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Gillis C, Williams J, Gillett G, McGrath R, Ang K, Bakolis I, Arias de La Torre J, Tredget G, Gaughran F, Cross S, Stepan N, Sevdalis N, Khadjesari Z. Exploring the Use of Digital Interventions by People with Severe Mental Illness to Support Their Physical Health: A Mixed Methods Study. Issues Ment Health Nurs 2024; 45:9-26. [PMID: 38190422 DOI: 10.1080/01612840.2023.2279207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
People with severe mental illness (SMI) are more likely to experience physical health conditions than the general population. Little is known about the experience of people with SMI using digital health interventions (DHIs) to support their physical health. We explored how people with SMI use DHIs to support their physical health, the acceptability, factors affecting use, and impact on physical health. This was a three-stage mixed methods study (1) online survey of people with SMI; (2) interviews with a subsample of participants from Stage 1; (3) stakeholder workshops. Participants were generally satisfied with the DHIs they used. The most popular DHIs were targeted at diet, exercise, and weight management. Factors that encouraged use included simplicity and data-linkage. Concerns included costs, data security, and reliability of information. Positive impacts included accountability and tangible physical health benefits. Mental health impacted engagement with DHIs. DHIs were seen as a useful tool to monitor physical health but could not replace contact with clinical services. DHIs were considered useful and acceptable by people with SMI and may be used as an extension of clinical care. The specific needs and priorities of people with SMI should be considered both in developing and recommending interventions.
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Affiliation(s)
- Cathy Gillis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - George Gillett
- Psychosis CAG, South London and Maudsley NHS Foundation Trust, London, UK
- Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ray McGrath
- Psychosis CAG, South London and Maudsley NHS Foundation Trust, London, UK
- Mind and Body Programme, King's Health Partners, London, UK
| | - Karen Ang
- Psychosis CAG, South London and Maudsley NHS Foundation Trust, London, UK
- Mind and Body Programme, King's Health Partners, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jorge Arias de La Torre
- Care for Long Term Conditions Research Division. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Institute of Biomedicine (IBIOMED), Universidad de León, León, Spain
| | - Gracie Tredget
- Psychosis CAG, South London and Maudsley NHS Foundation Trust, London, UK
- Mind and Body Programme, King's Health Partners, London, UK
| | - Fiona Gaughran
- Psychosis CAG, South London and Maudsley NHS Foundation Trust, London, UK
- Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Applied Health Research and Care (ARC), King's College London, London, UK
| | - Sean Cross
- Psychosis CAG, South London and Maudsley NHS Foundation Trust, London, UK
- Mind and Body Programme, King's Health Partners, London, UK
| | - Natalia Stepan
- Mind and Body Programme, King's Health Partners, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Applied Health Research and Care (ARC), King's College London, London, UK
| | - Zarnie Khadjesari
- Behavioural and Implementation Science (BIS) Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
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Nadalin S, Jakovac H, Peitl V, Karlović D, Buretić-Tomljanović A. Dysregulated inflammation may predispose patients with serious mental illnesses to severe COVID‑19 (Review). Mol Med Rep 2021; 24:611. [PMID: 34184073 PMCID: PMC8258463 DOI: 10.3892/mmr.2021.12250] [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: 03/21/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
Genetic and nongenetic factors associated with an increased inflammatory response may mediate a link between severe coronavirus disease 2019 (COVID‑19) and serious mental illness (SMI). However, systematic assessment of inflammatory response‑related factors associated with SMI that could influence COVID‑19 outcomes is lacking. In the present review, dietary patterns, smoking and the use of psychotropic medications are discussed as potential extrinsic risk factors and angiotensin‑converting enzyme (ACE) insertion/deletion (I/D) gene polymorphisms are considered as potential intrinsic risk factors. A genetics‑based prediction model for SMI using ACE‑I/D genotyping is also proposed for use in patients experiencing severe COVID‑19. Furthermore, the literature suggests that ACE inhibitors may have protective effects against SMI or severe COVID‑19, which is often linked to hypertension and other cardiovascular comorbidities. For this reason, we hypothesize that using these medications to treat patients with severe COVID‑19 might yield improved outcomes, including in the context of SMI associated with COVID‑19.
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Affiliation(s)
- Sergej Nadalin
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Hrvoje Jakovac
- Department of Physiology and Immunology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Vjekoslav Peitl
- Department of Psychiatry, Sestre Milosrdnice University Hospital Center and Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Dalibor Karlović
- Department of Psychiatry, Sestre Milosrdnice University Hospital Center and Catholic University of Croatia, 10000 Zagreb, Croatia
| | - Alena Buretić-Tomljanović
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
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The Influence of a Psychosocial Rehabilitation Program in a Community Health Setting for Patients with Chronic Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084319. [PMID: 33921774 PMCID: PMC8072785 DOI: 10.3390/ijerph18084319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
Purpose: To examine (a) the amount of health-related behavior, (b) the level of generalized optimism, (c) the belief about patients' abilities to cope with difficult situations and obstacles and (d) the subjective sense of social exclusion at baseline and at follow-up among patients with chronic mental health issues participating in a psychosocial rehabilitation program in a community mental health setting. Materials and Methods: This prospective study involved 52 participants aged 18-43 years and diagnosed with mental illness who participated in a 6-month psychosocial rehabilitation program, organized within a special community setting. Different questionnaires were used: the Health-Related Behavior Questionnaire, the Revised Life Orientation Test, the General Self-Efficacy Scale, the Personal Competence Scale and a self-made questionnaire concerning social exclusion problems. Results: Statistical analysis of the questionnaire results taken at the beginning and end of the six-month course, running from November 2015 to May 2016, revealed significant increases in health-related behavior (p = 0.006) and general self-efficacy (p = 0.01). Conclusions: Psychosocial rehabilitation programs offered by community mental health settings might serve as an easy, accessible strategy to deal with different interpersonal and intrapersonal problems and as a potential way to improve health behavior. Further research is required to evaluate other psychosocial rehabilitation programs in different community mental health settings in Lodz Voivodeship, Poland.
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Areas of uncertainties and unmet needs in bipolar disorders: clinical and research perspectives. Lancet Psychiatry 2018; 5:930-939. [PMID: 30146246 DOI: 10.1016/s2215-0366(18)30253-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 12/11/2022]
Abstract
This Review discusses crucial areas related to the identification, clinical presentation, course, and therapeutic management of bipolar disorder, a major psychiatric illness. Bipolar disorder is often misdiagnosed, leading to inappropriate, inadequate, or delayed treatment. Even when bipolar disorder is successfully diagnosed, its clinical management presents several major challenges, including how best to optimise treatment for an individual patient, and how to balance the benefits and risks of polypharmacy. We discuss the major unmet needs in the diagnosis and management of bipolar disorder in this Review, including improvement of adequate recognition and intervention in at-risk and early-disease stages, identification of reliable warning signs and prevention of relapses in unstable and rapid cycling patients, treatment of refractory depression, and prevention of suicide. Taken together, there are several promising opportunities for improving treatment of bipolar disorder to deliver medical care that is more personalised.
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Champion KE, Newton NC, Spring B, Wafford QE, Parmenter BJ, Teesson M. A systematic review of school-based eHealth interventions targeting alcohol use, smoking, physical inactivity, diet, sedentary behaviour and sleep among adolescents: a review protocol. Syst Rev 2017; 6:246. [PMID: 29208040 PMCID: PMC5717802 DOI: 10.1186/s13643-017-0645-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/24/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Six key behavioural risk factors (risky alcohol use, smoking, poor diet, physical inactivity, sedentary behaviour and unhealthy sleep patterns) have been identified as strong determinants of chronic disease, such as cardiovascular disease, diabetes and cancers. School-based interventions targeting these multiple health risk behaviours among adolescents have the potential to halt the trajectory towards later disease, whilst online and mobile technology interventions offer advantages in terms of student engagement, reach and scalability. Despite this, the efficacy of eHealth school-based interventions targeting these six health risk behaviours among adolescents has not been evaluated. The proposed systematic review aims to address this by determining the nature and efficacy of existing eHealth school-based interventions targeting multiple health risk behaviours among adolescents. METHODS A systematic search of the MEDLINE, Embase, PsycINFO and Cochrane Library databases will be conducted to identify eligible published papers. Eligible studies will be randomised controlled trials, including cluster randomised controlled trials, of interventions targeting two or more of the following lifestyle risk behaviours: alcohol use, smoking, poor diet, physical inactivity, sedentary behaviour and sleep. Eligible studies will be those evaluating interventions delivered in a secondary school setting among participants 11-18 years of age, via an eHealth platform (Internet, computers of mobile technology). Two reviewers will independently screen studies for eligibility, extract data and assess the risk of bias. Study outcomes will be summarised in a narrative synthesis, and meta-analyses will be conducted where it is appropriate to combine studies. DISCUSSION It is anticipated that the results from this review will serve to inform the development of future eHealth multiple health behaviour interventions for adolescents by identifying common characteristics of effective programs and highlighting knowledge gaps in the evidence base. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017072163.
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Affiliation(s)
- Katrina E. Champion
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611 USA
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, NDARC, UNSW Sydney, Sydney, NSW Australia
| | - Nicola C. Newton
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, NDARC, UNSW Sydney, Sydney, NSW Australia
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611 USA
| | - Q. Eileen Wafford
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | | | - Maree Teesson
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, NDARC, UNSW Sydney, Sydney, NSW Australia
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Mansur RB, Brietzke E, McIntyre RS, Cao B, Lee Y, Japiassú L, Chen K, Lu R, Lu W, Li T, Xu G, Lin K. BDNF and BMI effects on brain structures of bipolar offspring: results from the global mood and brain science initiative. Acta Psychiatr Scand 2017; 136:607-614. [PMID: 29023633 DOI: 10.1111/acps.12822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare brain-derived neurotrophic factor (BDNF) levels between offspring of individuals with bipolar disorders (BD) and healthy controls (HCs) and investigate the effects of BDNF levels and body mass index (BMI) on brain structures. METHOD Sixty-seven bipolar offspring and 45 HCs were included (ages 8-28). Structural images were acquired using 3.0 Tesla magnetic resonance imaging. Serum BDNF levels were measured using enzyme-linked immunosorbent assay. Multivariate and univariate analyses of covariance were conducted. RESULTS Significantly higher BDNF levels were observed among bipolar offspring, relative to HCs (P > 0.025). Offspring status moderated the association between BDNF and BMI (F1 =4.636, P = 0.034). After adjustment for relevant covariates, there was a trend for a significant interaction of group and BDNF on neuroimaging parameters (Wilks'λ F56,94 =1.463, P = 0.052), with significant effects on cerebellar white matter and superior and middle frontal regions. Brain volume and BDNF were positively correlated among HCs and negatively correlated among bipolar offspring. Interactions between BDNF and BMI on brain volumes were non-significant among HCs (Wilks'λ F28,2 =2.229, P = 0.357), but significant among bipolar offspring (Wilks'λ F28,12 =2.899, P = 0.028). CONCLUSION Offspring status and BMI moderate the association between BDNF levels and brain structures among bipolar offspring, underscoring BDNF regulation and overweight/obesity as key moderators of BD pathogenesis.
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Affiliation(s)
- R B Mansur
- Department of Affective Disorders, the Affiliated Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - E Brietzke
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - R S McIntyre
- Department of Affective Disorders, the Affiliated Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - B Cao
- Department of Affective Disorders, the Affiliated Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Y Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - L Japiassú
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - K Chen
- Department of Affective Disorders, the Affiliated Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China.,Laboratory of Emotion and Cognition, the Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
| | - R Lu
- Department of Affective Disorders, the Affiliated Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
| | - W Lu
- Department of Affective Disorders, the Affiliated Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
| | - T Li
- Department of Affective Disorders, the Affiliated Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
| | - G Xu
- Department of Affective Disorders, the Affiliated Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China.,Laboratory of Emotion and Cognition, the Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
| | - K Lin
- Department of Affective Disorders, the Affiliated Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China.,Laboratory of Emotion and Cognition, the Affiliated Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China.,Laboratory of Neuropsychology, University of Hong Kong, Hong Kong, Hong Kong
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Wakida EK, Akena D, Okello ES, Kinengyere A, Kamoga R, Mindra A, Obua C, Talib ZM. Barriers and facilitators to the integration of mental health services into primary health care: a systematic review protocol. Syst Rev 2017; 6:171. [PMID: 28841908 PMCID: PMC6389192 DOI: 10.1186/s13643-017-0561-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/09/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works. METHODS This review will use the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework approach to identify experiences of mental health integration into PHC; the findings will be reported using the "Best fit" framework synthesis. PubMed, EMBASE, PsycINFO, and Cochrane Central Register of Controlled trials (CENTRAL) will be searched including other sources like the WHO website and OpenGrey database. Assessment of bias and quality will be done at study level using two separate tools to check for the quality of evidence presented. Data synthesis will take on two synergistic approaches (qualitative and quantitative studies). Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. The findings will be useful to a wide array of stakeholders involved in the implementation of the mental health integration into PHC. DISCUSSION The SPIDER framework has been chosen for this review because of its suitable application to qualitative and mixed methods research and will be used as a guide when selecting articles for inclusion. Data extracted will be synthesized using the "Best fit" framework because it has been used before and proved its suitability in producing new conceptual models for explaining decision-making and possible behaviors. Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016052000.
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Affiliation(s)
- Edith K. Wakida
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dickens Akena
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- Africa Center for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elialilia S. Okello
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alison Kinengyere
- Africa Center for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
- Library, Africa Center for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Kamoga
- Department of Anatomy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Arnold Mindra
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Department of Pharmacology and Therapeutics and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Zohray M. Talib
- Department of Medicine & of Health Policy, George Washington University, Washington DC, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
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