Telepsychiatry in the Arab World: A Viewpoint Before and During COVID-19

Patient Perceptions on Telepsychiatry as an In-Consult Alternative During COVID-19 Pandemic: Peruvian Adaptation of the Telehealth Usability Questionnaire

Objective: To identify the perceptions of the patients who received alternative care by telepsychiatry at the Cayetano Heredia Hospital (HCH). Methods: This research consisted of two phases: (1) transcultural adaptation of the Telehealth Usability Questionnaire (TUQ) with three experts and (2) application of the questionnaire in 183 patients from psychiatry in HCH. Nonparametric tests were used to determine the association between variables. Results: We applied 20 questions to 60 men and 123 women, with a median age of 45. The ease of using the virtual consultation service, the comfort with its use, and the general satisfaction had a score of 6 out of 7 and are associated with the number of devices that patients have and their degree of education. The usefulness, communication by virtual means, and the solution of technical problems had scores higher than 6, being considered acceptable by the patients. Willingness to have a teleconsultation again was high and was associated with patient satisfaction with the consultation. Conclusions: Most patients were satisfied with telepsychiatry via telemonitoring during the COVID-19 pandemic. The usage of validated tools such as TUQ might be included as part of evaluations of new telemedicine services.

Telephone-based telepsychiatry consultations: a qualitative exploration of psychiatrists' experiences in Oman

OBJECTIVES

The utilisation of tele-mental health services has the potential to address challenges in mental health services within the Eastern Mediterranean Region. However, the adoption of tele-mental health in Oman remains limited. Therefore, this study aimed to explore the experiences of psychiatrists with telephone consultations, offering valuable insights to advance the field of telepsychiatry.

DESIGN

This is a qualitative exploratory study. The analysis of the data involved the application of manifest content analysis.

SETTING

The semi-structured interviews were conducted with the psychiatrists at Al Masarra Hospital.

PARTICIPANTS

A total of 10 semi-structured interviews were conducted.

RESULTS

The study reveals that psychiatrists encounter communication challenges in telephone consultations, such as the absence of visual cues, confirming patient identity, conducting comprehensive assessments and effectively communicating with younger patients who may lack developed social skills or patients with specific health conditions. Infrastructure limitations, such as outdated medical records, lack of electronic prescriptions and limited availability of child/adolescent psychiatric medications, further restrict the effectiveness of telepsychiatry consultations. In contrast, telephone appointments offer convenience and flexibility for psychiatrists, allowing them to manage non-clinical responsibilities and provide focused consultations tailored to individual needs. In addition, it benefits patients by improving appointment adherence, diminishing stigma and financial savings compared with in-person consultations.

CONCLUSIONS

Tele-mental health has emerged as a promising avenue for enhancing mental healthcare services in Oman. Addressing psychiatrists' challenges is crucial to further developing and strengthening these services.

Attitudes of psychiatrists toward telepsychiatry: A policy Delphi study

Objectives

To delineate areas of consensus and disagreements among practicing psychiatrists from various levels of clinical experience, hierarchy and organizations, and to test their ability to converge toward agreement, which will enable better integration of telepsychiatry into mental health services.

Methods

To study attitudes of Israeli public health psychiatrists, we utilized a policy Delphi method, during the early stages of the COVID pandemic. In-depth interviews were conducted and analyzed, and a questionnaire was generated. The questionnaire was disseminated amongst 49 psychiatrists, in two succeeding rounds, and areas of consensus and controversies were identified.

Results

Psychiatrists showed an overall consensus regarding issues of economic and temporal advantages of telepsychiatry. However, the quality of diagnosis and treatment and the prospect of expanding the usage of telepsychiatry to normal circumstances-beyond situations of pandemic or emergency were disputed. Nonetheless, efficiency and willingness scales slightly improved during the 2nd round of the Delphi process. Prior experience with telepsychiatry had a strong impact on the attitude of psychiatrists, and those who were familiar with this practice were more favorable toward its usage in their clinic.

Conclusions

We have delineated experience as a major impact on the attitudes toward telepsychiatry and the willingness for its assimilation in clinical practice as a legitimate and trustworthy method. We have also observed that the organizational affiliation significantly affected psychiatrists' attitude, when those working at local clinics were more positive toward telepsychiatry compared with employees of governmental institutions. This might be related to experience and differences in organizational environment. Taken together, we recommend to include hands-on training of telepsychiatry in medical education curriculum during residency, as well as refresher exercises for attending practitioners.

Knowledge, Attitudes, and Perceptions of Jordanians Toward Adopting and Using Telemedicine: National Cross-sectional Study

Background

Due to the upsurge of COVID-19, nations are increasingly adopting telemedicine programs in anticipation of similar crises. Similar to all nations worldwide, Jordan is implementing efforts to adopt such technologies, yet it is far from complete.

Objective

This study aims to assess the knowledge, attitudes, and perceptions of Jordanians toward telemedicine, to identify key factors predisposing individuals to its use or acting as barriers to its implementation.

Methods

We implemented a cross-sectional design using an online, self-administered questionnaire executed in Google Forms and distributed through social media. Differences in knowledge and attitude scores were examined using independent sample t tests and ANOVA. A multivariate linear regression model was computed to assess predictors of awareness toward telemedicine.

Results

A total of 1201 participants fully completed the questionnaire. Participants were characterized by a mean age of 36.3 (SD 14.4) years and a male-to-female ratio of nearly 1:1. About 50% (619/1201, 51.5%) of our studied population were aware of telemedicine, while nearly 25% (299/1201, 24.9%) declared they had observed it in action. Approximatively 68% (814/1201, 67.8%) of respondents were willing to use telemedicine. The majority of the sample portrayed favorable and positive views toward telemedicine. Higher educational degrees, living in urban districts, and having a higher perception of electronic usage ability were associated with higher knowledge and better attitudes toward telemedicine (all P<.05). The multivariate linear regression analysis demonstrated that perceived ability to use electronics was associated with positive attitudes (β=0.394; 95% CI 0.224 to 0.563), while living in Southern Jordan predicted poor attitudes toward telemedicine (β=–2.896; 95% CI –4.873 to –0.919).

Conclusions

Jordanians portray favorable perceptions of telemedicine. Nonetheless, concerns with regards to privacy, medical errors, and capacity for accurate diagnoses are prevalent. Furthermore, Jordanians believe that integrating telemedicine within the health care system is not applicable due to limited resources.

The quality of telepsychiatry in terms of accessibility, appropriateness, effectiveness, and safety among psychiatric patients in King Abdulaziz Medical City: An observational cross-sectional analytical study

There has been an increasing demand for psychiatric care in recent decades, and "telepsychiatry" was developed to meet these demands. It is a type of telemedicine in which they provide many medical services virtually, such as therapy, counseling, and medication management. Telepsychiatry has numerous advantages, including lower costs, reduced stigma, and improved continuity of care. To the best of our knowledge, no previous studies in the western region of Saudi Arabia addressed patients satisfaction with telepsychiatry. This cross-sectional study aims to assess patient satisfaction in telepsychiatry in terms of accessibility and timeliness, appropriateness, effectiveness, and safety, and to see whether patient satisfaction affects their decision to use the service again in the future. A cross-sectional study was conducted using a prestructured survey on the basis of the Client Satisfaction Questionnaire-18, which is a validated questionnaire used to assess patients' satisfaction with the services provided to them. From January 2021 to July 2021, all male and female psychiatric patients over the age of 18 years who had psychiatric virtual appointments were included in this study. This study included 182 patients, of whom 106 were female. Patients were generally satisfied with the telepsychiatry services; 56.6%, 81.9%, 86.8%, and 91.2% of the participants were satisfied with the access and timeliness, appropriateness, effectiveness, and safety, respectively, and a total of 58.3% either strongly agree or agree of the overall satisfaction level. Depression and anxiety disorders were the most common psychiatric diseases. The statistical analysis revealed no significant relationships between patients' satisfaction and demographic characteristics. Telepsychiatry has been evaluated to meet the growing demand for psychiatric care; it also has significant advantages. Patients had an overall positive satisfaction level toward telepsychiatry service, and so the results of this study support the continuity of using telepsychiatry in the future. Further research area could include a comparison between patients' and providers' satisfaction levels with telepsychiatry.

The Use of Telehealth in Depression Treatment during the Crisis Caused by COVID-19

Throughout the COVID-19 pandemic, there has been increased interest in telehealth as a means of providing care for depression. In this article, we provide an overview of telehealth utilization for the treatment of depression and provide some insight into the rapid shift made to quickly implement these telehealth services into our everyday practices due to COVID-19 personal distancing requirements. We review the application of telehealth in the treatment of depression during the COVID-19 pandemic. The multiple advantages and disadvantages of telehealth in treatment of depression are summarized through the literature, and we analyze the methods to improve the effect and quality of telehealth in depression treatment. It has been highlighted in the current research that against its proven capacity for convenience, its relative cheapness, and its ability to overcome geographic barriers, telehealth has its own shortfalls, including disparities in rural-urban infrastructure and an alleged inability to be exhaustive when intensive interventions are needed. Recommendations for the improvement of telehealth during the COVID-19 pandemic also presuppose that it is infrastructure and human resource intensive and that short-term improvements in its efficiency are largely dependent on the creativity and resourcefulness of physicians to provide custom solutions for patients.

LeiP#netz 2.0: mapping COVID-19-related changes in mental health services in the German city of Leipzig

PURPOSE

The purpose of the study was to investigate the changes in psychosocial and psychiatric services in the German city of Leipzig during the COVID-19-pandemic.

METHODS

A participatory, mixed-methods study was used involving a quantitative online survey and qualitative semi-structured interviews with professionals. Quantitative findings were reported with descriptive statistics, and thematic analysis was conducted for qualitative data.

RESULTS

Fifty professionals from various mental health services participated in the survey and eleven professionals were interviewed. Quantitative findings showed that some services were closed intermittently and that there was a stiff increase in use of digital/telephonic service and a decrease in face-to-face services. Staff or funding did not change considerably during the pandemic. Psychosocial groups were suspended or reduced, while access to services became more difficult and professional training for staff was stopped. Thematic analysis of the interviews showed that professionals experienced different phases and levels of change during the pandemic, including changes on a structural level, on the users' level, and on the staff' level. Professionals particularly criticised the equivocality of COVID-19 regulations, a defective flow of information and lack of attention for mental healthcare in public policies. They also saw positive aspects, such as the capacity of users and the outpatient care system to adapt to the new situation.

CONCLUSION

This study suggests directions for policy and service development, such as communicating clearly in infection-control measures, fostering outpatient care and networks between services.

Mental health services in conflict areas - An experience from Libya

The Libyan mental health system has long been seen as inefficient and insufficient for the demands of the country. Thousands of Libyans require mental health therapy now more than ever before. Libya's Ministry of Health has worked to improve access to mental health services. Despite international assistance, Libya continues to face issues due to stigma and a shortage of competent psychiatrists. The majority of Libyan individuals are unable to obtain private psychiatric care. This places the burden on the public sector to care for the majority's psychological pain and suffering and this needs to be addressed.

A promising future for tele-mental health in Oman: A qualitative exploration of clients and therapists' experiences

Objectives

Tele-mental health services can play an important role in overcoming barriers in mental health services in the Eastern Mediterranean Region. However, despite its potential, tele-mental health has not been widely adopted in Oman. This study is an exploratory investigation into the experiences of therapists and their clients in utilizing video-based tele-mental health care during the COVID-19 pandemic.

Methods

A total of 19 semistructured qualitative interviews were individually conducted, it included 13 adult clients with mental health conditions who received video-based tele-mental health care and six clinical psychologists who provided video-based tele-mental health care during the COVID-19 pandemic.

Results

The clients reported favorable experiences using tele-mental health, with the primary benefits being convenience, easy accessibility to subspecialized care, reduced absenteeism from work with commuting costs, and alleviated mental health stigma. The therapists also expressed experiencing benefits from tele-mental health, such as reduced risk of intrahospital infection, reduced healthcare costs, and the achievement of work-life balance. Primary concerns were related to the lack of public tele-mental health services, lack of specified tele-mental health guidelines, shortage of trained therapists, limited access to high-speed Internet, electronic devices, privacy, and concerns toward the security of telehealth systems in general.

Conclusion

Clients and therapists report that tele-mental health offers new opportunities to improve the quality of mental healthcare services in Oman, and that the challenges could be resolved by establishing governmental tele-mental health services along with developing tele-mental health guidelines and implementing local postgraduate clinical psychology programs in universities in Oman.

COVID-19-Related Psychological Trauma and Psychological Distress Among Community-Dwelling Psychiatric Patients: People Struck by Depression and Sleep Disorders Endure the Greatest Burden

COVID-19 has created a general state of worry and distress, especially among vulnerable groups such as those with psychiatric diagnoses. Worldwide, psychiatric care provision has drastically suffered during the pandemic, with many patients unable to access proper care, which may have implications for increased mental health consequences in patients with psychiatric disorders (e.g., relapse and suicide). This cross-sectional study used structural equation modeling to investigate COVID-19-related trauma and distress among Arab psychiatric population during COVID-19 quarantine. Patients with pre-existing psychiatric disorders (N = 168) completed an online survey that comprised the Depression Anxiety Stress Scale 21 (DASS-21), the Impact of Event Scale-Revised (IES-R), and a questionnaire on COVID-19-related attitudes/perceptions, sources of information, used protective measures, and socio-demographic information. Respondents commonly reported feeling down-hearted/blue, trouble concentrating, along with symptoms of avoidance and rumination related to the pandemic. Patients with depression and sleep disorders expressed higher COVID-19-related trauma than patients with other disorders. Perceived physical health mediated the effect of co-morbid chronic physical disorders on COVID-19 trauma, psychological distress, perceived vulnerability to COVID-19, and perceived likelihood of recovery in case of contracting COVID-19. Perceived physical health and perceived vulnerability to COVID-19 were strong direct predictors of COVID-19-related trauma and psychological distress. Staying at home negatively predicted COVID-19 trauma and exerted an indirect negative effect on psychological distress via COVID-19 trauma. COVID-19 trauma, age, and marital status directly predicted psychological distress, with COVID-19 trauma being the strongest predictor. Educational level, income, having family members working in the medical field, keeping up to date with the news on deaths/infected cases or the development of COVID-19 drugs or vaccines, satisfaction with available information on COVID-19, and using different protective measures were not associated with significant differences in COVID-19 trauma and psychological distress scores. Immuno-psychiatric interventions should be designed to target COVID-19-trauma and distress among younger single patients with perceived poor physical health, especially those diagnosed with depression and sleep disorders.

The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future

During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients' privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals' and patients' awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.

The (mis)government in the COVID-19 pandemic and the psychosocial implications: discipline, subjection, and subjectivity

Abstract Objective: to analyze the psychosocial implications arising from the COVID-19 pandemic, reported in online service, from the perspective of Michel Foucault’s concepts of biopower, biopolitics and governmentality. Method: qualitative documental research, with analysis of medical records of users assisted in a therapeutic listening chat, between April and October 2020. Results: the data were organized into two themes: Governmentality in the COVID-19 pandemic and the production of psychosocial implications of anxiety and fear and Discipline and subjection in the COVID-19 pandemic: subjectivities marked by sadness and anguish. The first demonstrates that the “art of governing” in Brazil produced instabilities and uncertainties that influenced the production of fear of contamination/death/and non-access to treatment and anxiety. In the second theme, we can see how disciplinary control and biopolitical regulation are combined. In Brazil, an extremely unequal country, subjectivity and subjectivities marked by anguish, feelings of discouragement and sadness have been produced. Conclusion: the exclusionary processes were deepened in the pandemic, with the exercise of a biopolitics that makes life precarious and produces psychological distress.

Psychological impact of the COVID-19 pandemic on individuals with serious mental disorders: A systematic review of the literature

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic is having a great impact on individuals from all over the world, particularly on individuals with mental disorders. Several studies found more pronounced psychiatric symptoms, notably symptoms of depression and anxiety.

AIM

To assess the situation of patients with serious mental illness (SMI: Affective disorders and schizophrenia) regarding their mental health outcome during the pandemic.

METHODS

A systematic search using the databases PubMed and MEDLINE was conducted, employing the key words “COVID-19”, “SARS-CoV-2”, “psychiatric/mental disorder/illness”, “affective/mood disorder”, “bipolar disorder”, “(major) depression”, “schizoaffective disorder”, and “schizophrenia”. Studies that had been published up until January 9, 2021 were included. Information of studies in languages other than English and German was mostly taken from their English abstracts.

RESULTS

The literature search concluded in the finding of 36 studies containing relevant clinical data. A general impairment of the mental health of individuals with SMI could be detected, particularly in individuals with affective disorders, as compared to those with schizophrenia. Compared to healthy controls, symptoms of anxiety, depression, and stress were more pronounced in individuals with SMI. Relevant factors found that impacted their mental health were age, resilience, and socioeconomic environment, especially the shortage of mental health services, lack of social support, and inadequate information about COVID-19.

CONCLUSION

In light of these results, mental health services should be reinforced, notably the use of telemental health services. Furthermore, supplying individuals with SMI with adequate information about the COVID-19 pandemic and increasing their resilience is important. When researching the impact of the COVID-19 pandemic on individuals with SMI, standardization as well as follow-up studies are needed to enable better comparability and understanding.

Change Management and Digital Innovations in Hospitals of Five European Countries

The objective of the paper is to evaluate the quality of systemic change management (CHM) and readiness for change in five Central European countries. The secondary goal is to identify trends and upcoming changes in the field of digital innovations in healthcare. The results show that all compared countries (regardless of their historical context) deal with similar CHM challenges with a rather similar degree of success. A questionnaire distributed to hospitals clearly showed that there is still considerable room for improvement in terms of the use of specific CHM tools. A review focused on digital innovations based on the PRISMA statement showed that there are five main directions, namely, data collection and integration, telemedicine, artificial intelligence, electronic medical records, and M-Health. In the hospital environment, there are considerable reservations in applying change management principles, as well as the absence of a systemic approach. The main factors that must be monitored for a successful and sustainable CHM include a clearly defined and widely communicated vision, early engagement of all stakeholders, precisely set rules, adaptation to the local context and culture, provision of a technical base, and a step-by-step implementation with strong feedback.

Health policy experts' perspectives on implementing mental health specialist video consultations in routine primary care - a qualitative interview study

BACKGROUND

Many patients with mental disorders are treated by their general practitioner (GP). Innovative technology-based integrated care models (e.g., mental health specialist video consultations) have been proposed to facilitate access to specialist services in primary care settings. While perspectives of patients and providers have been examined, there is little insight into the perspectives of health policy experts on such models. The purpose of this study was to examine the perspectives of health policy experts on (1) current challenges for continuity of care, (2) anticipated benefits and barriers for implementation of mental health specialist video consultations along with (3) practical and regulative preconditions for sustained implementation in primary care.

METHODS

In a cross-sectional qualitative study, we conducted 15 semi-structured interviews with health policy experts representing various stakeholders in the German health care system: health insurances, governmental bodies, clinicians' professional associations, and patient representatives. Following a critical realism approach, we applied a qualitative inductive content analysis to derive key themes from the material.

RESULTS

Health policy experts saw long waiting times for patients and a lack of collaboration between in- and outpatient mental health services as well as mental health specialists and GPs as main barriers for current continuity of care. Health policy experts also felt that video consultations bear great potential to foster coordinated care between GPs and specialists and ensure timely referral for severely burdened patients. Increased workload for the general practice staff to facilitate video consultations and difficulties in establishing reliable therapeutic alliances between patients and specialists via remote treatment were considered as major barriers. Health policy experts varied significantly in their level of knowledge concerning legal frameworks and regulations pertaining to video consultations. However, the implementation of appropriate reimbursement schemes and sufficient data protection were regarded as the major regulative challenges.

CONCLUSIONS

Health policy experts mostly consider mental health specialist video consultations as a promising way to overcome current challenges for the management of patients with mental disorders at the interface between primary and specialist care. To ensure sustained implementation, a multi-stakeholder approach accounting for the perspective of health policy experts, patients, and providers should be followed.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00012487.

Online consultations in mental healthcare during the COVID-19 outbreak: An international survey study on professionals' motivations and perceived barriers

INTRODUCTION

While the general uptake of e-mental health interventions remained low over the past years, physical distancing and lockdown measures relating to the COVID-19 pandemic created a need and demand for online consultations in only a matter of weeks.

OBJECTIVE

This study investigates the uptake of online consultations provided by mental health professionals during lockdown measures in the first wave of the COVID-19 pandemic in the participating countries, with a specific focus on professionals' motivations and perceived barriers regarding online consultations.

METHODS

An online survey on the use of online consultations was set up in March 2020. The Unified Theory of Acceptance and Use of Technology (UTAUT) guided the deductive qualitative analysis of the results.

RESULTS

In total, 2082 mental health professionals from Austria, Belgium, Cyprus, France, Germany, Italy, Lebanon, Lithuania, the Netherlands, Norway, Portugal, Spain, and Sweden were included. The results showed a high uptake of online consultations during the COVID-19 pandemic but limited previous training on this topic undergone by mental health professionals. Most professionals reported positive experiences with online consultations, but concerns about the performance of online consultations in a mental health context (e.g., in terms of relational aspects) and practical considerations (e.g., relating to privacy and security of software) appear to be major barriers that hinder implementation.

CONCLUSIONS

This study provides an overview of the mental health professionals' actual needs and concerns regarding the use of online consultations in order to highlight areas of possible intervention and allow the implementation of necessary governmental, educational, and instrumental support so that online consultations can become a feasible and stable option in mental healthcare.

A national telemedicine program in the Kingdom of Jordan - Editorial

The coronavirus disease 2019 (COVID19) is on the rise in the Kingdom of Jordan. The healthcare system is under pressure to handle the increasing numbers of COVID19 cases while providing routine and emergent care to the population. Telemedicine represents an opportunity to utilize during the pandemic. The feasibility of telemedicine in Jordan has been established in a few small projects over the past two decades. Here, we present a timely proposal for a national telemedicine program to be designed and deployed during the pandemic and sustain after the pandemic. Further, we identify the stakeholders and the steps to design and implement the program.

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Telemedicine is feasible in the Kingdom of Jordan.

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A National telemedicine program is lacking but is needed in the setting of the coronavirus pandemic and beyond.

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Identified key stakeholders for a national telemedicine program.

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Proposed the key steps for the design and implementation of a national telemedicine program.