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Qin K, Yu Y, Cai H, Li J, Zeng J, Liang H. Effectiveness of mindfulness-based intervention in schizophrenia: A meta-analysis of randomized controlled trials. Psychiatry Res 2024; 334:115808. [PMID: 38402743 DOI: 10.1016/j.psychres.2024.115808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
Schizophrenia poses significant societal challenges, including interpersonal tension, an increased risk of suicide, and soaring medical costs. Although antipsychotics can prevent relapses, they often give rise to adverse effects and do not provide lasting relief. Mindfulness-based interventions (MBI) emerge as a hopeful avenue for improving outcomes. However, existing research and meta-analyses of the efficacy of MBI in schizophrenia remain limited. This study aimed to evaluate the efficacy of MBI as an adjunctive therapy for schizophrenia. Relevant randomized controlled trials (RCTs) were searched across PubMed, Embase, Web of Science, and Cochrane Library from inception dates up to January 12, 2023. Statistical analyses were conducted using Stata software (version 15.0) and Review Manager 5.4. The quality of the included RCTs was assessed using the revised Cochrane risk of bias tool. A total of 18 RCTs were included, with 675 patients and 704 health controls. Our meta-analysis revealed that MBI significantly improved psychosocial function, insight, and mindfulness in individuals with schizophrenia. The quality of the included RCTs had a low to moderate risk of bias. These findings suggest that MBI holds promise for improving the mental health of individuals with schizophrenia.
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Affiliation(s)
- Keke Qin
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Yong Yu
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China.
| | - Huiling Cai
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Jiahong Li
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Jingyuan Zeng
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
| | - Huolan Liang
- School of Politics and Public Administration, Guangxi Normal University, No. 15 Yucai Road, Qixing District, Guilin City, Guangxi Province 541004, China
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Seiler JPH, Zerr K, Rumpel S, Tüscher O. High state boredom vastly affects psychiatric inpatients and predicts their treatment duration. Transl Psychiatry 2023; 13:350. [PMID: 37973905 PMCID: PMC10654381 DOI: 10.1038/s41398-023-02650-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/23/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
Boredom is a ubiquitous, aversive human experience typically elicited by low information and monotony. Boredom can occur either as a transient mental state that prompts individuals to adapt their behavior to avoid monotony or as a temporally stable trait, describing a chronic susceptibility to feeling bored. Increased trait boredom was found to correlate with various psychopathologies and indicators of mental burden. However, the role of state boredom in psychopathological conditions and its implications for psychiatric treatment remain elusive. Here, we address this issue by investigating state boredom and trait boredom in a cohort of psychiatric inpatients and a healthy control cohort. We find that in both groups, state boredom, even more than trait boredom, shows remarkable associations with psychopathology. In the inpatient group, state boredom is implicated broadly in multiple mental disorders and shows an association with treatment in closed psychiatric wards. Furthermore, through statistical modeling, we find that high-state boredom during inpatient therapy is predictive of a longer therapy duration. Thus, we show that state boredom constitutes an indicator of mild and severe psychopathology in different mental disorders, affecting the outcome of psychiatric patients. Potential therapeutic interventions are discussed, aiming to enhance information flow in the brain in order to alleviate boredom in clinical settings.
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Affiliation(s)
- Johannes P-H Seiler
- Institute of Physiology, Focus Program Translational Neurosciences, University Medical Center of the Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 19, 55131, Mainz, Germany.
| | - Katharina Zerr
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
- Leibniz Institute for Resilience Research, Wallstraße 7, 55122, Mainz, Germany
| | - Simon Rumpel
- Institute of Physiology, Focus Program Translational Neurosciences, University Medical Center of the Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 19, 55131, Mainz, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
- Leibniz Institute for Resilience Research, Wallstraße 7, 55122, Mainz, Germany
- Institute of Molecular Biology, Ackermannweg 4, 55128, Mainz, Germany
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Shen H, Zhang L, Li Y, Zheng D, Du L, Xu F, Xu C, Liu Y, Shen J, Li Z, Cui D. Mindfulness-based intervention improves residual negative symptoms and cognitive impairment in schizophrenia: a randomized controlled follow-up study. Psychol Med 2023; 53:1390-1399. [PMID: 36468948 PMCID: PMC10009398 DOI: 10.1017/s0033291721002944] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 07/03/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Residual negative symptoms and cognitive impairment are common for chronic schizophrenia patients. The aim of this study was to investigate the efficacy of a mindfulness-based intervention (MBI) on negative and cognitive symptoms of schizophrenia patients with residual negative symptoms. METHODS In this 6-week, randomized, single-blind, controlled study, a total of 100 schizophrenia patients with residual negative symptoms were randomly assigned to the MBI or control group. The 6-week MBI group and the control group with general rehabilitation programs maintained their original antipsychotic treatments. The scores for the Positive and Negative Syndrome Scale (PANSS), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Symptom Checklist 90 (SCL-90) were recorded at baseline and week 6 to assess psychotic symptoms, cognitive performance, and emotional state, respectively. RESULTS Compared with general rehabilitation programs, MBI alleviated the PANSS-negative subscore, general psychopathology subscore, and PANSS total score in schizophrenia patients with residual negative symptoms (F = 33.77, pBonferroni < 0.001; F = 42.01, pBonferroni < 0.001; F = 52.41, pBonferroni < 0.001, respectively). Furthermore, MBI improved RBANS total score and immediate memory subscore (F = 8.80, pBonferroni = 0.024; F = 11.37, pBonferroni = 0.006), as well as SCL-90 total score in schizophrenia patients with residual negative symptoms (F = 18.39, pBonferroni < 0.001). CONCLUSIONS Our results demonstrate that MBI helps schizophrenia patients with residual negative symptoms improve clinical symptoms including negative symptom, general psychopathology symptom, and cognitive impairment. TRIAL REGISTRATION ChiCTR2100043803.
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Affiliation(s)
- Hui Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhuan Li
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Denise Zheng
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lizhao Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Med-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feikang Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuchen Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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Sharma G, Schlosser L, Jones BDM, Blumberger DM, Gratzer D, Husain MO, Mulsant BH, Rappaport L, Stergiopoulos V, Husain MI. Brief App-Based Cognitive Behavioral Therapy for Anxiety Symptoms in Psychiatric Inpatients: Feasibility Randomized Controlled Trial. JMIR Form Res 2022; 6:e38460. [DOI: 10.2196/38460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background
Psychiatric inpatients often have limited access to psychotherapeutic education or skills for managing anxiety, a common transdiagnostic concern in severe and acute mental illness. COVID-19–related restrictions further limited access to therapy groups on inpatient psychiatric units. App-based interventions may improve access, but evidence supporting the feasibility of their use, acceptability, and effectiveness in psychiatric inpatient settings is limited. MindShift CBT is a free app based on cognitive behavioral therapy principles with evidence for alleviating anxiety symptoms in the outpatient setting.
Objective
We aimed to recruit 24 participants from an acute general psychiatric inpatient ward to a 1-month randomized control study assessing the feasibility and acceptability of providing patients with severe and acute mental illness access to the MindShift CBT app for help with managing anxiety symptoms.
Methods
Recruitment, data collection, analysis, and interpretation were completed collaboratively by clinician and peer researchers. Inpatients were randomized to two conditions: treatment as usual (TAU) versus TAU plus use of the MindShift CBT app over 6 days. We collected demographic and quantitative data on acceptability and usability of the intervention. Symptoms of depression, anxiety, and psychological distress were measured in pre- and poststudy surveys for preliminary signals of efficacy. We conducted individual semistructured interviews with participants in the MindShift CBT app group at the end of their trial period, which were interpreted using a standardized protocol for thematic analysis.
Results
Over 4 weeks, 33 inpatients were referred to the study, 24 consented to participate, 20 were randomized, and 11 completed the study. Of the 9 randomized participants who did not complete the study, 7 were withdrawn because they were discharged or transferred prior to study completion, with a similar distribution among both conditions. Among the enrolled patients, 65% (13/20) were admitted for a psychotic disorder and no patient was admitted primarily for an anxiety disorder. The average length of stay was 20 days (SD 4.4; range 3-21) and 35% (7/20) of patients were involuntarily admitted to hospital. Small sample sizes limited accurate interpretation of the efficacy data. Themes emerging from qualitative interviews included acceptability and usability of the app, and patient agency associated with voluntary participation in research while admitted to hospital.
Conclusions
Our study benefitted from collaboration between peer and clinician researchers. Due to rapid patient turnover in the acute inpatient setting, additional flexibility in recruitment and enrollment is needed to determine the efficacy of using app-based psychotherapy on an acute psychiatric ward. Despite the limited sample size, our study suggests that similar interventions may be feasible and acceptable for acutely unwell inpatients. Further study is needed to compare the efficacy of psychotherapeutic apps with existing standards of care in this setting.
Trial Registration
ClinicalTrials.gov NCT04841603; https://clinicaltrials.gov/ct2/show/NCT04841603
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International PRISMA scoping review to understand mental health interventions for depression in COVID-19 patients. Psychiatry Res 2022; 316:114748. [PMID: 35944370 PMCID: PMC9313534 DOI: 10.1016/j.psychres.2022.114748] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 01/19/2023]
Abstract
Preliminary research indicates that the COVID-19 illness affects the mental well-being of patients. This scoping review, thus, aims to examine the current state of research into mental health treatments for depression symptoms in COVID-19 patients. Select databases were searched on 7/1/2021. Full-text articles involved (1) mental health treatment (2) suicide and/or depression outcomes, (3) a quasi-experimental research trial, and (4) a primary analysis. 11 articles were included in this review. The studies spanned 5 countries, and demonstrated immediate positive effects of mental health treatments and tele-health as a treatment modality for depression in COVID-19 patients. 6 studies were randomized controlled trials. Various treatments were administered, including cognitive behavior therapy, mindfulness, and muscle relaxation. Most interventions were conducted in in-patient units and focused on acute symptoms. There were limitations in the design and description of methodology in many studies, which affects the generalizability and replicability of positive findings. Only two studies included a post-intervention follow-up and one study assessed suicide risk. Thus, this review found there is a pressing need for more research in the area, with greater rigor in study methodology, and for treatments targeting long-term symptoms and suicidality, and outpatient services.
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Metri NJ, Ee C, Wardle J, Ng CH, Siskind D, Brakoulias V, Ho FYY, Wong VWH, Naidoo U, Eaton M, Firth J, Sarris J. Assessing dietary, exercise, and non-pharmacological modalities within psychiatric hospitals. Gen Hosp Psychiatry 2022; 76:31-35. [PMID: 35358900 DOI: 10.1016/j.genhosppsych.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Najwa-Joelle Metri
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
| | - Chee H Ng
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Richmond, Victoria, Australia
| | - Dan Siskind
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Vlasios Brakoulias
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia; Western Sydney Local Health District Mental Health Services, Sydney, NSW, Australia
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
| | | | - Uma Naidoo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Melissa Eaton
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, Richmond, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Morton E, Nicholas J, Yang L, Lapadat L, Barnes SJ, Provencher MD, Depp C, Chan M, Kulur R, Michalak EE. Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management. Int J Bipolar Disord 2022; 10:10. [PMID: 35368207 PMCID: PMC8977125 DOI: 10.1186/s40345-022-00256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Individuals with bipolar disorder (BD) are increasingly turning to smartphone applications (apps) for health information and self-management support. While reviews have raised concerns regarding the effectiveness and safety of publicly available apps for BD, apps surveyed may not reflect what individuals with BD are using. The present study had two aims: first, to characterize the use of health apps to support mood and sleep amongst people with BD, and second, to evaluate the quality, safety and functionality of the most commonly used self-management apps. Methods A web-based survey was conducted to explore which apps people with BD reported using to support self-management of mood and sleep. The characteristics of the most commonly nominated apps were described using a standardized framework, including their privacy policy, clinical foundations, and functionality. Results Respondents (n = 919) were 77.9% female with a mean age of 36.9 years. 41.6% of participants (n = 382) reported using a self-management app to support mood or sleep. 110 unique apps were nominated in relation to mood, and 104 unique apps nominated in relation to sleep; however, most apps were only mentioned once. The nine most frequently nominated apps related to mood and sleep were subject to further evaluation. All reviewed apps offered a privacy policy, however user control over data was limited and the complexity of privacy policies was high. Only one app was developed for BD populations. Half of reviewed apps had published peer-reviewed evidence to support their claims of efficacy, but little research was specific to BD. Conclusion Findings illustrate the potential of smartphone apps to increase the reach of psychosocial interventions amongst people with BD. Apps were largely created by commercial developers and designed for the general population, highlighting a gap in the development and dissemination of evidence-informed apps for BD. There may be risks in using generic health apps for BD self-management; clinicians should enquire about patients’ app use to foster conversations about their particular benefits and limitations. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00256-6.
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Chan AHY, Honey MLL. User perceptions of mobile digital apps for mental health: Acceptability and usability - An integrative review. J Psychiatr Ment Health Nurs 2022; 29:147-168. [PMID: 33604946 DOI: 10.1111/jpm.12744] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 01/16/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mobile mental health apps are increasingly being used by both mental health nurses to promote individual self-managemental of mental health conditions and by consumers. Perceptions about specific apps are known, but the overarching acceptability and usability of mental health apps in general less understood. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper identified consumer perceptions of mobile mental health apps. Six key areas were identified that future mobile app developers should consider to maximize consumer engagement with mental health apps. Consumers also highlighted that apps do not replace traditional mental health nursing-rather these supplement existing care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review found that mental health apps are generally viewed positively by consumers; however, factors such as ease of use, usefulness of content and privacy need to be considered to maximise and sustain app engagement. ABSTRACT: Introduction There is increasing interest in the use of mobile mental health applications (apps) to manage mental health conditions. Understanding user perceptions is key to maximise app engagement and inform how apps can be used to support mental health nursing care. Aim This integrative review explores consumers' perceptions of mobile mental health apps to gain insight into user preferences and acceptability. Methods This integrative review was based on searching four databases: CINAHL, EMBASE, Medline, PsycInfo. Inclusion criteria were: (i) articles published after 2000; (ii) focused on apps for mental health disorders; (iii) explored consumers' perception of using a mental health app. Abstracts were screened and eligible papers reviewed. Data on user perceptions were extracted and analysed thematically. Results Seventeen articles were identified. Overall, consumers did not feel that app use replaced traditional health care. Six themes were identified: "Helpfulness," "Improvements/enhancements," "Technical issues," "Easy to use," "Satisfaction with the app" and "Perceived issues." Consumers indicated a preference for personalization for the app to meet individual needs. Discussion and Implications for Practice Mental health apps are generally viewed positively by consumers; however, factors such as ease of use, usefulness of content and privacy need to be considered to maximise and sustain app engagement.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, University of Auckland, Auckland, New Zealand
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Teepe GW, Da Fonseca A, Kleim B, Jacobson NC, Salamanca Sanabria A, Tudor Car L, Fleisch E, Kowatsch T. Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review. J Med Internet Res 2021; 23:e29412. [PMID: 34309569 PMCID: PMC8512178 DOI: 10.2196/29412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/06/2021] [Accepted: 07/26/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The number of smartphone apps that focus on the prevention, diagnosis, and treatment of depression is increasing. A promising approach to increase the effectiveness of the apps while reducing the individual's burden is the use of just-in-time adaptive intervention (JITAI) mechanisms. JITAIs are designed to improve the effectiveness of the intervention and reduce the burden on the person using the intervention by providing the right type of support at the right time. The right type of support and the right time are determined by measuring the state of vulnerability and the state of receptivity, respectively. OBJECTIVE The aim of this study is to systematically assess the use of JITAI mechanisms in popular apps for individuals with depression. METHODS We systematically searched for apps addressing depression in the Apple App Store and Google Play Store, as well as in curated lists from the Anxiety and Depression Association of America, the United Kingdom National Health Service, and the American Psychological Association in August 2020. The relevant apps were ranked according to the number of reviews (Apple App Store) or downloads (Google Play Store). For each app, 2 authors separately reviewed all publications concerning the app found within scientific databases (PubMed, Cochrane Register of Controlled Trials, PsycINFO, Google Scholar, IEEE Xplore, Web of Science, ACM Portal, and Science Direct), publications cited on the app's website, information on the app's website, and the app itself. All types of measurements (eg, open questions, closed questions, and device analytics) found in the apps were recorded and reviewed. RESULTS None of the 28 reviewed apps used JITAI mechanisms to tailor content to situations, states, or individuals. Of the 28 apps, 3 (11%) did not use any measurements, 20 (71%) exclusively used self-reports that were insufficient to leverage the full potential of the JITAIs, and the 5 (18%) apps using self-reports and passive measurements used them as progress or task indicators only. Although 34% (23/68) of the reviewed publications investigated the effectiveness of the apps and 21% (14/68) investigated their efficacy, no publication mentioned or evaluated JITAI mechanisms. CONCLUSIONS Promising JITAI mechanisms have not yet been translated into mainstream depression apps. Although the wide range of passive measurements available from smartphones were rarely used, self-reported outcomes were used by 71% (20/28) of the apps. However, in both cases, the measured outcomes were not used to tailor content and timing along a state of vulnerability or receptivity. Owing to this lack of tailoring to individual, state, or situation, we argue that the apps cannot be considered JITAIs. The lack of publications investigating whether JITAI mechanisms lead to an increase in the effectiveness or efficacy of the apps highlights the need for further research, especially in real-world apps.
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Affiliation(s)
- Gisbert W Teepe
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Ashish Da Fonseca
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Birgit Kleim
- Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Departments of Biomedical Data Science and Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Alicia Salamanca Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Elgar Fleisch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
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10
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Haliwa I, Ford CG, Wilson JM, Shook NJ. A Mixed-Method Assessment of a 10-Day Mobile Mindfulness Intervention. Front Psychol 2021; 12:722995. [PMID: 34531801 PMCID: PMC8438152 DOI: 10.3389/fpsyg.2021.722995] [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: 06/09/2021] [Accepted: 08/02/2021] [Indexed: 01/08/2023] Open
Abstract
Mobile mindfulness interventions represent a promising alternative to traditional in-person interventions that are resource demanding and have limited accessibility, preventing use by many populations. Despite greater accessibility and popularity of mobile mindfulness applications (apps), research is needed testing the effectiveness of brief interventions delivered via these platforms. The present study assessed the efficacy of a brief mobile mindfulness intervention compared to an active control for increasing state and trait mindfulness and improving mood, as well as the acceptability of the app, in a sample of undergraduate students. Participants (N=139; Mage=19.43years, 80.6% female, 83.5% White) were randomly assigned to either a 10-day mobile mindfulness (Headspace) or cognitive training (Peak) condition. Trait mindfulness was measured pre- and post-intervention. During the 10-day intervention, participants completed 10-min daily exercises on the assigned app, responded to daily questionnaires of state mindfulness and mood, and completed a daily written log of their reactions to the app exercises. Attrition was low (90% completion rate) and did not differ by condition. Participants in the mindfulness condition spent an average of 88.15min (SD=24.75) meditating out of the full 100min prescribed by the intervention. State mindfulness significantly increased across the 10-day intervention for participants in the mindfulness, but not the cognitive training, condition beginning around days 5 and 6. Some aspects of trait mindfulness increased and mood improved from pre- to post-intervention, but these changes were observed in both conditions (i.e., no significant differences were observed by condition). Qualitative analysis of open-ended reactions to the mindfulness app indicated that participants reported more likes than dislikes. Common themes for likes were that participants experienced feelings of calm and focus following the daily mindfulness exercises. Dislikes included discomfort and anxiety associated with increased awareness of thoughts and physical sensations. These findings suggest that while a brief mobile mindfulness intervention is acceptable to undergraduate college students and effective at increasing state mindfulness, a longer intervention may be needed in order to elicit corresponding changes in trait-level mindfulness or mood.
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Affiliation(s)
- Ilana Haliwa
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Cameron G Ford
- Department of Psychology, West Virginia University, Morgantown, WV, United States.,NOVA Behavioral Healthcare Corporation, Goldsboro, NC, United States
| | - Jenna M Wilson
- Department of Psychology, West Virginia University, Morgantown, WV, United States
| | - Natalie J Shook
- Department of Psychology, West Virginia University, Morgantown, WV, United States.,School of Nursing, University of Connecticut, Storrs, CT, United States
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11
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Ball E, Rivas C. Health Apps Require Co-development to Be Acceptable and Effective. Front Psychol 2021; 12:714453. [PMID: 34335428 PMCID: PMC8322940 DOI: 10.3389/fpsyg.2021.714453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Elizabeth Ball
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, London, United Kingdom.,Women's Health Research Unit, Yvonne Carter Building, Queen Mary University of London, London, United Kingdom.,Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, London, United Kingdom
| | - Carol Rivas
- Social Research Institute, University College London, London, United Kingdom
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Mahlo L, Windsor TD. Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Mindfulness-Meditation Program Among Older Adults. THE GERONTOLOGIST 2021; 61:775-786. [PMID: 32663286 DOI: 10.1093/geront/gnaa093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Few studies have focused on the utility of mindfulness-meditation for well-being in older adults. The present study investigated the feasibility, acceptability, and preliminary efficacy of an app-based mindfulness-meditation program among older adults. RESEARCH DESIGN AND METHODS A community-based sample of 46 participants aged between 63 and 81 (M = 70.85, SD = 4.70) engaged with a 30-day app-based mindfulness-meditation program for 10 min daily on their smartphones. Each meditation session comprised focusing on the breath, mentally scanning the body, monitoring the mind's activity, and cultivating a nonjudgmental orientation toward experiences. Participants completed questionnaires at baseline, day 10, and day 30. RESULTS On average, participants completed 25 sessions and almost 4 h of application use across the 30 days. Results of linear mixed effects models showed significant improvements in positive affect, negative affect, and life satisfaction across the study interval, but no meaningful change in total mindfulness or perceived stress. Furthermore, relative to high levels of smartphone efficacy, low smartphone efficacy was associated with higher perceived stress and negative affect, and less life satisfaction at baseline; and steeper improvements on these outcomes across the study interval. On average, older adults rated the app-based mindfulness-meditation training as interesting, enjoyable, valuable, and useful. DISCUSSION AND IMPLICATIONS The findings provide preliminary support for the feasibility and acceptability of an app-based mindfulness-meditation program with community-dwelling older adults and demonstrate potential benefits for well-being. Results suggest the value of further research investigating the efficacy of digital mindfulness-meditation interventions for older adults via larger randomized controlled trials.
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Affiliation(s)
- Leeann Mahlo
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Tim D Windsor
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
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Iliescu R, Kumaravel A, Smurawska L, Torous J, Keshavan M. Smartphone ownership and use of mental health applications by psychiatric inpatients. Psychiatry Res 2021; 299:113806. [PMID: 33667947 DOI: 10.1016/j.psychres.2021.113806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/11/2021] [Indexed: 12/20/2022]
Abstract
Little is known about the use of mental health smartphone applications during the greatest period of vulnerability - immediately following discharge from a psychiatric inpatient unit. Currently, no data are available regarding smartphone ownership or technology literacy of individuals who receive inpatient psychiatric treatment. The goal of this study was to determine psychiatric inpatients' smartphone ownership, current uses of, and interest in utilizing apps to aid in mental health treatment after discharge. A single time point self-report survey was given to patients prior to discharge from a psychiatric inpatient unit at a major academic hospital in a metropolitan area of the United States. Of the 101 survey respondents, 82.8% indicated that they own a smartphone, and over 70% indicated that they use smartphone apps, can access the internet from their phones, and use social media. While only 25.3% reported that they currently use a mental health app, a majority of respondents (53.2%) expressed interest in using such apps in the future, and almost 60% would use those apps to track their mental health. Our data suggest that there is significant untapped potential for utilizing smartphone applications for psychiatric monitoring and treatment following discharge from an inpatient psychiatric unit.
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Affiliation(s)
- Radu Iliescu
- Beth Israel Deaconess Medical Center, Department of Psychiatry, 330 Brookline Avenue, Boston, MA 02215, United States.
| | - Arthi Kumaravel
- Beth Israel Deaconess Medical Center, Department of Psychiatry, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Liliana Smurawska
- Beth Israel Deaconess Medical Center, Department of Psychiatry, 330 Brookline Avenue, Boston, MA 02215, United States
| | - John Torous
- Beth Israel Deaconess Medical Center, Department of Psychiatry, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center, Department of Psychiatry, 330 Brookline Avenue, Boston, MA 02215, United States
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Muñoz AO, Camacho E, Torous J. Marketplace and Literature Review of Spanish Language Mental Health Apps. Front Digit Health 2021; 3:615366. [PMID: 34713093 PMCID: PMC8521936 DOI: 10.3389/fdgth.2021.615366] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Language differences between patients and providers remains a barrier to accessing health care, especially mental health services. One potential solution to reduce inequities for patients that speak different languages and improve their access to care is through the delivery of healthcare through mobile technology. Given that the Latinx community serves as the largest ethnic minority in the United States, this two-phased review examines Spanish app development, feasibility and efficacy. Phase 1 explored the commercial marketplace for apps available in Spanish, while phase 2 involved a literature review of published research centered around the creation, functions, and usability of these apps using the PubMed and Google Scholar electronic databases. Of the apps available on the database, only 14.5% of them had Spanish operability. The literature search uncovered 629 results, of which 12 research articles that tested or described 10 apps met the inclusion criteria. Of the 10 apps studied in this literature review, only four apps were translated to Spanish. Our study reveals that despite increasing interest in Spanish-language apps to address mental health, the commercial marketplace is not currently meeting the demand.
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Affiliation(s)
| | - Erica Camacho
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - John Torous
- Harvard Medical School, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
- *Correspondence: John Torous
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Pizarro-Ruiz JP, Ordóñez-Camblor N, Del-Líbano M, Escolar-LLamazares MC. Influence on Forgiveness, Character Strengths and Satisfaction with Life of a Short Mindfulness Intervention via a Spanish Smartphone Application. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:802. [PMID: 33477831 PMCID: PMC7832842 DOI: 10.3390/ijerph18020802] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 02/07/2023]
Abstract
Mindfulness-based interventions (MBI) are a recognized effective psychological practice characterized by attention control, awareness, acceptance, non-reactivity, and non-judgmental thinking obtained through the practice of meditation. They have been shown to be useful in reducing stress and enhancing well-being in different contexts. In this research, the effectiveness of an MBI was evaluated on variables that can promote successful job performance such as mindfulness trait, positive and negative affect, forgiveness, personality strengths and satisfaction with life. The intervention was carried out through a smartphone application called "Aire Fresco" (Fresh Air) during 14 days in the middle of the quarantine produced by the Covid-19 pandemic. The study sample was composed of 164 Spanish people who were distributed in two groups: control group and experimental group, which were evaluated before and after the intervention. The MANCOVA performed showed an overall positive effect of the intervention on the variables evaluated. The different ANCOVAs carried out showed that the intervention was beneficial in increasing mindfulness trait, reducing negative affect or increasing life satisfaction, among others. Our study is, as far as we know, the first to demonstrate the effectiveness of a brief intervention in mindfulness conducted using a smartphone application in Spanish.
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Affiliation(s)
- Juan Pablo Pizarro-Ruiz
- Educational Sciences Department, Faculty of Education, University of Burgos, 09001 Burgos, Spain; (J.P.P.-R.); (M.D.-L.)
| | - Nuria Ordóñez-Camblor
- Health Sciences Department, Faculty of Health Sciences, University of Burgos, 09001 Burgos, Spain;
| | - Mario Del-Líbano
- Educational Sciences Department, Faculty of Education, University of Burgos, 09001 Burgos, Spain; (J.P.P.-R.); (M.D.-L.)
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16
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Reyes AT, Serafica R, Sojobi A. College student veterans' experience with a mindfulness- and acceptance-based mobile app intervention for PTSD: A qualitative study. Arch Psychiatr Nurs 2020; 34:497-506. [PMID: 33280672 DOI: 10.1016/j.apnu.2020.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/25/2020] [Accepted: 09/07/2020] [Indexed: 12/13/2022]
Abstract
This study aimed to explore college student military veterans' experience with a mindfulness- and acceptance-based smartphone app intervention. Upon the 4-week participation in the intervention, 23 student veterans took part in semi-structured interviews. In the thematic analysis of the interview transcripts, three main themes emerged: (1) generating momentum of app use; (2) optimizing the functions and benefits of the app; and (3) resolving to deepen the practice of mindfulness and acceptance. Considering the low engagement rates of several previous app-based studies, our results provide a useful framework for incorporating human feedback and support in enhancing users' engagement with the app.
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Affiliation(s)
| | - Reimund Serafica
- School of Nursing, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Angela Sojobi
- School of Nursing, University of Nevada Las Vegas, Las Vegas, NV, USA
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Avalos LA, Aghaee S, Kurtovich E, Quesenberry C, Nkemere L, McGinnis MK, Kubo A. A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study. JMIR Ment Health 2020; 7:e17405. [PMID: 33180028 PMCID: PMC7691085 DOI: 10.2196/17405] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/21/2020] [Accepted: 09/22/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Approximately 20% of women suffer from postpartum depression (PPD). Due to barriers such as limited access to care, half of the women with PPD do not receive treatment. Therefore, it is critical to identify effective and scalable interventions. Traditional mindfulness programs have been effective in reducing depressive symptoms, however access remains a barrier. A self-paced mobile health (mHealth) mindfulness program may fit the lifestyle of busy mothers who are unable to attend in-person classes. However, little is known regarding the feasibility or efficacy of mHealth mindfulness interventions in postpartum women with depressive symptoms. OBJECTIVE This study aims to assess the feasibility, acceptability, and preliminary efficacy of an mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms. METHODS We conducted a single-arm feasibility trial of an mHealth mindfulness intervention within Kaiser Permanente Northern California (KPNC), a large integrated health care system. Participants were identified through clinician referral and electronic health records via KPNC's universal perinatal depression screening program and recruited by the study team. Inclusion criteria included the following: English-speaking, up to 6 months postpartum with a Patient Health Questionnaire (PHQ-8) score of 10 to 19, and no regular mindfulness/meditation practice. Participants were asked to use a mindfulness app, Headspace, 10 to 20 min/day for 6 weeks. Baseline and postintervention surveys captured data on patient-reported outcomes (depression and stress symptoms, sleep quality, and mindfulness). Semistructured interviews captured acceptability. Retention and adherence were used to assess feasibility. RESULTS Of the 115 women who were contacted and met the eligibility criteria or declined participation before eligibility assessment, 27 (23%) were enrolled. In addition, 70% (19/27) completed the study. The mean age of participants was 31 years (SD 5.2), 30% (8/27) were non-Hispanic White, and, on average, participants were 12.3 weeks postpartum (SD 5.7). Of the women who completed the study, 100% (19/19) used the Headspace app at least once, and nearly half (9/19, 47%) used the app on ≥50% of the days during the 6-week intervention period. Of the 16 participants who completed the postintervention interview, 69% (11/16) reported that they were very or extremely satisfied with the app. Interviews indicated that women appreciated the variety of meditations and felt that the program led to reduced anxiety and improved sleep. Significant improvements in pre- and postintervention scores were observed for depressive symptoms (PHQ-8: -3.8, P=.004), perceived stress (10-item Perceived Stress Scale: -6.0, P=.005), and sleep quality (Pittsburgh Sleep Quality Index: -2.1, P=.02, indicating less sleep disturbance). Improvements in mindfulness were also significant (Five Facet Mindfulness Questionnaire-Short Form: 10.9, P=.01). CONCLUSIONS An mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms is feasible and acceptable. An efficacy trial is warranted.
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Affiliation(s)
- Lyndsay A Avalos
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Sara Aghaee
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Elaine Kurtovich
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Charles Quesenberry
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Linda Nkemere
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - MegAnn K McGinnis
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
| | - Ai Kubo
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, United States
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Shen H, Chen M, Cui D. Biological mechanism study of meditation and its application in mental disorders. Gen Psychiatr 2020; 33:e100214. [PMID: 32695961 PMCID: PMC7359050 DOI: 10.1136/gpsych-2020-100214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/08/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
In recent years, research on meditation as an important alternative therapy has developed rapidly and been widely applied in clinical medicine. Mechanism studies of meditation have also developed progressively, showing that meditation has great impact on brain structure and function, and epigenetic and telomere regulation. In line with this, the application of meditation has gradually been expanded to mental illness, most often applied for major depressive disorders and substance-related and addictive disorders. The focus of this paper is to illustrate the biological mechanisms of meditation and its application in mental disorders.
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Affiliation(s)
- Hui Shen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meijuan Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donghong Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Rung AL, Oral E, Berghammer L, Peters ES. Feasibility and Acceptability of a Mobile Mindfulness Meditation Intervention Among Women: Intervention Study. JMIR Mhealth Uhealth 2020; 8:e15943. [PMID: 32442147 PMCID: PMC7298633 DOI: 10.2196/15943] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/14/2019] [Accepted: 01/30/2020] [Indexed: 01/30/2023] Open
Abstract
Background Traditional mindfulness-based stress reduction programs are resource intensive for providers and time- and cost-intensive for participants, but the use of mobile technologies may be particularly convenient and cost-effective for populations that are busy, less affluent, or geographically distant from skilled providers. Women in southern Louisiana live in a vulnerable, disaster-prone region and are highly stressed, making a mobile program particularly suited to this population. Objective This study aimed to (1) assess the feasibility and acceptability of a mobile mindfulness app in real-world conditions in a pilot study of a community sample of women residing in southern Louisiana, (2) describe predictors of app usage, and (3) assess the effect of the app on secondary health outcomes. Methods Women were recruited from an oil spill study on health. A total of 236 women completed a baseline survey, were offered the mobile mindfulness program, and completed a follow-up survey. Subjects were asked to download and use the app for at least 30 days for 10 min. All study procedures were completed on the web. Primary outcomes were feasibility and acceptability of the app and characteristics of app utilization. Secondary outcomes included mindfulness, depression, perceived stress, sleep quality, physical activity, BMI, and healthy eating. Results Overall, 74.2% (236/318) of subjects completed the follow-up survey, and 13.5% (43/318) used the app. The main barrier to app usage was lack of time, cited by 37% (16/43) of users and 48.7% (94/193) of nonusers of the app. Women who chose to use the app were more highly educated (16/43, 63% had a college education vs 65/193, 33.7% of nonparticipants; P<.001), had higher incomes (23/43, 58% had incomes >US $50,000 per year vs 77/193, 43.0% of nonparticipants), and were employed (34/43, 79% vs 122/193, 63.2% of nonparticipants; P=.047). Those who engaged with the app did so at high levels, with 72% (31/43) of participants self-reporting the completion of some or all sessions and 74% (32/43) reporting high levels of satisfaction with the app. Participation with the app had a beneficial impact on depression (odds ratio [OR] 0.3, 95% CI 0.11-0.81), sleep quality (OR 0.1, 95% CI 0.02-0.96), sleep duration (OR 0.3, 95% CI 0.07-0.86), sleep latency (OR 0.3, 95% CI 0.11-0.81), and physical activity (2.8 95% CI 1.0-7.8), but mindfulness scores did not change from baseline to follow-up. Conclusions The Headspace mobile mindfulness app was easy and cost-effective to implement and acceptable to those who participated, but few women elected to try it. The unique characteristics of this southern Louisiana population suggest that more intense promotion of the benefits of mindfulness training is needed, perhaps in conjunction with some therapist or researcher support. Several short-term benefits of the app were identified, particularly for depression and sleep.
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Affiliation(s)
- Ariane Lisann Rung
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States
| | - Evrim Oral
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States
| | | | - Edward S Peters
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States
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Miralles I, Granell C, Díaz-Sanahuja L, Van Woensel W, Bretón-López J, Mira A, Castilla D, Casteleyn S. Smartphone Apps for the Treatment of Mental Disorders: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e14897. [PMID: 32238332 PMCID: PMC7163422 DOI: 10.2196/14897] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/05/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders.
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Affiliation(s)
| | | | | | | | - Juana Bretón-López
- Universitat Jaume I, Castellón de la Plana, Spain.,CIBER of Physiopathology of Obesity and Nutrition CIBERobn, Castellón, Spain
| | - Adriana Mira
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Diana Castilla
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, Castellón, Spain.,Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
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Ball E, Newton S, Rohricht F, Steed L, Birch J, Dodds J, Cantalapiedra Calvete C, Taylor S, Rivas C. mHealth: providing a mindfulness app for women with chronic pelvic pain in gynaecology outpatient clinics: qualitative data analysis of user experience and lessons learnt. BMJ Open 2020; 10:e030711. [PMID: 32165550 PMCID: PMC7069307 DOI: 10.1136/bmjopen-2019-030711] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine whether a pre-existing smartphone app to teach mindfulness meditation is acceptable to women with chronic pelvic pain (CPP) and can be integrated into clinical practice within the National Health Service (NHS) CPP pathways, and to inform the design of a potential randomised clinical trial. DESIGN A prestudy patient and public involvement (PPI) group to collect feedback on the acceptability of the existing app and study design was followed by a three-arm randomised feasibility trial. In addition, we undertook interviews and focus groups with patients and staff to explore app usability and acceptability. We also obtained participant comments on the research process, such as acceptability of the study questionnaires. SETTING Two gynaecology clinics within Barts Health NHS, London, UK. PARTICIPANTS Patients with CPP lasting ≥6 months with access to smartphone or personal computer and understanding of basic English. INTERVENTION The intervention was mindfulness meditation content plus additional pain module delivered by a smartphone app. Active controls received muscle relaxation content from the same app. Passive (waiting list) controls received usual care. MAIN OUTCOME MEASURES Themes on user feedback, app usability and integration, and reasons for using/not using the app. RESULTS The use of the app was low in both active groups. Patients in the prestudy PPI group, all volunteers, were enthusiastic about the app (convenience, content, portability, flexibility, ease of use). Women contributing to the interview or focus group data (n=14), from a 'real world' clinic (some not regular app users), were less positive, citing as barriers lack of opportunities/motivation to use the app and lack of familiarity and capabilities with technology. Staff (n=7) were concerned about the potential need for extra support for them and for the patients, and considered the app needed organisational backing and peer acceptance. CONCLUSION The opinions of prestudy PPI volunteers meeting in their private time may not represent those of patients recruited at a routine clinic appointment. It may be more successful to codesign/codevelop an app with typical users than to adapt existing apps for use in real-world clinical populations. TRIAL REGISTRATION NUMBER ISRCTN10925965.
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Affiliation(s)
- Elizabeth Ball
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, London, UK
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
- Centre for Maternal and Child Health Research, City University London, London, UK
| | - Sian Newton
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Frank Rohricht
- Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Liz Steed
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | | | - Julie Dodds
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | | | - Stephanie Taylor
- Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Carol Rivas
- UCL Social Research Institute, University College London, London, UK
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Inal Y, Wake JD, Guribye F, Nordgreen T. Usability Evaluations of Mobile Mental Health Technologies: Systematic Review. J Med Internet Res 2020; 22:e15337. [PMID: 31904579 PMCID: PMC6971511 DOI: 10.2196/15337] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 12/31/2022] Open
Abstract
Background Many mobile health (mHealth) apps for mental health have been made available in recent years. Although there is reason to be optimistic about their effect on improving health and increasing access to care, there is a call for more knowledge concerning how mHealth apps are used in practice. Objective This study aimed to review the literature on how usability is being addressed and measured in mHealth interventions for mental health problems. Methods We conducted a systematic literature review through a search for peer-reviewed studies published between 2001 and 2018 in the following electronic databases: EMBASE, CINAHL, PsycINFO, PubMed, and Web of Science. Two reviewers independently assessed all abstracts against the inclusion and exclusion criteria, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Results A total of 299 studies were initially identified based on the inclusion keywords. Following a review of the title, abstract, and full text, 42 studies were found that fulfilled the criteria, most of which evaluated usability with patients (n=29) and health care providers (n=11) as opposed to healthy users (n=8) and were directed at a wide variety of mental health problems (n=24). Half of the studies set out to evaluate usability (n=21), and the remainder focused on feasibility (n=10) or acceptability (n=10). Regarding the maturity of the evaluated systems, most were either prototypes or previously tested versions of the technology, and the studies included few accounts of sketching and participatory design processes. The most common reason referred to for developing mobile mental health apps was the availability of mobile devices to users, their popularity, and how people in general became accustomed to using them for various purposes. Conclusions This study provides a detailed account of how evidence of usability of mHealth apps is gathered in the form of usability evaluations from the perspective of computer science and human-computer interaction, including how users feature in the evaluation, how the study objectives and outcomes are stated, which research methods and techniques are used, and what the notion of mobility features is for mHealth apps. Most studies described their methods as trials, gathered data from a small sample size, and carried out a summative evaluation using a single questionnaire, which indicates that usability evaluation was not the main focus. As many studies described using an adapted version of a standard usability questionnaire, there may be a need for developing a standardized mHealth usability questionnaire.
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Affiliation(s)
- Yavuz Inal
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
| | | | - Frode Guribye
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Psychiatric Division, Haukeland University Hospital, Bergen, Norway
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Ilagan GS, Iliakis EA, Wilks CR, Vahia IV, Choi-Kain LW. Smartphone applications targeting borderline personality disorder symptoms: a systematic review and meta-analysis. Borderline Personal Disord Emot Dysregul 2020; 7:12. [PMID: 32549987 PMCID: PMC7296633 DOI: 10.1186/s40479-020-00127-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Smartphone applications could improve symptoms of borderline personality disorder (BPD) in a scalable and resource-efficient manner in the context limited access to specialized care. OBJECTIVE This systematic review and meta-analysis aims to evaluate the effectiveness of applications designed as treatment interventions for adults with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD. DATA SOURCES Search terms for BPD symptoms, smartphone applications, and treatment interventions were combined on PubMed, MEDLINE, and PsycINFO from database inception to December 2019. STUDY SELECTION Controlled and uncontrolled studies of smartphone interventions for adult participants with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD were included. STUDY APPRAISAL AND SYNTHESIS METHODS Comprehensive Meta-Analysis v3 was used to compute between-groups effect sizes in controlled designs. The primary outcome was BPD-related symptoms such as anger, suicidality, and impulsivity; and the secondary outcome was general psychopathology. An average dropout rate across interventions was computed. Study quality, target audiences, therapeutic approach and targets, effectiveness, intended use, usability metrics, availability on market, and downloads were assessed qualitatively from the papers and through internet search. RESULTS Twelve studies of 10 applications were included, reporting data from 408 participants. Between-groups meta-analyses of RCTs revealed no significant effect of smartphone applications above and beyond in-person treatments or a waitlist on BPD symptoms (Hedges' g = - 0.066, 95% CI [-.257, .125]), nor on general psychopathology (Hedges' g = 0.305, 95% CI [- 0.14, 0.75]). Across the 12 trials, dropout rates ranged from 0 to 56.7% (M = 22.5, 95% CI [0.15, 0.46]). A majority of interventions studied targeted emotion dysregulation and behavioral dyscontrol symptoms. Half of the applications are commercially available. CONCLUSIONS The effects of smartphone interventions on symptoms of BPD are unclear and there is currently a lack of evidence for their effectiveness. More research is needed to build on these preliminary findings in BPD to investigate both positive and adverse effects of smartphone applications and identify the role these technologies may provide in expanding mental healthcare resources.
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Affiliation(s)
| | | | | | - Ipsit V Vahia
- McLean Hospital, 115 Mill St, Belmont, MA 02478 USA.,Harvard Medical School, Boston, USA
| | - Lois W Choi-Kain
- McLean Hospital, 115 Mill St, Belmont, MA 02478 USA.,Harvard Medical School, Boston, USA
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Marshall CA, McIntosh E, Sohrabi A, Amir A. Boredom in inpatient mental healthcare settings: a scoping review. Br J Occup Ther 2019. [DOI: 10.1177/0308022619876558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Emma McIntosh
- Addiction and Mental Health Services, Kingston, ON, Canada. At the time of this study, Emma McIntosh was a student in the MSc.OT program at Queen's University, Kingston, ON, Canada
| | - Almas Sohrabi
- Addiction and Mental Health Services, Kingston, ON, Canada. At the time of this study, Emma McIntosh was a student in the MSc.OT program at Queen's University, Kingston, ON, Canada
| | - Adam Amir
- At the time of this study, Almas Sohrabi was a student in the MSc.OT program at Queen's University, Kingston, ON
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Vo V, Auroy L, Sarradon-Eck A. Patients' Perceptions of mHealth Apps: Meta-Ethnographic Review of Qualitative Studies. JMIR Mhealth Uhealth 2019; 7:e13817. [PMID: 31293246 PMCID: PMC6652126 DOI: 10.2196/13817] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/09/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded. OBJECTIVE The aim of this paper is to reach a better understanding of people's perceptions, beliefs, and experience of mHealth apps as well as to determine how highly they appreciate these tools. METHODS A systematic review was carried out on qualitative studies published in English, on patients' perception of mHealth apps between January 2013 and June 2018. Data extracted from these articles were synthesized using a meta-ethnographic approach and an interpretative method. RESULTS A total of 356 articles were selected for screening, and 43 of them met the inclusion criteria. Most of the articles included populations inhabiting developed countries and were published during the last 2 years, and most of the apps on which they focused were designed to help patients with chronic diseases. In this review, we present the strengths and weaknesses of using mHealth apps from the patients' point of view. The strengths can be categorized into two main aspects: engaging patients in their own health care and increasing patient empowerment. The weaknesses pointed out by the participants focus on four main topics: trustworthiness, appropriateness, personalization, and accessibility of these tools. CONCLUSIONS Although many of the patients included in the studies reviewed considered mHealth apps as a useful complementary tool, some major problems arise in their optimal use, including the need for more closely tailored designs, the cost of these apps, the validity of the information delivered, and security and privacy issues. Many of these issues could be resolved with more support from health providers. In addition, it would be worth developing standards to ensure that these apps provide patients accurate evidence-based information.
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Affiliation(s)
- VanAnh Vo
- Department of Epidemiology, Columbia University, New York, NY, United States
| | - Lola Auroy
- Université Grenoble Alpes, Centre National de la Recherche Scientifique, Sciences Po Grenoble, Pacte, Grenoble, France
| | - Aline Sarradon-Eck
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Développement, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,Institut Paoli-Calmettes, CanBios UMR1252, Marseille, France
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Bucci S, Schwannauer M, Berry N. The digital revolution and its impact on mental health care. Psychol Psychother 2019; 92:277-297. [PMID: 30924316 DOI: 10.1111/papt.12222] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Indexed: 11/27/2022]
Abstract
The digital revolution is evolving at an unstoppable pace. Alongside the unprecedented explosion of digital technology facilities and systems, mental health care is under greater pressure than ever before. With its emphasis on big data, computing power, mobile technology, and network information, digital technology is set to transform health care delivery. This article reviews the field of digital health technology assessment and intervention primarily in secondary service mental health care, including the barriers and facilitators to adopting and implementing digitally mediated interventions in service delivery. We consider the impact of digitally mediated communication on human interaction and its potential impact on various mental states such as those linked to mood, anxiety but also well-being. These developments point to a need for both theory- and data-driven approaches to digital health care. We argue that, as developments in digital technology are outpacing the evaluation of rigorous digital health interventions, more advanced methodologies are needed to keep up with the pace of digital technology development. The need for co-production of digital tools with and for people with chronic and mental health difficulties, and implications of digital technology for psychotherapy practice, will be central to this development. PRACTITIONER POINTS: Mental health problems are one of the main causes of global and societal burden and are a growing public health. People with mental health problems around the world have limited, if any, chance of accessing psychological help at all. Technological innovations and solutions are being considered in an attempt to address the size and scale of the mental health crisis worldwide. Digital platforms allow people to self-monitor and self-manage in a way that face-to-face/paper-based methods of assessment have up until now not allowed. We provide examples of digital tools that are being developed and used in the secondary setting and identify a number of challenges in the digital health field that require careful consideration.
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Affiliation(s)
- Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, UK
| | | | - Natalie Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
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Aref-Adib G, McCloud T, Ross J, O'Hanlon P, Appleton V, Rowe S, Murray E, Johnson S, Lobban F. Factors affecting implementation of digital health interventions for people with psychosis or bipolar disorder, and their family and friends: a systematic review. Lancet Psychiatry 2019; 6:257-266. [PMID: 30522979 DOI: 10.1016/s2215-0366(18)30302-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Abstract
Digital health interventions present an important opportunity to improve health care for people with psychosis or bipolar disorder, but despite their potential, integrating and implementing them into clinical settings has been difficult worldwide. This Review aims to identify factors affecting implementation of digital health interventions for people affected by psychosis or bipolar disorder. We searched seven databases and synthesised data from 26 studies using the Consolidated Framework for Implementation Research. Attitudes and beliefs about interventions were crucial factors for both staff and service users, with negative attitudes and scepticism resulting in a lack of motivation to engage with interventions or complete them. The complexity of the interventions was a barrier for people with psychiatric symptoms, low premorbid intelligence quotient, or minimal information technology skills. The accessibility and adaptability of interventions were key facilitators, but insufficient resources, finances, and staff time were barriers to implementation. Interventions need to be user friendly and adaptable to the needs and capabilities of people with psychosis or bipolar disorder, and the staff who support their implementation. Service users and staff should cofacilitate the process of developing and implementing the interventions.
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Affiliation(s)
- Golnar Aref-Adib
- Division of Psychiatry, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, London, UK.
| | - Tayla McCloud
- Division of Psychiatry, University College London, London, UK
| | - Jamie Ross
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Puffin O'Hanlon
- Division of Psychiatry, University College London, London, UK
| | - Victoria Appleton
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
| | - Sarah Rowe
- Division of Psychiatry, University College London, London, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, London, UK
| | - Fiona Lobban
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
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Barbeito S, Sánchez-Gutiérrez T, Mayoral M, Moreno M, Ríos-Aguilar S, Arango C, Calvo A. Mobile App-Based Intervention for Adolescents With First-Episode Psychosis: Study Protocol for a Pilot Randomized Controlled Trial. Front Psychiatry 2019; 10:27. [PMID: 30804818 PMCID: PMC6370739 DOI: 10.3389/fpsyt.2019.00027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/16/2019] [Indexed: 01/26/2023] Open
Abstract
Introduction: Previous studies have shown an improvement in the access to treatment for patients with first-episode psychosis (FEP), specifically young patients, through mobile app-based interventions. The aim of this study is to test the effectiveness of a mobile app-based intervention to improve community functioning in adolescents with FEP. Mobile app-based interventions could increase quality of life and disease awareness, which improve adherence to treatment and reduce the frequency of relapses and rehospitalizations in adolescents with FEP. Methods: This article describes a mobile app treatment and the pilot trial protocol for patients with FEP. We will perform a single-blind randomized clinical trial (RCT) including patients with FEP aged 14-19 years recruited from Gregorio Marañón Hospital, Madrid, Spain. Patients will be randomly assigned to an intervention group, which will receive treatment as usual plus five modules of a psychological intervention through the mobile app (psychoeducation, recognition of symptoms and prevention of relapses, problem solving, mindfulness, and contact wall), or to a control group (standard care). The effectiveness of the intervention will be assessed by means of an extensive battery of clinical tests at baseline and at 3 months of follow-up. The primary outcome is reduction in psychotic and depressive symptoms; secondary outcomes comprise adherence, awareness, use of drugs, and quality of life. Data will be analyzed on an intention-to-treat (ITT) basis. Mixed model repeated-measures analysis will be used to explore the following effect: group × time interaction between the control group and the intervention group for clinical and functional variables during the follow-up period. Discussion: This is an innovative study for the assessment of a psychological intervention through a mobile app for patients with FEP during the critical period. This pilot RCT is intended to be a precursor to larger studies, which in turn could facilitate dissemination of mobile app therapy for patients with FEP. Ethics and Dissemination: The local ethics committee approved the study protocol. All participants must sign the informed consent, to participate. After finalizing the study, the results will be published. Trial registration: NCT03161249. NCT clinicaltrials.gov. Date of registration in primary registry 02 May 2017. clinicaltrials.gov.
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Affiliation(s)
- Sara Barbeito
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | | | - María Mayoral
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Miguel Moreno
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Logroño, Spain.,Mental Health Network of Guipuzcoa, Biodonostia, San Sebastian, Spain
| | - Sergio Ríos-Aguilar
- School of Engineering and Technology, Universidad Internacional de La Rioja (UNIR), Logroño, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Ana Calvo
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Logroño, Spain
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