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Bajraktarov S, Blazhevska Stoilkovska B, Russo M, Repišti S, Maric NP, Dzubur Kulenovic A, Arënliu A, Stevovic LI, Novotni L, Ribic E, Konjufca J, Ristic I, Novotni A, Jovanovic N. Factor structure of the brief psychiatric rating scale-expanded among outpatients with psychotic disorders in five Southeast European countries: evidence for five factors. Front Psychiatry 2023; 14:1207577. [PMID: 37953936 PMCID: PMC10634518 DOI: 10.3389/fpsyt.2023.1207577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/21/2023] [Indexed: 11/14/2023] Open
Abstract
The Brief Psychiatric Rating Scale (BPRS) is a useful tool for measuring the severity of psychopathological symptoms among patients with psychosis. Many studies, predominantly in Western countries, have investigated its factor structure. This study has the following aims: (a) to further explore the factor structure of the BPRS-Expanded version (BPRS-E, 24 items) among outpatients with psychotic disorders in Southeast European countries; (b) to confirm the identified model; and (c) to investigate the goodness-of-fit of the three competing BPRS-E factor models derived from previous studies. The exploratory factor analysis (EFA) produced a solution with 21 items grouped into five factors, thus supporting the existence of a fifth factor, i.e., Disorganization. A follow-up confirmatory factor analysis (CFA) revealed a 19-item model (with two items removed) that fit the data well. In addition, the stability of two out of three competing factor models was confirmed. Finally, the BPRS-E model with 5 factors developed in this cross-national study was found to include a greater number of items compared to competing models.
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Affiliation(s)
- Stojan Bajraktarov
- University Clinic of Psychiatry, Ss. Cyril in Methodius University in Skopje, Skopje, North Macedonia
| | | | - Manuela Russo
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Selman Repišti
- Faculty of Applied Sciences, University of Donja Gorica, Podgorica, Montenegro
| | - Nadja P. Maric
- Faculty of Medicine, Institute of Mental Health, University of Belgrade, Belgrade, Serbia
| | | | - Aliriza Arënliu
- Department of Psychology, Faculty of Philosophy, University of Prishtina, Prishtina, Kosovo
| | - Lidija Injac Stevovic
- Psychiatric Clinic, Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Ljubisha Novotni
- University Clinic of Psychiatry, Ss. Cyril in Methodius University in Skopje, Skopje, North Macedonia
| | - Emina Ribic
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Jon Konjufca
- Department of Psychology, Faculty of Philosophy, University of Prishtina, Prishtina, Kosovo
| | - Ivan Ristic
- Faculty of Medicine, Institute of Mental Health, University of Belgrade, Belgrade, Serbia
| | - Antoni Novotni
- University Clinic of Psychiatry, Ss. Cyril in Methodius University in Skopje, Skopje, North Macedonia
| | - Nikolina Jovanovic
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Zimmermann R, Konjufca J, Sakejo P, Kilonzo M, Quevedo Y, Blum K, Biba E, Mosha T, Cottin M, Hernández C, Kaaya S, Arenliu A, Behn A. Mental Health Information Reporting Assistant (MHIRA)-an open-source software facilitating evidence-based assessment for clinical services. BMC Psychiatry 2023; 23:706. [PMID: 37784115 PMCID: PMC10544613 DOI: 10.1186/s12888-023-05201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
Evidence-based assessment (EBA) in mental health is a critical aspect of improving patient outcomes and addressing the gaps in mental health care. EBA involves the use of psychometric instruments to gather data that can inform clinical decision-making, inform policymakers, and serve as a basis for research and quality management. Despite its potential, EBA is often hindered by barriers such as workload and cost, leading to its underutilization. Regarding low- and middle-income countries (LMIC), the implementation of EBA is recognized as a key strategy to address and close the prevalent mental health treatment gap.To simplify the application of EBA including in LMIC, an international team of researchers and practitioners from Tanzania, Kosovo, Chile, and Switzerland developed the Mental Health Information Reporting Assistant (MHIRA). MHIRA is an open-source electronic health record that streamlines EBA by digitising psychometric instruments and organising patient data in a user-friendly manner. It provides immediate and convenient reports to inform clinical decision-making.The current article provides a comprehensive overview of the features and technical details of MHIRA, as well as insights from four implementation scenarios. The experience gained during the implementations as well as the user-feedback suggests that MHIRA has the potential to be successfully implemented in a variety of clinical contexts and simplify the use of EBA. However, further research is necessary to establish its potential to sustainably transform healthcare services and impact patient outcomes.In conclusion, MHIRA represents an important step in promoting the widespread adoption of EBA in mental health. It offers a promising solution to the barriers that have limited the use of EBA in the past and holds the potential to improve patient outcomes and support the ongoing efforts to address gaps in mental health care.
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Affiliation(s)
- Ronan Zimmermann
- Psychiatric University Hospitals of Basel, Basel, Switzerland.
- Faculty of Psychology, University of Basel, Basel, Switzerland.
| | - Jon Konjufca
- Faculty of Psychology, University of Basel, Basel, Switzerland
- University of Prishtina "Hasan Prishtina", Pristina, Kosovo
| | - Peter Sakejo
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Mrema Kilonzo
- Faculty of Psychology, University of Basel, Basel, Switzerland
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Yamil Quevedo
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Kathrin Blum
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | | | | | - Marianne Cottin
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Universidad Finis Terrae, Santiago, Chile
| | - Cristóbal Hernández
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Universidad Adolfo Ibáñez, Santiago, Chile
| | - Sylvia Kaaya
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | | | - Alex Behn
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Pontificia Universidad Católica de Chile, Santiago, Chile
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Ribic E, Sikira H, Dzubur Kulenovic A, Pemovska T, Russo M, Jovanovic N, Radojicic T, Repisti S, Milutinović M, Blazevska B, Konjufca J, Ramadani F, Jerotic S, Savic B. Perceived sustainability of psychosocial treatment in low- and middle-income countries in South-Eastern Europe - CORRIGENDUM. BJPsych Open 2023; 9:e142. [PMID: 37540024 PMCID: PMC10486243 DOI: 10.1192/bjo.2023.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
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Uka F, Konjufca J, Ramadani F, Arënliu A, Bërxulli D, Jovanović N, Russo M. The relations between socio-demographic information and negative symptoms, mental health, and quality of life: a latent profile analysis with psychotic patients in Kosovo. Front Psychiatry 2023; 14:1135385. [PMID: 37564239 PMCID: PMC10410071 DOI: 10.3389/fpsyt.2023.1135385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/27/2023] [Indexed: 08/12/2023] Open
Abstract
The current study aims to identify meaningful psychotic patients' profiles by examining certain combinations of patient's demographic and socio-economic variables (sex, age, marital status, number of children, cohabitant and level of education). Moreover, we aim to assess whether there is any significant effect of class membership (profile) on negative symptoms, health state, and quality of life among psychotic patients. A convenience sample of 103 patients (age: M = 22, SD = 1.75), was drawn from the clinical populations of Kosovo. Demographic and socio-economic data was obtained through individual interviews, meanwhile a battery of questionnaires was used to assess negative symptoms, mental health, and quality of life of patients. The 4-class solution was selected as the best fitting model and used in subsequent analyses. Results indicated a significant effect of class membership on health state, quality of life and negative symptoms. Practical implications are discussed.
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Affiliation(s)
- Fitim Uka
- Department of Psychology, University of Pristina “Hasan Prishtina”, Prishtina, Kosovo
| | - Jon Konjufca
- Department of Psychology, University of Pristina “Hasan Prishtina”, Prishtina, Kosovo
| | - Fjolla Ramadani
- Department of Psychology, University of Pristina “Hasan Prishtina”, Prishtina, Kosovo
| | - Aliriza Arënliu
- Department of Psychology, University of Pristina “Hasan Prishtina”, Prishtina, Kosovo
| | - Dashamir Bërxulli
- Department of Psychology, University of Pristina “Hasan Prishtina”, Prishtina, Kosovo
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Manuela Russo
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
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Ribic E, Sikira H, Dzubur Kulenovic A, Pemovska T, Russo M, Jovanovic N, Radojicic T, Repisti S, Milutinović M, Blazevska B, Konjufca J, Ramadani F, Jerotic S, Savic B. Perceived sustainability of psychosocial treatment in low- and middle-income countries in South-Eastern Europe. BJPsych Open 2022; 8:e156. [PMID: 35968901 PMCID: PMC9438482 DOI: 10.1192/bjo.2022.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND DIALOG+ is an evidence-based, generic, cost-saving and easily deliverable psychosocial intervention, adaptable to clinicians' personal manner of interaction with patients. It was implemented in mental health services in five low- and middle-income countries in South-Eastern Europe during a 12-month randomised-controlled trial (IMPULSE) to improve the effectiveness of out-patient treatment for people with psychotic disorders. AIMS To investigate barriers and facilitators to the perceived sustainability of DIALOG+ that has been successfully implemented as a part of the IMPULSE project. METHOD Three months after the IMPULSE trial's end, perceived sustainability of the DIALOG+ intervention was assessed via a short survey of clinicians and patients who took part in the trial. Quantitative data collected from the survey were analysed using descriptive statistics; content analysis assessed qualitative survey data. The views and experiences of key informants (patients, clinicians and healthcare policy influencers) regarding the sustainability and scale-up of DIALOG+ were further explored through semi-structured interviews. These data were explored using framework analysis. RESULTS Clinicians mostly appreciated the comprehensiveness of DIALOG+, and patients described DIALOG+ meetings as empowering and motivating. The barrier most commonly identified by key informants was availability of financial resources; the most important facilitators were the clinically relevant structure and comprehensiveness of the DIALOG+ intervention. CONCLUSIONS Participants showed a willingness to sustain the implementation of DIALOG+. It is important to maintain collaboration with healthcare policy influencers to improve implementation of DIALOG+ across different levels of healthcare systems and ensure availability of resources for implementing psychosocial interventions such as DIALOG+.
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Affiliation(s)
- Emina Ribic
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Hana Sikira
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Tamara Pemovska
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK; and WHO Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Manuela Russo
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Nikolina Jovanovic
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK; and Newham Centre for Mental Health, London, UK
| | | | | | | | | | - Jon Konjufca
- Department of Psychology, University of Prishtina 'Hasan Prishtina', Prishtina, Kosovo, Albania; and University of Prishtina, Kosovska Mitrovica, Serbia
| | - Fjolla Ramadani
- Department of Psychology, University of Prishtina 'Hasan Prishtina', Prishtina, Kosovo, Albania
| | - Stefan Jerotic
- Department of Psychiatry, University Clinical Center of Serbia, Belgrade, Serbia; and Department of Psychiatry, Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Bojana Savic
- University Clinical Center of Serbia, Belgrade, Serbia
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Cottin M, Blum K, Konjufca J, Quevedo Y, Kaaya S, Behn A, Schmeck K, Sharp C, Zimmermann R. Digital use of standardised assessment tools for children and adolescents: can available paper-based questionnaires be used free of charge in electronic format? BMC Psychiatry 2022; 22:379. [PMID: 35659275 PMCID: PMC9166519 DOI: 10.1186/s12888-022-04023-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
QUESTION Most adolescents live in low- and middle-income countries (LMIC), and about 10% of them face mental problems. The mental health provision gap in low- and middle-income countries could be addressed by evidence-based practices, however costs are implementational barriers. Digitalization can improve the accessibility of these tools and constitutes a chance for LMIC to use them more easily at a low cost. We reviewed free and brief evidence-based mental health assessment tools available for digital use to assess psychopathology across different domains in youth. METHODS For the current study, instruments from a recent review on paper-based instruments were re-used. Additionally, a systematic search was conducted to add instruments for the personality disorder domain. We searched and classified the copyright and license terms available from the internet in terms of free usage and deliverability in a digital format. In the case that this information was insufficient, we contacted the authors. RESULTS In total, we evaluated 109 instruments. Of these instruments, 53 were free and digitally usable covering 11 mental health domains. However, retrieving information on copyright and license terms was very difficult. CONCLUSIONS Free and digitally adaptable instruments are available, supporting the strategy of using instruments digitally to increase access. The instrument's authors support this initiative, however, the lack of copyright information and the difficulties in contacting the authors and licence holders are barriers to using this strategy in LMIC. A comprehensive, online instrument repository for clinical practice would be an appropriate next step to make the instruments more accessible and reduce implementation barriers.
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Affiliation(s)
- Marianne Cottin
- grid.488997.3Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile ,grid.443909.30000 0004 0385 4466Department of Psychiatry East Campus, Faculty of Medicine, University of Chile, Santiago, Chile ,grid.440629.d0000 0004 5934 6911School of Psychology, Finis Terrae University, Santiago, Chile ,grid.7870.80000 0001 2157 0406School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Kathrin Blum
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
| | - Jon Konjufca
- grid.449627.a0000 0000 9804 9646University of Prishtina, Pristina, Kosovo ,grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Yamil Quevedo
- grid.488997.3Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile ,grid.443909.30000 0004 0385 4466Department of Psychiatry East Campus, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sylvia Kaaya
- grid.25867.3e0000 0001 1481 7466Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania ,grid.266436.30000 0004 1569 9707Department of Psychology, University of Houston, Houston, TX USA
| | - Alex Behn
- grid.488997.3Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile ,grid.7870.80000 0001 2157 0406School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Klaus Schmeck
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Carla Sharp
- grid.266436.30000 0004 1569 9707Department of Psychology, University of Houston, Houston, TX USA
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland. .,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.
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Arënliu A, Benbenishty R, Kelmendi K, Duraku ZH, Konjufca J, Astor RA. Prevalence and predictors of staff victimization of students in Kosovo. School Psychology International 2022. [DOI: 10.1177/01430343221081994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Student victimization by school staff members has important potential consequences for students’ academic achievement and physical and psychological outcomes. Several studies have shown that such victimization exists in multiple contexts and there is considerable variation in prevalence among contexts. This study examined the prevalence of student victimization in public schools by staff members and its relationships with other school-related factors in the context of Kosovo. The sample was designed to represent all students from Grades 6–9 in 13 of Kosovo's 38 municipalities. The sample consisted of 12,040 students from 100 schools, 49.2% of whom were female. They were equally divided between Grades 6 to 9. Overall, more than a quarter of the students reported that a staff member victimized them in the last month. The least prevalent victimization type was sexual—touched or tried to touch you in a sexual manner (2.3%). The most prevalent physical behavior was slapping (15.8%); 12.7% reported being offended or humiliated by a staff member and 8.3% indicated that a staff member cursed them. Boys were victimized significantly more than girls for all types of victimization. The strongest predictors of staff victimization of students were students’ involvement in peer-to-peer victimization and risky behaviors, which were correlated with school climate. Future research should examine each type of staff victimization of students (emotional, physical, sexual) separately and test comprehensive models that include multiple predictors, including contextual and school-level variables and staff characteristics.
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Affiliation(s)
- Aliriza Arënliu
- Faculty of Philosophy, Department of Psychology, University of Prishtina, Hasan
- University of Prishtina, Albania
| | - Rami Benbenishty
- Hebrew University of Jerusalem, Israel; Universidad Andres Belo, Chile
- University of Prishtina, Albania
| | - Kaltrina Kelmendi
- Faculty of Philosophy, Department of Psychology, University of Prishtina, Hasan
- University of Prishtina, Albania
| | - Zamira Hyseni Duraku
- Faculty of Philosophy, Department of Psychology, University of Prishtina, Hasan
- University of Prishtina, Albania
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Feng Y, Roukas C, Russo M, Repišti S, Džubur Kulenović A, Injac Stevović L, Konjufca J, Markovska-Simoska S, Novotni L, Ristić I, Smajić-Mešević E, Uka F, Zebić M, Vončina L, Bobinac A, Jovanović N. Cost-effectiveness of implementing a digital psychosocial intervention for patients with psychotic spectrum disorders in low- and middle-income countries in Southeast Europe: Economic evaluation alongside a cluster randomised trial. Eur Psychiatry 2022; 65:e56. [PMID: 36017673 PMCID: PMC9532216 DOI: 10.1192/j.eurpsy.2022.2310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background DIALOG+ is a digital psychosocial intervention aimed at making routine meetings between patients and clinicians therapeutically effective. This study aimed to evaluate the cost-effectiveness of implementing DIALOG+ treatment for patients with psychotic disorders in five low- and middle-income countries in Southeast Europe alongside a cluster randomised trial. Methods Resource use and quality of life data were collected alongside the multi-country cluster randomised trial of 468 participants with psychotic disorders. Due to COVID-19 interruptions of the trial’s original 12-month intervention period, adjusted costs and quality-adjusted life years (QALYs) were estimated at the participant level using a mixed-effects model over the first 6 months only. We estimated the incremental cost-effectiveness ratio (ICER) with uncertainty presented using a cost-effectiveness plane and a cost-effectiveness acceptability curve. Seven sensitivity analyses were conducted to check the robustness of the findings. Results The average cost of delivering DIALOG+ was €91.11 per participant. DIALOG+ was associated with an incremental health gain of 0.0032 QALYs (95% CI –0.0015, 0.0079), incremental costs of €84.17 (95% CI –8.18, 176.52), and an estimated ICER of €26,347.61. The probability of DIALOG+ being cost-effective against three times the weighted gross domestic product (GDP) per capita for the five participating countries was 18.9%. Conclusion Evidence from the cost-effectiveness analyses in this study suggested that DIALOG+ involved relatively low costs. However, it is not likely to be cost-effective in the five participating countries compared with standard care against a willingness-to-pay threshold of three times the weighted GDP per capita per QALY gained.
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Jovanović N, Russo M, Pemovska T, Francis JJ, Arenliu A, Bajraktarov S, Džubur Kulenović A, Injac Stevović L, Novotni A, Andrić Petrović S, Radojičić T, Ribić E, Konjufca J, Marić NP. Improving treatment of patients with psychosis in low-and-middle-income countries in Southeast Europe: Results from a hybrid effectiveness-implementation, pragmatic, cluster-randomized clinical trial (IMPULSE). Eur Psychiatry 2022; 65:e50. [PMID: 35946167 PMCID: PMC9491080 DOI: 10.1192/j.eurpsy.2022.2302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In Southeast Europe (SEE) standard treatment of patients with psychosis is largely based on pharmacotherapy with psychosocial interventions rarely available. DIALOG+ is a digital psychosocial intervention designed to make routine care therapeutically effective. This trial simultaneously examined effectiveness of DIALOG+ versus standard care on clinical and social outcomes (Aim 1) and explored intervention fidelity (Aim 2). Methods A hybrid type II effectiveness–implementation, cluster-randomized trial was conducted in five SEE countries: Bosnia and Herzegovina, Kosovo*, Montenegro, North Macedonia, and Serbia. The intervention was offered to patients six times across 12 months instead of routine care. The outcomes were subjective quality of life (primary), clinical symptoms, satisfaction with services, and economic costs. Intervention fidelity was operationalized as adherence to the protocol in terms of frequency, duration, content, and coverage. Data were analyzed using multilevel regression. Results A total of 81 clinicians and 468 patients with psychosis were randomized to DIALOG+ or standard care. The intervention was delivered with high fidelity. The average number of delivered sessions was 5.5 (SD = 2.3) across 12 months. Patients in the intervention arm had better quality of life (MANSA) at 6 months (p = 0.03). No difference was found for other outcomes at 6 months. Due to disruptions caused by the COVID-19 pandemic, 12-month data were not interpretable. Conclusions DIALOG+ improved subjective quality of life of individuals with psychosis at 6 months (after four sessions), albeit with small effect size. The intervention has the potential to contribute to holistic care of patients with psychosis.
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Pelikan ER, Korlat S, Reiter J, Holzer J, Mayerhofer M, Schober B, Spiel C, Hamzallari O, Uka A, Chen J, Välimäki M, Puharić Z, Anusionwu KE, Okocha AN, Zabrodskaja A, Salmela-Aro K, Käser U, Schultze-Krumbholz A, Wachs S, Friðriksson F, Gunnþórsdóttir H, Höller Y, Aoyama I, Ieshima A, Toda Y, Konjufca J, Llullaku N, Gedutienė R, Borg Axisa G, Avirovic Bundalevska I, Keskinova A, Radulovic M, Lewandowska-Walter A, Michałek-Kwiecień J, Plichta P, Pyżalski J, Walter N, Cautisanu C, Voda AI, Gao S, Islam S, Wistrand K, Wright MF, Lüftenegger M. Distance learning in higher education during COVID-19: The role of basic psychological needs and intrinsic motivation for persistence and procrastination-a multi-country study. PLoS One 2021; 16:e0257346. [PMID: 34613978 PMCID: PMC8494346 DOI: 10.1371/journal.pone.0257346] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Due to the COVID-19 pandemic, higher educational institutions worldwide switched to emergency distance learning in early 2020. The less structured environment of distance learning forced students to regulate their learning and motivation more independently. According to self-determination theory (SDT), satisfaction of the three basic psychological needs for autonomy, competence and social relatedness affects intrinsic motivation, which in turn relates to more active or passive learning behavior. As the social context plays a major role for basic need satisfaction, distance learning may impair basic need satisfaction and thus intrinsic motivation and learning behavior. The aim of this study was to investigate the relationship between basic need satisfaction and procrastination and persistence in the context of emergency distance learning during the COVID-19 pandemic in a cross-sectional study. We also investigated the mediating role of intrinsic motivation in this relationship. Furthermore, to test the universal importance of SDT for intrinsic motivation and learning behavior under these circumstances in different countries, we collected data in Europe, Asia and North America. A total of N = 15,462 participants from Albania, Austria, China, Croatia, Estonia, Finland, Germany, Iceland, Japan, Kosovo, Lithuania, Poland, Malta, North Macedonia, Romania, Sweden, and the US answered questions regarding perceived competence, autonomy, social relatedness, intrinsic motivation, procrastination, persistence, and sociodemographic background. Our results support SDT's claim of universality regarding the relation between basic psychological need fulfilment, intrinsic motivation, procrastination, and persistence. However, whereas perceived competence had the highest direct effect on procrastination and persistence, social relatedness was mainly influential via intrinsic motivation.
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Affiliation(s)
- Elisabeth R. Pelikan
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Selma Korlat
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Julia Reiter
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Julia Holzer
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Martin Mayerhofer
- Department of Mathematics, Faculty of Mathematics, University of Vienna, Vienna, Austria
| | - Barbara Schober
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Christiane Spiel
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Oriola Hamzallari
- Department of Psychology, Faculty of Education, Aleksandër Moisiu University, Durrës, Albania
| | - Ana Uka
- Department of Educational Sciences, Faculty of Philology and Education, Bedër University, Tirana, Albania
| | - Jiarui Chen
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Maritta Välimäki
- Xiangya School of Nursing, Central South University, Changsha, China
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Zrinka Puharić
- Study of Nursing, University of Applied Sciences Bjelovar, Bjelovar, Croatia
| | | | - Angela Nkem Okocha
- Baltic Film, Media and Arts School, Tallinn University, Tallinn, Estonia
| | | | | | - Udo Käser
- Department of Psychology, University of Bonn, Bonn, Germany
| | | | - Sebastian Wachs
- Department of Educational Studies, University of Potsdam, Potsdam, Germany
| | | | | | - Yvonne Höller
- Faculty of Education, University of Akureyri, Akureyri, Iceland
| | - Ikuko Aoyama
- Department of Global Education, Tsuru University, Tsuru, Japan
| | - Akihiko Ieshima
- Career Center, Osaka University, Osaka University, Suita, Japan
| | - Yuichi Toda
- Graduate School of Education, Osaka Kyoiku University, Kashiwara, Japan
| | - Jon Konjufca
- Department of Psychology, Faculty of Philosophy, University of Prishtina ’Hasan Prishtina’, Pristina, Kosovo
| | - Njomza Llullaku
- Department of Social Work, Faculty of Philosophy, University of Pristina ’Hasan Prishtina’, Pristina, Kosovo
| | - Reda Gedutienė
- Department of Psychology, Faculty of Social Sciences and Humanities, Klaipėda University, Klaipėda, Lithuania
| | | | - Irena Avirovic Bundalevska
- Institute of Family Studies, Faculty of Philosophy, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Angelka Keskinova
- Institute of Family Studies, Faculty of Philosophy, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Makedonka Radulovic
- Institute of Family Studies, Faculty of Philosophy, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | | | | | - Piotr Plichta
- Faculty of Historical and Pedagogical Sciences, University of Wrocław, Wrocław, Poland
| | - Jacek Pyżalski
- Faculty of Educational Studies, Adam Mickiewicz University, Poznań, Poland
| | - Natalia Walter
- Faculty of Educational Studies, Adam Mickiewicz University, Poznań, Poland
| | - Cristina Cautisanu
- CERNESIM Environmental Research Center, Alexandru Ioan Cuza University, Iași, România
| | - Ana Iolanda Voda
- Social Sciences and Humanities Research Department, Institute for Interdisciplinary Research, Alexandru Ioan Cuza University of Iași, Iași, România
| | - Shang Gao
- Department of Informatics, Örebro University School of Business, Örebro University, Örebro, Sweden
| | - Sirajul Islam
- Department of Informatics, Örebro University School of Business, Örebro University, Örebro, Sweden
| | - Kai Wistrand
- Department of Informatics, Örebro University School of Business, Örebro University, Örebro, Sweden
| | - Michelle F. Wright
- Faculty of Social Studies, Penn State University, State College, Pennsylvania, United States of America
| | - Marko Lüftenegger
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department for Teacher Education, Centre for Teacher Education, University of Vienna, Vienna, Austria
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11
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Pemovska T, Arënliu A, Konjufca J, Uka F, Hunter J, Bajraktarov S, Stevović LI, Jerotić S, Kulenović AD, Novotni A, Novotni L, Radojičić T, Repišti S, Ribić E, Ristić I, Mešević ES, Zebić M, Jovanović N. Implementing a digital mental health intervention for individuals with psychosis - a multi-country qualitative study. BMC Psychiatry 2021; 21:468. [PMID: 34563145 PMCID: PMC8466399 DOI: 10.1186/s12888-021-03466-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/07/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Implementation of psychosocial interventions in mental health services has the potential to improve the treatment of psychosis spectrum disorders (PSD) in low- and middle-income countries (LMICs) where care is predominantly focused on pharmacotherapy. The first step is to understand the views of key stakeholders. We conducted a multi-language qualitative study to explore the contextual barriers and facilitators to implementation of a cost-effective, digital psychosocial intervention, called DIALOG+, for treating PSD. DIALOG+ builds on existing clinician-patient relationships without requiring development of new services, making it well-fitting for healthcare systems with scarce resources. METHODS Thirty-two focus groups were conducted with 174 participants (patients, clinicians, policymakers and carers), who were familiarized with DIALOG+ through a presentation. The Southeast European LMICs included in this research were: Bosnia and Herzegovina, Kosovo, (Kosovo is referred throughout the text by United Nations resolution) North Macedonia, Montenegro and Serbia. Framework analysis was used to analyse the participants' accounts. RESULTS Six major themes were identified. Three themes (Intervention characteristics; Carers' involvement; Patient and organisational benefits) were interpreted as perceived implementation facilitators. The theme Attitudes and perceived preparedness of potential adopters comprised of subthemes that were interpreted as both perceived implementation facilitators and barriers. Two other themes (Frequency of intervention delivery; Suggested changes to the intervention) were more broadly related to the intervention's implementation. Participants were exceedingly supportive of the implementation of a digital psychosocial intervention such as DIALOG+. Attractive intervention characteristics, efficient use of scarce resources for its implementation and potential to improve mental health services were seen as the main implementation facilitators. The major implementation barrier identified was psychiatrists' time constrains. CONCLUSIONS This study provided important insights regarding implementation of digital psychosocial interventions for people with PSD in low-resource settings by including perspectives from four stakeholder groups in five LMICs in Southeast Europe - a population and region rarely explored in the literature. The perceived limited availability of psychiatrists could be potentially resolved by increased inclusion of other mental health professionals in service delivery for PSD. These findings will be used to inform the implementation strategy of DIALOG+ across the participating countries. The study also offers insights into multi-country qualitative research.
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Affiliation(s)
- Tamara Pemovska
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, E13 8SP, UK
| | - Aliriza Arënliu
- Department of Psychology, University of Pristina, 10000, Pristina, Kosovo.
| | - Jon Konjufca
- Department of Psychology, University of Pristina, 10000, Pristina, Kosovo
| | - Fitim Uka
- Department of Psychology, University of Pristina, 10000, Pristina, Kosovo
| | - Jennifer Hunter
- School of Health Sciences, City University of London, London, EC1R 1UB, UK
| | - Stojan Bajraktarov
- University Clinic of Psychiatry, Ss. Cyril and Methodius University in Skopje, Skopje, 1000, North Macedonia
| | - Lidija Injac Stevović
- Clinical Centre, Psychiatric Clinic, University of Montenegro, Podgorica, Montenegro
| | - Stefan Jerotić
- Faculty of Medicine University of Belgrade & Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Alma Džubur Kulenović
- Department of Psychiatry, Clinical Centre of the University of Sarajevo, 71000, Sarajevo, Bosnia and Herzegovina
| | - Antoni Novotni
- University Clinic of Psychiatry, Ss. Cyril and Methodius University in Skopje, Skopje, 1000, North Macedonia
| | - Ljubisa Novotni
- University Clinic of Psychiatry, Ss. Cyril and Methodius University in Skopje, Skopje, 1000, North Macedonia
| | - Tamara Radojičić
- Clinical Centre, Psychiatric Clinic, University of Montenegro, Podgorica, Montenegro
| | - Selman Repišti
- Clinical Centre, Psychiatric Clinic, University of Montenegro, Podgorica, Montenegro
| | - Emina Ribić
- Department of Psychiatry, Clinical Centre of the University of Sarajevo, 71000, Sarajevo, Bosnia and Herzegovina
| | - Ivan Ristić
- Faculty of Medicine University of Belgrade & Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Eldina Smajić Mešević
- Department of Psychiatry, Clinical Centre of the University of Sarajevo, 71000, Sarajevo, Bosnia and Herzegovina
| | - Mirjana Zebić
- Faculty of Medicine University of Belgrade & Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, E13 8SP, UK
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