care settings, which showed superior improvement in the symptoms of adults with anxiety disorders who received 12 sessions of transdiagnostic cognitive-behavioural group therapy in addition to treatment as usual (tCBT + TAU) compared to TAU alone. METHODS This study evaluates the cost-utility and cost-effectiveness of tCBT + TAU over an 8-month time horizon. For the reference case, quality-adjusted life years (QALYs) obtained using the EQ-5D-5L, and the health system perspective were chosen. Alternatively, anxiety-free days (AFDs), derived from the Beck Anxiety Inventory, and the limited societal perspective were considered. Unadjusted incremental cost-effectiveness/utility ratios were calculated. Net-benefit regressions were done for a willingness-to-pay (WTP) thresholds range to build cost-effectiveness acceptability curves (CEAC). Sensitivity analyses were included. RESULTS Compared to TAU (n = 114), tCBT + TAU (n = 117) generated additional QALYs, AFDs, and higher mental health care costs from the health system perspective. From the health system and the limited societal perspectives, at a WTP of Can$ 50 000/QALY, the CEACs showed that the probability of tCBT + TAU v. TAU being cost-effective was 97 and 89%. Promising cost-effectiveness results using AFDs are also presented. The participation of therapists from the public health sector could increase cost-effectiveness. CONCLUSIONS From the limited societal and health system perspectives, this first economic evaluation of tCBT shows favourable cost-effectiveness results at a WTP threshold of Can$ 50 000/QALY. Future research is needed to replicate findings in longer follow-up studies and different health system contexts to better inform decision-makers for a full-scale implementation.
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Affiliation(s)
- Alexandra Chapdelaine
- PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, local Z7-3004, Sherbrooke, Québec, J1H 5N4, Canada
| | - Helen-Maria Vasiliadis
- Université de Sherbrooke - Campus de Longueuil, Charles-Le Moyne Research Center, 150 Place Charles Lemoyne, Longueuil, Québec, J4K 0A8, Canada
| | - Martin D Provencher
- École de psychologie, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, Université Laval, Québec, Québec, G1V 0A6, Canada
| | - Peter J Norton
- The Cairnmillar Institute, 391-393 Tooronga Rd, Hawthorn East, Victoria 3123, Australia
| | - Pasquale Roberge
- Department of family medicine and emergency medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e avenue Nord, local Z7-3004, Sherbrooke, Québec, J1H 5N4, Canada
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Beymer PN, Robinson KA. Motivating by Measuring Motivation? Examining Reactivity in a Diary Study on Student Motivation. CONTEMPORARY EDUCATIONAL PSYCHOLOGY 2022. [DOI: 10.1016/j.cedpsych.2022.102072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gibbons C, Porter I, Gonçalves-Bradley DC, Stoilov S, Ricci-Cabello I, Tsangaris E, Gangannagaripalli J, Davey A, Gibbons EJ, Kotzeva A, Evans J, van der Wees PJ, Kontopantelis E, Greenhalgh J, Bower P, Alonso J, Valderas JM. Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice. Cochrane Database Syst Rev 2021; 10:CD011589. [PMID: 34637526 PMCID: PMC8509115 DOI: 10.1002/14651858.cd011589.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.
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Affiliation(s)
| | - Ian Porter
- Health Services & Policy Research, University of Exeter Medical School, Exeter, UK
| | - Daniela C Gonçalves-Bradley
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stanimir Stoilov
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | | | | | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Elizabeth J Gibbons
- PROM Group, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Kotzeva
- Health Technology Assessment Department, Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
| | - Jonathan Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
| | - Evangelos Kontopantelis
- Centre for Health Informatics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Jordi Alonso
- CIBER Epidemiologia y Salud Publica (CIBERESP), IMIM-Hospital del mar, Barcelona, Spain
| | - Jose M Valderas
- Health Services & Policy Research, Exeter Collaboration for Academic Primary Care (APEx), NIHR School for Primary Care Research, NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
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Rauschenberg C, Hirjak D, Ganslandt T, Schulte-Strathaus JCC, Schick A, Meyer-Lindenberg A, Reininghaus U. [Digital forms of service delivery for personalized crisis resolution and home treatment]. DER NERVENARZT 2021; 93:279-287. [PMID: 33730181 PMCID: PMC7966885 DOI: 10.1007/s00115-021-01100-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/14/2022]
Abstract
Hintergrund Die stationsäquivalente psychiatrische Behandlung (StäB) wurde 2018 als Krankenhausleistung für Menschen eingeführt, die die Kriterien einer stationären Behandlung erfüllen. Die rasanten Fortschritte im Bereich der Informations- und Kommunikationstechnologie bieten neue Chancen für innovative digitale Versorgungsangebote wie telemedizinische, eHealth- oder mHealth-Verfahren. Ziel der Arbeit Diese Übersichtsarbeit soll einen umfassenden Überblick über neue digitale Versorgungsformen geben, die zur Personalisierung der StäB bei schweren psychischen Erkrankungen beitragen und somit klinische und soziale Outcomes verbessern sowie direkte und indirekte Kosten reduzieren könnten. Methode Diese Arbeit basiert auf einer selektiven Literaturrecherche (Narratives Review). Ergebnisse Es wurden vier primäre digitale Versorgungsformen identifiziert, die in der StäB gewinnbringend genutzt werden könnten: (1) Kommunikation, Behandlungskontinuität und -flexibilität durch Online-Chat und Videotelefonie, (2) Monitoring von Symptomen und Verhaltensweisen in Echtzeit durch Anwendung des ambulatorischen Assessments („ecological momentary assessment“ [EMA]), (3) Nutzung multimodaler EMA-Daten für die Generierung von personalisiertem Feedback über subjektives Erleben und Verhaltensmuster sowie (4) auf Person, Moment und Kontext zugeschnittene, adaptive ambulatorische Interventionen („ecological momentary interventions“ [EMIs]). Diskussion Digitale Versorgungsformen haben erhebliches Potenzial die Effektivität und Kosteneffektivität der StäB zu steigern. Ein wichtiger nächster Schritt besteht darin, die Anwendung dieser Versorgungsformen im Bereich der StäB zu modellieren und deren Qualität aus Sicht der Patient*innen, Sicherheit und initiale Prozess- und Ergebnisqualität sowie Implementierungsbedingungen sorgfältig zu untersuchen.
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Affiliation(s)
- Christian Rauschenberg
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Niederlande
| | - Dusan Hirjak
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Thomas Ganslandt
- Heinrich-Lanz-Zentrum für Personalisierte Medizin, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Julia C C Schulte-Strathaus
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Anita Schick
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Andreas Meyer-Lindenberg
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Ulrich Reininghaus
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland. .,ESRC Centre for Society and Mental Health, King's College London, London, Großbritannien. .,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Großbritannien.
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8
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Rauschenberg C, Schick A, Hirjak D, Seidler A, Paetzold I, Apfelbacher C, Riedel-Heller SG, Reininghaus U. Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review. J Med Internet Res 2021; 23:e23365. [PMID: 33606657 PMCID: PMC7951054 DOI: 10.2196/23365] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking. Objective The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic. Methods A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic. Results Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited. Conclusions There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs.
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Affiliation(s)
- Christian Rauschenberg
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,ESRC Centre for Society and Mental Health, King´s College London, London, United Kingdom
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9
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So SHW, Chung LKH, Tse CY, Chan SSM, Chong GHC, Hung KSY, Sommer IEC. Moment-to-moment dynamics between auditory verbal hallucinations and negative affect and the role of beliefs about voices. Psychol Med 2021; 51:661-667. [PMID: 31907105 DOI: 10.1017/s0033291719003611] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Negative affect (NA) has been suggested to be both an antecedent and a consequence of auditory verbal hallucinations (AVH). Furthermore, negative appraisals of voices have been theorized to contribute to the maintenance of AVH. Using the experience sampling method (ESM), this study examined the bi-directional relationship between NA and AVH, and the moderating effect of negative beliefs about voices. METHODS Forty-seven patients diagnosed with schizophrenia spectrum disorders with frequent AVH completed a clinical interview, followed by ESM for 10 times a day over 6 days on an electronic device. Time-lagged analyses were conducted using multilevel regression modeling. Beliefs about voices were assessed at baseline. RESULTS A total of 1654 data points were obtained. NA predicted an increase in AVH in the subsequent moment, and AVH predicted an increase in NA in the subsequent moment. Baseline beliefs about voices as malevolent and omnipotent significantly strengthened the association between NA and AVH within the same moment. In addition, the belief of omnipotence was associated with more hallucinatory experiences in the moment following NA. However, beliefs about voices were not associated directly with momentary levels of NA or AVH. CONCLUSIONS Experiences of NA and AVH drove each other, forming a feedback loop that maintained the voices. The associations between NA and AVH, either within the same moment or across moments, were exacerbated by negative beliefs about voices. Our results suggest that affect-improving interventions may stop the feedback loop and reduce AVH frequency.
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Affiliation(s)
- Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Lawrence Kin-Hei Chung
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Chun-Yu Tse
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Sandra Sau-Man Chan
- Department of Psychiatry, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | | | - Karen Shee-Yueng Hung
- Department of Psychiatry, Castle Peak Hospital, New Territories, Hong Kong SAR, China and
| | - Iris E C Sommer
- Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands
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10
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Maatoug R, Peiffer-Smadja N, Delval G, Brochu T, Pitrat B, Millet B. Ecological Momentary Assessment Using Smartphones in Patients With Depression: Feasibility Study. JMIR Form Res 2021; 5:e14179. [PMID: 33625367 PMCID: PMC7946583 DOI: 10.2196/14179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/18/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background Ecological momentary assessment (EMA) is a promising tool in the management of psychiatric disorders and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. The generalization of the smartphone in the modern world offers a new, large-scale support for EMA. Objective The main objective of this study was twofold: (1) to assess patients’ compliance with an EMA smartphone app defined by the number of EMAs completed, and (2) to estimate the external validity of the EMA using a correlation between self-esteem/guilt/mood variables and Hamilton Depression Rating Scale (HDRS) score. Methods Eleven patients at the Pitié-Salpêtrière Hospital, Paris, France, were monitored for 28 days by means of a smartphone app. Every patient enrolled in the study had two types of assessment: (1) three outpatient consultations with a psychiatrist at three different time points (days 1, 15, and 28), and (2) real-time data collection using an EMA smartphone app with a single, fixed notification per day at 3 pm for 28 days. The results of the real-time data collected were reviewed during the three outpatient consultations by a psychiatrist using a dashboard that aggregated all of the patients’ data into a user-friendly format. Results Of the 11 patients in the study, 6 patients attended the 3 outpatient consultations with the psychiatrist and completed the HDRS at each consultation. We found a positive correlation between the HDRS score and the variables of self-esteem, guilt, and mood (Spearman correlation coefficient 0.57). Seven patients completed the daily EMAs for 28 days or longer, with an average response rate to the EMAs of 62.5% (175/280). Furthermore, we observed a positive correlation between the number of responses to EMAs and the duration of follow-up (Spearman correlation coefficient 0.63). Conclusions This preliminary study with a prolonged follow-up demonstrates significant patient compliance with the smartphone app. In addition, the self-assessments performed by patients seemed faithful to the standardized measurements performed by the psychiatrist. The results also suggest that for some patients it is more convenient to use the smartphone app than to attend outpatient consultations.
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Affiliation(s)
- Redwan Maatoug
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Nathan Peiffer-Smadja
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.,French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution, UMR 1137, University Paris Diderot, Paris, France
| | - Guillaume Delval
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Térence Brochu
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Benjamin Pitrat
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
| | - Bruno Millet
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, Paris, France
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11
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Duevel JA, Hasemann L, Peña-Longobardo LM, Rodríguez-Sánchez B, Aranda-Reneo I, Oliva-Moreno J, López-Bastida J, Greiner W. Considering the societal perspective in economic evaluations: a systematic review in the case of depression. HEALTH ECONOMICS REVIEW 2020; 10:32. [PMID: 32964372 PMCID: PMC7510122 DOI: 10.1186/s13561-020-00288-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/07/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Depressive disorders are associated with a high burden of disease. However, due to the burden posed by the disease on not only the sufferers, but also on their relatives, there is an ongoing debate about which costs to include and, hence, which perspective should be applied. Therefore, the aim of this paper was to examine whether the change between healthcare payer and societal perspective leads to different conclusions of cost-utility analyses in the case of depression. METHODS A systematic literature search was conducted to identify economic evaluations of interventions in depression, launched on Medline and the Cost-Effectiveness Registry of the Tufts University using a ten-year time horizon (2008-2018). In a two-stepped screening process, cost-utility studies were selected by means of specified inclusion and exclusion criteria. Subsequently, relevant findings was extracted and, if not fully stated, calculated by the authors of this work. RESULTS Overall, 53 articles with 92 complete economic evaluations, reporting costs from healthcare payer/provider and societal perspective, were identified. More precisely, 22 estimations (24%) changed their results regarding the cost-effectiveness quadrant when the societal perspective was included. Furthermore, 5% of the ICURs resulted in cost-effectiveness regarding the chosen threshold (2% of them became dominant) when societal costs were included. However, another four estimations (4%) showed the opposite result: these interventions were no longer cost-effective after the inclusion of societal costs. CONCLUSIONS Summarising the disparities in results and applied methods, the results show that societal costs might alter the conclusions in cost-utility analyses. Hence, the relevance of the perspectives chosen should be taken into account when carrying out an economic evaluation. This systematic review demonstrates that the results of economic evaluations can be affected by different methods available for estimating non-healthcare costs.
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Affiliation(s)
- Juliane Andrea Duevel
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany.
| | - Lena Hasemann
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Luz María Peña-Longobardo
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Beatriz Rodríguez-Sánchez
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
- Faculty of Technology and Science, University Camilo José Cela, Urb. Villafranca del Castillo, Calle Castillo de Alarcón, 49, 28692 Villanueva de la Cañada, Madrid, Spain
| | - Isaac Aranda-Reneo
- Faculty of Social Science, Economic Analysis and Finance Department, Research Group in Economics and Health, University of Castilla-La Mancha, Avda. Real Fábrica s/n, Talavera de la Reina, 45600, Toledo, Spain
| | - Juan Oliva-Moreno
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Julio López-Bastida
- Faculty of Health Science, Research Group in Economics and Health, University of Castilla-La Mancha, Av. Real Fábrica de Sedas, s/n, Talavera de la Reina, 45600, Toledo, Spain
| | - Wolfgang Greiner
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
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12
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Willemse BJPC, Kaptein MC, Hasaart F. Developing Effective Methods for Electronic Health Personalization: Protocol for Health Telescope, a Prospective Interventional Study. JMIR Res Protoc 2020; 9:e16471. [PMID: 32734930 PMCID: PMC7428913 DOI: 10.2196/16471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Existing evaluations of the effects of mobile apps to encourage physical activity have been criticized owing to their common lack of external validity, their short duration, and their inability to explain the drivers of the observed effects. This protocol describes the setup of Health Telescope, a longitudinal panel study in which the long-term effects of mobile electronic health (eHealth) apps are investigated. By setting up Health Telescope, we aim to (1) understand more about the long-term use of eHealth apps in an externally valid setting, (2) understand the relationships between short-term and long-term outcomes of the usage of eHealth apps, and (3) test different ways in which eHealth app allocation can be personalized. OBJECTIVE The objectives of this paper are to (1) demonstrate and motivate the validity of the many choices that we made in setting up an intensive longitudinal study, (2) provide a resource for researchers interested in using data generated by our study, and (3) act as a guideline for researchers interested in setting up their own longitudinal data collection using wearable devices. For the third objective, we explicitly discuss the General Data Protection Regulation and ethical requirements that need to be addressed. METHODS In this 4-month study, a group of approximately 450 participants will have their daily step count measured and will be asked daily about their mood using experience sampling. Once per month, participants will receive an intervention containing a recommendation to download an app that focuses on increasing physical activity. The mechanism for assigning recommendations to participants will be personalized over time, using contextual data obtained from previous interventions. RESULTS The data collection software has been developed, and all the legal and ethical checks are in place. Recruitment will start in Q4 of 2020. The initial results will be published in 2021. CONCLUSIONS The aim of Health Telescope is to investigate how different individuals respond to different ways of being encouraged to increase their physical activity. In this paper, we detail the setup, methods, and analysis plan that will enable us to reach this aim. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/16471.
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Affiliation(s)
| | - Maurits Clemens Kaptein
- Jheronimus Academy of Data Science, 's-Hertogenbosch, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
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Bartels SL, van Knippenberg RJ, Dassen FC, Asaba E, Patomella AH, Malinowsky C, Verhey FR, de Vugt ME. A narrative synthesis systematic review of digital self-monitoring interventions for middle-aged and older adults. Internet Interv 2019; 18:100283. [PMID: 31890630 PMCID: PMC6926211 DOI: 10.1016/j.invent.2019.100283] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Self-monitoring is crucial to raise awareness for own behaviors and emotions, and thus facilitate self-management. The composition of self-monitoring within interventions, however, varies and guidelines are currently unavailable. This review aimed to provide a comprehensive overview of technology-based self-monitoring interventions that intend to improve health in middle-aged and older adults (>45 years). METHODS Five online databases were systematically searched and articles were independently screened. A narrative synthesis of 26 studies with 21 unique interventions was conducted. Primary focus lay on the composition of self-monitoring within interventions, including technology used, health-aspects monitored, and type of feedback provided. Secondly, the usability of/adherence to the self-monitoring treatment, intervention effects, and their sustainability were examined. FINDINGS Studies concentrated on middle-aged adults (mean of 51 years). Mobile technologies seem necessary to ensure flexible self-monitoring in everyday life. Social health aspects were rarely monitored. Mechanisms and the sustainability of intervention effect are understudied. CONCLUSION Digital self-monitoring technologies hold promise for future trials as they seem suitable to understand and support health-related self-management. Key elements including automatic and personal feedback following the blended care principle were highlighted and may guide study designs. Prospectively, research is especially needed to study sustained self-monitoring to support disease prevention and lasting lifestyle changes.
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Affiliation(s)
- Sara Laureen Bartels
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200 MD, Maastricht, the Netherlands
| | - Rosalia J.M. van Knippenberg
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200 MD, Maastricht, the Netherlands
| | - Fania C.M. Dassen
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200 MD, Maastricht, the Netherlands
| | - Eric Asaba
- Division of Occupational Therapy, Department of Neurobiology, Care Science and Society (NVS), Karolinska Institutet, Fack 23 200, SE-141 83 Huddinge, Sweden
| | - Ann-Helen Patomella
- Division of Occupational Therapy, Department of Neurobiology, Care Science and Society (NVS), Karolinska Institutet, Fack 23 200, SE-141 83 Huddinge, Sweden
| | - Camilla Malinowsky
- Division of Occupational Therapy, Department of Neurobiology, Care Science and Society (NVS), Karolinska Institutet, Fack 23 200, SE-141 83 Huddinge, Sweden
| | - Frans R.J. Verhey
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200 MD, Maastricht, the Netherlands
| | - Marjolein E. de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200 MD, Maastricht, the Netherlands
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14
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Bastiaansen JA, Meurs M, Stelwagen R, Wunderink L, Schoevers RA, Wichers M, Oldehinkel AJ. Self-monitoring and personalized feedback based on the experiencing sampling method as a tool to boost depression treatment: a protocol of a pragmatic randomized controlled trial (ZELF-i). BMC Psychiatry 2018; 18:276. [PMID: 30176845 PMCID: PMC6122175 DOI: 10.1186/s12888-018-1847-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/13/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression is a leading cause of disability worldwide. To reduce the societal burden and improve quality of life for individual patients, treatments for depression need to be optimized. There is a particular need for person-tailored interventions that reinforce self-management of patients. Systematic self-monitoring and personalized feedback through the Experience Sampling Method (ESM) could provide such a person-tailored, empowering intervention that enhances treatment outcomes. The primary aim of this study is to investigate the efficacy of self-monitoring and personalized feedback as an add-on tool in the treatment of depressive complaints in a natural setting. METHODS The ZELF-i study is a pragmatic multi-site randomized controlled trial (RCT). We aim to recruit 150 individuals with depressive symptoms aged between 18 and 65 years, who have an intake for outpatient basic or specialized treatment at a mental health care organization in the North of the Netherlands. After the intake, participants will be randomly allocated to one of three study arms: two experimental groups engaging in 28 days of systematic self-monitoring (5 times per day) and receiving weekly personalized feedback on positive affect and activities ("Do"-module) or on negative affect and thinking patterns ("Think"-module), and a control group receiving no additional intervention. Self-report inventories of depressive symptoms, psychosocial functioning and feelings of empowerment will be administered before and after the intervention period, and at follow-up measurements at 1, 2, 3 and 6 months. The patient-experienced utility of the intervention will be investigated by a combination of quantitative and qualitative research methods. DISCUSSION The present study is the first to examine the effects of add-on self-monitoring and personalized feedback on depressive complaints in clinical practice. It is also the first to evaluate two different ESM modules targeted at both of depression's core symptoms. Lastly, it is the first study that uses a combination of qualitative and quantitative methods to evaluate the patient-experienced utility of ESM with personalized feedback as an intervention for depression. Results of the present study may improve treatment for depression, if the intervention is found to be effective. TRIAL REGISTRATION Dutch Trial Register, NTR5707 , registered prospectively 1 February 2016.
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Affiliation(s)
- Jojanneke A. Bastiaansen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, The Netherlands ,Friesland Mental Health Care Services, Department of Education and Research, Leeuwarden, The Netherlands
| | - Maaike Meurs
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, The Netherlands
| | - Renee Stelwagen
- Friesland Mental Health Care Services, Department of Education and Research, Leeuwarden, The Netherlands
| | - Lex Wunderink
- Friesland Mental Health Care Services, Department of Education and Research, Leeuwarden, The Netherlands
| | - Robert A. Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, The Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, The Netherlands
| | - Albertine J. Oldehinkel
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, The Netherlands
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15
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van Os J, Delespaul P, Barge D, Bakker RP. Testing an mHealth momentary assessment Routine Outcome Monitoring application: a focus on restoration of daily life positive mood states. PLoS One 2014; 9:e115254. [PMID: 25513813 PMCID: PMC4267819 DOI: 10.1371/journal.pone.0115254] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/18/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Routine Outcome Monitoring (ROM) is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM). METHOD In a sample of 34 patients with major depressive disorder, treated with antidepressants, the combined effect of treatment and natural course was examined over a period of 18 weeks with Ecological Momentary Assessment (EMA). EMA consisted of repeated, within-subject, mini-measurements of experience (eg positive affect, negative affect, medication side effects) and context (eg stressors, situations, activities) at 10 unselected semi-random moments per day, for a period of six days, repeated three times over the 18-week period (baseline, week 6 and week 18). RESULTS EMA measures of emotional and behavioural adjustment were sensitive to the effects of treatment and natural course over the 18-week period, particularly EMA measures focussing on positive mood states and the ability to use natural rewards (impact of positive events on positive mood states), with standardized effect sizes of 0.4-0.5. EMA measures of activities, social interaction, stress-sensitivity and negative mood states were also sensitive to change over time. CONCLUSION This study supports the use of mROM as a means to involve the patient in the process of needs assessment and treatment. EMA data are meaningful to the patient, as they reflect daily life circumstances. Assessment of treatment response with mROM data allows for an interpretation of the effect of treatment at the level of daily life emotional and social adjustment--as an index of health, obviating the need for an exclusive focus on traditional measures of 'sickness'.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
- King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Philippe Delespaul
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
| | - Daniela Barge
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Roberto P. Bakker
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
- Psychiatric Centre GGZ Centraal, Amersfoort, The Netherlands
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