Remote mental health care interventions during the COVID-19 pandemic: An umbrella review

Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.

Social factors and suicidal ideation in adulthood

Introduction

In recent years, it has been possible to corroborate that people’s social environment is a key aspect in the study of suicide risk.

Objectives

The aim of this study is to assess the relation between suicidal ideation and social factors (loneliness, social support, trust, participation and cohabiting) in a representative sample of the Spanish adult population, comparing the effect according to sex different age groups (18-49, 50-64, ≥65 years).

Methods

Cross-sectional study of a representative sample of the Spanish population (n = 4,217) conducted between 2011 and 2012. Loneliness was assessed using the UCLA Loneliness Scale. Social support was assessed using the OSLO-3 Social Support Scale, and participation scale and trust. Data were analyzed using logistic regression models adjusting for sex, sociodemographic and health variables (lifestyles, depression, and multimorbidity).

Results

Prevalence rates of suicidal ideation were higher in young and middle-aged adults. In the middle-aged groups, loneliness is significantly associated with suicidal ideation in both women and man. Among man, cohabiting and trust were identified as a protective factors of suicidal ideation. Among women, only social support was identified as a protective factor. In the older adult’s group, trust acted as a protective factor of suicide ideation among women. For man was the social support. Among younger adults, cohabiting was identified as a protective factor in man.

Conclusions

Due to the different results involving social factors and suicidal ideation according to age and sex, we highlight the importance of studying social factors for the detection of specific needs among the Spanish adult population.

Identification of Relevant Problems of Individuals with Bipolar Disorder: A Worldwide Expert Survey

Aims:

We aimed to explore the expert perspective on relevant issues of individuals with bipolar disorder. The specific aims are to identify problems in functioning important to individuals with BD and to quantify these using the ICF.

Method:

An online survey on functioning in BD was conduced. For each ICF domain one question was presented. Recruited participants were psychiatrists, general physicians, psychologists, nurses and social workers worldwide. Answers were linked to the ICF according to predefined rules (Cieza, 2001). Data analyses include frequencies of ICF categories named by experts.

Results:

Health professionals from all WHO-world regions and from different professional backgrounds accepted our invitation to participate. The Americas was the highest represented region (36%) and a significant part of the professionals involved were psychiatrists. From all the concepts contained in the answers, body functions categories with highest frequency of appearance were emotional functions (3,5%), mentioned by 62% of the experts and sleep functions (2,4%) mentioned by 58%. The body structure brain corresponds to 2% of the total categories obtained and was included by 56% of the experts. Maintaining one's health was the most mentioned activity and participation (2,8%), referred by 36% of the participants and important environmental factors include health services (4,8%) and immediate family(3,8%), which appeared in 82% of the questionnaires.

Conclusion:

The present study is an important step in applying of the ICF to BD. It also shows an important level of agreement between experts around the world regarding central issues of the disorder.

Funded by MURINET-MRTN-CT-2006-035794

High Cognitive Reserve in Bipolar Disorders as a Moderator of Neurocognitive Impairment

Background

Cognitive reserve (CR) reflects the capacity of the brain to endure neuropathology, minimize clinical manifestations and successfully complete cognitive tasks. The present study aims to determine whether high CR may constitute a moderator of cognitive functioning in bipolar disorder (BD).

Methods

One hundred and two patients with BD and 32 healthy controls were enrolled. All patients met DSM-IV criteria for I or II BD and were euthymic (YMRS ≤ 6 and HDRS ≤ 8) during a 6-month period. All participants were tested with a comprehensive neuropsychological battery, and a Cerebral Reserve Score (CRS) was estimated. Subjects with a CRS below the group median were classified as having low CR, whereas participants with a CRS above the median value were considered to have high CR.

Results

Participants with BD with high CR displayed a better performance in measures of attention (digits forward: F = 4.554, P = 0.039); phonemic and semantic verbal fluency (FAS: F = 9.328, P = 0.004; and Animal Naming: F = 8.532, P = 0.006); and verbal memory (short cued recall of California Verbal Learning Test: F = 4.236, P = 0.046), after multivariable adjustment for potential confounders, including number of admissions and prior psychotic symptoms.

Conclusions

High cognitive reserve may therefore be a valuable construct to explore for predicting neurocognitive performance in patients with BD regarding premorbid status.

Disclosure of interest

Dr. I. Grande has received a Juan Rodés Contract (JR15/00012), Instituto de Salud Carlos III, Spanish Ministry of Economy and Competiveness, Barcelona, Spain and has served as a consultant for Ferrer and as a speaker for AstraZeneca, Ferrer and Janssen-Cilag.

Disclosure of interest

Dr. I. Grande has received a Juan Rodés Contract (JR15/00012), Instituto de Salud Carlos III, Spanish Ministry of Economy and Competiveness, Barcelona, Spain and has served as a consultant for Ferrer and as a speaker for AstraZeneca, Ferrer and Janssen-Cilag.

Incidence of Suicide Attempts in Madrid: Characteristics of the Attempts and Response of the Health System

Background:

Suicide is a serious public health problem. In 2005, 793 people were hospitalized in Madrid due to suicide attempt. However, most of the attempts do not require hospitalization and patients are discharged after the intervention in the emergency units. With the aim to implement local policies to prevent suicide, it is important to know the whole spectrum of suicide attempts that contact emergency units in Madrid.

Aims:

To explore the incidence of suicide attempts assisted in the public health system in Madrid and to analyze their characteristics and the response of the health system.

Method:

Clinical reports of all patients attempting suicide were analyzed during 4 months in 4 general public hospitals (covering 44.7% of the whole population) in the Community of Madrid.

Results:

1009 suicide attempts committed by 921 people (66.2% women) were collected, with an incidence of 34.3 people per 100.000 in 4 months. 57 people (6.2%) committed more than one attempt (range 2 to 10, mean=2.5 ± 1.3). After the emergency intervention 71.9% of the patients were discharged, 25.3% hospitalized, 2.6% fled, and 0.2% died. Regarding suicidal ideation, 7.5% presented very high levels during evaluation, while 13.1% had high levels, 20.3% moderate and 47.3% had no suicidal ideation.

Conclusion:

Compared with other European countries, our findings show moderate incidence of suicide attempts, most of which were mild, treated in the emergency units and derived to outpatient psychiatric follow-up. These results suggest places to develop and implement prevention measures.

Funded by Instituto de Salud Pública de Madrid.