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Karch J, Kast K. [How can the potential of internet- and mobile-based interventions be used in the treatment of depression? Findings from a qualitative survey among German psychotherapists]. Z Evid Fortbild Qual Gesundhwes 2024:S1865-9217(24)00051-5. [PMID: 38604921 DOI: 10.1016/j.zefq.2024.03.001] [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] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION AND OBJECTIVES Internet and mobile-based interventions (IMIs) can reduce the unmet need for treatment of people with depression. The service providers as key actors in the healthcare market play an essential role in implementation. Therefore, the barriers, drivers and expectations from the perspective of psychotherapists were examined. METHODS In the Nuremberg area, n=15 psychotherapists were interviewed using a semi-structured guideline. The data were then evaluated according to the principles of Grounded Theory. RESULTS Primarily, optimizing patient benefits and bridging waiting times and aftercare were seen as advantages. Challenges exist in relation to insufficient information and communication channels between those involved in the healthcare market and the resulting lack of therapists' experiences with IMIs. DISCUSSION In addition to the drivers and barriers, different fields of action must be taken into account in order to increase the implementation of IMIs in the care of people with depression; these include the way that IMIs are integrated into the treatment process, the conception of IMIs and the relationships on the healthcare market. The decisive factor here is to increase cooperation between all those involved in the healthcare market. CONCLUSION The barriers identified are mainly due to insufficient information and communication channels within the healthcare market. They provide helpful guidance for understanding how the increased implementation of IMIs into the care process in the treatment of depression can succeed.
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Affiliation(s)
- Julia Karch
- Friedrich-Alexander Universität Erlangen-Nürnberg, Nürnberg, Deutschland.
| | - Kristina Kast
- Friedrich-Alexander Universität Erlangen-Nürnberg, Nürnberg, Deutschland
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Dietel FA, Rupprecht R, Seriyo AM, Post M, Sudhoff B, Reichart J, Berking M, Buhlmann U. Efficacy of a smartphone-based Cognitive Bias Modification program for emotion regulation: A randomized-controlled crossover trial. Internet Interv 2024; 35:100719. [PMID: 38370286 PMCID: PMC10869929 DOI: 10.1016/j.invent.2024.100719] [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] [Received: 10/24/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024] Open
Abstract
Previous research has identified maladaptive emotion regulation as a key factor in psychopathology. Thus, addressing emotion regulation via scalable, low-threshold digital interventions - such as smartphone-based Cognitive Bias Modification (CBM) - holds important therapeutic potential. Using a randomized-controlled crossover trial, we tested the efficacy of an integrated CBM module within the Affect Regulation Training (ART, i.e., CBM-ART) that targeted emotion regulation through elements of appraisal-based and approach avoidance training. Undergraduate students reporting elevated stress were randomized to a one-week active intervention (Mindgames; including psychoeducation, a quiz, and CBM-ART; n = 40), active control training (Emo Shape; including placebo psychoeducation, a quiz, and a placebo swiping task; n = 36) or waitlist (n = 25). Before and after the intervention, we assessed emotion regulation, interpretation bias, stress and depression. We further tested post-training stress reactivity using an anagram task. Results indicated that the active intervention improved negative (OR = 0.35) and positive (OR = 2.40) interpretation biases and symptom measures (d = 0.52-0.87). However, active control training showed attenuated concurrent pre-post changes on interpretation biases (i.e., OR = 0.53 for negative, and OR = 1.49 for positive interpretations) and symptom measures (d = 0.26-0.91). The active intervention was rated positively in terms of acceptability and usability. These findings provide initial evidence for the efficacy and acceptability of an integrated app-based CBM intervention for emotion regulation in reducing interpretation biases and psychopathological symptoms, including stress. However, future studies should disentangle specific mechanisms underlying interventional effects.
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Fuhrmann LM, Weisel KK, Harrer M, Kulke JK, Baumeister H, Cuijpers P, Ebert DD, Berking M. Additive effects of adjunctive app-based interventions for mental disorders - A systematic review and meta-analysis of randomised controlled trials. Internet Interv 2024; 35:100703. [PMID: 38225971 PMCID: PMC10788289 DOI: 10.1016/j.invent.2023.100703] [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] [Received: 05/26/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/17/2024] Open
Abstract
Background It is uncertain whether app-based interventions add value to existing mental health care. Objective To examine the incremental effects of app-based interventions when used as adjunct to mental health interventions. Methods We searched PubMed, PsycINFO, Scopus, Web of Science, and Cochrane Library databases on September 15th, 2023, for randomised controlled trials (RCTs) on mental health interventions with an adjunct app-based intervention compared to the same intervention-only arm for adults with mental disorders or respective clinically relevant symptomatology. We conducted meta-analyses on symptoms of different mental disorders at postintervention. PROSPERO, CRD42018098545. Results We identified 46 RCTs (4869 participants). Thirty-two adjunctive app-based interventions passively or actively monitored symptoms and behaviour, and in 13 interventions, the monitored data were sent to a therapist. We found additive effects on symptoms of depression (g = 0.17; 95 % CI 0.02 to 0.33; k = 7 comparisons), anxiety (g = 0.80; 95 % CI 0.06 to 1.54; k = 3), mania (g = 0.2; 95 % CI 0.02 to 0.38; k = 4), smoking cessation (g = 0.43; 95 % CI 0.29 to 0.58; k = 10), and alcohol use (g = 0.23; 95 % CI 0.08 to 0.39; k = 7). No significant effects were found on symptoms of depression within a bipolar disorder (g = -0.07; 95 % CI -0.37 to 0.23, k = 4) and eating disorders (g = -0.02; 95 % CI -0.44 to 0.4, k = 3). Studies on depression, mania, smoking, and alcohol use had a low heterogeneity between the trials. For other mental disorders, only single studies were identified. Only ten studies had a low risk of bias, and 25 studies reported insufficient statistical power. Discussion App-based interventions may be used to enhance mental health interventions to further reduce symptoms of depression, anxiety, mania, smoking, and alcohol use. However, the effects were small, except for anxiety, and limited due to study quality. Further high-quality research with larger sample sizes is warranted to better understand how app-based interventions can be most effectively combined with established interventions to improve outcomes.
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Affiliation(s)
- Lukas M. Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Kiona K. Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Jennifer K. Kulke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - David D. Ebert
- Department of Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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Opozda MJ, Oxlad M, Turnbull D, Gupta H, Smith JA, Ziesing S, Nankivell ME, Wittert G. Facilitators of, barriers to, and preferences for e-mental health interventions for depression and anxiety in men: Metasynthesis and recommendations. J Affect Disord 2024; 346:75-87. [PMID: 37949238 DOI: 10.1016/j.jad.2023.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Little is known about men's use of online mental health (eMH) interventions and factors that promote their engagement or attrition. We aimed to synthesise the qualitative literature on men's preferences for, attitudes towards, and experiences of using eMH interventions for depression and anxiety, and develop recommendations from the findings. METHOD Systematic searches were conducted (Jan 2000-Oct 2020) in six databases; study quality was assessed using Qualsyst with a minimum total of 0.55 required for inclusion. Extracted data were synthesised using meta-aggregation. RESULTS Eight studies met inclusion criteria and three synthesised findings were generated. (1) Facilitators of men's eMH use: finding apps and technology motivating and convenient, support and encouragement from important others, and interventions allowing men to take action, gain control over their mental health, and resulting in positive outcomes; (2) Barriers to men's eMH use: lack of free time, predicted or experienced lack of benefit from use, and technical difficulties; (3) What men want in eMH: personalised, tailored, relevant interventions that are bright and easy to use, with information presented in multiple formats, psychoeducation, exercises, self-monitoring, information on further resources, and the option of clinician involvement, without any repetitive questioning, boring tools, or negative feedback. LIMITATIONS All included studies were conducted in high income, 'Western' countries; most data related to experiences of using an existing eMH intervention within a trial, rather than in 'real world' settings where eMH acceptability is generally lower and experiences may differ. CONCLUSIONS Practice, research, and policy recommendations are presented.
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Affiliation(s)
- Melissa J Opozda
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
| | - Melissa Oxlad
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia; School of Psychology, University of Adelaide, Adelaide, Australia
| | - Deborah Turnbull
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia; School of Psychology, University of Adelaide, Adelaide, Australia
| | - Himanshu Gupta
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, Australia
| | - James A Smith
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, Australia
| | - Samuel Ziesing
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Murray E Nankivell
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Gary Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
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Zantvoort K, Scharfenberger J, Boß L, Lehr D, Funk B. Finding the Best Match - a Case Study on the (Text-)Feature and Model Choice in Digital Mental Health Interventions. J Healthc Inform Res 2023; 7:447-479. [PMID: 37927375 PMCID: PMC10620349 DOI: 10.1007/s41666-023-00148-z] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 08/29/2023] [Indexed: 11/07/2023]
Abstract
With the need for psychological help long exceeding the supply, finding ways of scaling, and better allocating mental health support is a necessity. This paper contributes by investigating how to best predict intervention dropout and failure to allow for a need-based adaptation of treatment. We systematically compare the predictive power of different text representation methods (metadata, TF-IDF, sentiment and topic analysis, and word embeddings) in combination with supplementary numerical inputs (socio-demographic, evaluation, and closed-question data). Additionally, we address the research gap of which ML model types - ranging from linear to sophisticated deep learning models - are best suited for different features and outcome variables. To this end, we analyze nearly 16.000 open-text answers from 849 German-speaking users in a Digital Mental Health Intervention (DMHI) for stress. Our research proves that - contrary to previous findings - there is great promise in using neural network approaches on DMHI text data. We propose a task-specific LSTM-based model architecture to tackle the challenge of long input sequences and thereby demonstrate the potential of word embeddings (AUC scores of up to 0.7) for predictions in DMHIs. Despite the relatively small data set, sequential deep learning models, on average, outperform simpler features such as metadata and bag-of-words approaches when predicting dropout. The conclusion is that user-generated text of the first two sessions carries predictive power regarding patients' dropout and intervention failure risk. Furthermore, the match between the sophistication of features and models needs to be closely considered to optimize results, and additional non-text features increase prediction results. Supplementary Information The online version contains supplementary material available at 10.1007/s41666-023-00148-z.
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Affiliation(s)
- Kirsten Zantvoort
- Institute of Information Systems, Leuphana University, Lüneburg, Germany
| | | | - Leif Boß
- Institute of Psychology, Leuphana University, Lüneburg, Germany
| | - Dirk Lehr
- Institute of Psychology, Leuphana University, Lüneburg, Germany
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lüneburg, Germany
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Lim MH, Thurston L, Eres R, Rodebaugh TL, Alvarez-Jimenez M, Penn DL, Kostakos V, Gleeson JFM. A pilot randomised controlled trial of the Peer Tree digital intervention targeting loneliness in young people: a study protocol. Trials 2023; 24:77. [PMID: 36732797 PMCID: PMC9893200 DOI: 10.1186/s13063-022-07029-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/16/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Young people are vulnerable to experiencing problematic levels of loneliness which can lead to poor mental health outcomes. Loneliness is a malleable treatment target and preliminary evidence has shown that it can be addressed with digital platforms. Peer Tree is a strength-based digital smartphone application aimed at reducing loneliness. The study aim is to reduce loneliness and assess the acceptability, usability, and feasibility of Peer Tree in young people enrolled at university. METHODS This will be a pilot randomised controlled trial (RCT) comparing a strength-based digital smartphone application (Peer Tree) with a control condition. Forty-two young people enrolled at university will be recruited for this pilot RCT. Participants with suicidal ideation or behaviours, acute psychiatric symptoms in the past month, or a current diagnosis of a mood or social anxiety disorder will be excluded. Allocation will be made on a 1:1 ratio and will occur after the initial baseline assessment. Assessments are completed at baseline, at post-intervention, and at follow-up. Participants in the control condition complete the same three assessment sessions. The primary outcome of the study will be loneliness. Depression, social anxiety, quality of life, acceptability, usability, feasibility, and safety of Peer Tree will also be measured as secondary outcomes. DISCUSSION This trial will report the findings of implementing Peer Tree, a smartphone application aimed at reducing loneliness in university students. Findings from this trial will highlight the initial efficacy, acceptability, and feasibility of using digital positive psychology interventions to reduce subthreshold mental health concerns. Findings from this trial will also describe the safety of Peer Tree as a digital tool. Results will contribute evidence for positive psychology interventions to address mental ill-health. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12619000350123. Registered on 6 March 2020.
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Affiliation(s)
- Michelle H. Lim
- grid.1013.30000 0004 1936 834XPrevention Research Collaboration, School of Public Health, University of Sydney, Camperdown, Australia ,grid.1027.40000 0004 0409 2862Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria Australia
| | - Lily Thurston
- grid.1027.40000 0004 0409 2862Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria Australia ,grid.488501.00000 0004 8032 6923Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria Australia
| | - Robert Eres
- grid.1027.40000 0004 0409 2862Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria Australia ,grid.1017.70000 0001 2163 3550Department of Psychology, RMIT University, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Paediatrics, The University of Melbourne, Melbourne, Australia ,grid.1058.c0000 0000 9442 535XNeurodisability and Rehabilitation, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Thomas L. Rodebaugh
- grid.4367.60000 0001 2355 7002School of Arts and Sciences, Washington University in St. Louis, St. Louis, USA
| | - Mario Alvarez-Jimenez
- grid.488501.00000 0004 8032 6923Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria Australia
| | - David L. Penn
- grid.410711.20000 0001 1034 1720Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, USA ,grid.411958.00000 0001 2194 1270School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria Australia
| | - Vassilis Kostakos
- grid.1008.90000 0001 2179 088XSchool of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - John F. M. Gleeson
- grid.411958.00000 0001 2194 1270School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria Australia
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Van Der Poll R, Coetzee B, Bantjes J. Willing and unwilling digital cyborg assemblages: University students talk about mental health apps. Digit Health 2023; 9:20552076231210658. [PMID: 37915793 PMCID: PMC10617263 DOI: 10.1177/20552076231210658] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
Objective Explore how students talk about mental health mobile applications (i.e., apps). Methods Data collected in focus group interviews with 51 students (all self-identifying as having mental health problems) and analysed using inductive thematic content analysis. Results Participants describe mental health apps as an anti-dote to the loss of control, vulnerability, helplessness, impotence, isolation, conspicuousness, and shame which characterise their experience of mental illness. They describe the on-campus clinic as inaccessible and associated with "serious" problems, while configuring psychologists and psychotherapy as out of reach, scarce, formal, structured and anxiety provoking. In contrast, they imagine mental health apps as informal, relaxed, inviting, and accessible. Participants expressed openness and optimism about using apps to improve their mental health. They idealise technology as a means to connect effortlessly, anonymously, and informally, as well as learn skills, assert agency, and act responsibly. They also articulate reluctance to trust technology, show cognisance of participating in a capitalist economy, demonstrate scepticism about the legitimacy of mental health apps, and call for regulation, thereby resisting the position of responsible neoliberal subjects. Conclusion Participants express ambivalence towards mental health apps without surrendering to either technophobia or technophilia. They express faith in technologies' potential to support mental health while questioning the implicit assumption that people are competent to manage their own mental health. In talking about mental health apps students reproduce broader cultural discourses (including techno-optimism, techno-solutionism, somatopiamism, neo-liberalism, responsibilisationism, technoscepticism, and discourses about neuroplasticity and self-help) thus presenting themselves as both willing and unwilling digital cyborgs.
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Affiliation(s)
- Ryan Van Der Poll
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Bronwyne Coetzee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Jason Bantjes
- Mental Health, Alcohol, Substance use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cae Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
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Marinova N, Rogers T, MacBeth A. Predictors of adolescent engagement and outcomes - A cross-sectional study using the togetherall (formerly Big White Wall) digital mental health platform. J Affect Disord 2022; 311:284-293. [PMID: 35588912 DOI: 10.1016/j.jad.2022.05.058] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Online mental health platforms can improve access to, and use of, mental health support for young people who may find it difficult to engage with face-to-face delivery. OBJECTIVE We modelled predictors of engagement and symptom change in adolescent users of the Togetherall (formerly "Big White Wall") anonymous digital mental health peer-support platform. METHODS We report a retrospective analysis of longitudinal user data from UK 16-18 year Togetherall users, referred from mental health services (N = 606). Baseline demographics were reported for participants who logged anxiety and depression measures. Number of log-ins, mean session duration, total usage time, number of guided support courses and self-help materials accessed were our usage metrics. Participant characteristics and symptoms were used to predict engagement. For n = 245 users with symptom measures at >1 timepoint we modelled the effect of predictors on symptom scores. RESULTS Mean logins was 5.11 and mean usage time was 64.22 mins. Participants with one log-in represented 33.5% of the sample. Total time accessing Togetherall predicated greater usage of self-help materials and courses. Females made greater use of materials and courses than males. In a subsample, higher baseline depression and anxiety, longer total usage time and mean session duration predicted final depression scores, whereas higher baseline depression and anxiety and greater accessed self-help materials predicted lower final anxiety scores. LIMITATIONS A naturalistic design was used and symptom modelling should be interpreted with caution. CONCLUSIONS Findings suggest adolescents can engage with the Togetherall platform. Baseline symptoms and characteristics can inform user engagement with digital platforms.
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Affiliation(s)
| | - Tim Rogers
- Togetherall (formerly Big White Wall), UK
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Weitzel EC, Pabst A, Luppa M, Kersting A, König HH, Löbner M, Riedel-Heller SG. Are self-managed online interventions for depression effective in improving behavioral activation? A secondary analysis of a cluster-randomized controlled trial. J Affect Disord 2022; 308:413-420. [PMID: 35460734 DOI: 10.1016/j.jad.2022.04.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/23/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Online interventions can effectively improve depressive symptoms. They often include behavioral activation (BA) techniques, but research on the effects on behavioral activation is scarce. This study aims to examine short- and long-term effects of online interventions on behavioral activation in routine care. METHODS This study is a secondary analysis of a pragmatic cluster-randomized controlled trial (@ktiv) with a sample of N = 647 GP patients with mild to moderate depression. The intervention group (IG) received treatment-as-usual (TAU) and adjunct access to an online intervention; the control group (CG) received TAU. BA was assessed in terms of the frequency and enjoyment of pleasant activities at baseline, after six weeks and after six months. Intention-to-treat analyses were performed via multilevel mixed linear regression. RESULTS The frequency of pleasant activities was significantly higher in the IG than in the CG six months after baseline (t(1406) = 2.25, p = .024). The enjoyment of pleasant activities was significantly higher in the IG than in the CG both six weeks (t(1405) = 2.11, p = .035) and six months after baseline (t(1405) = 3.44, p = .001). Initial depressive symptoms significantly moderated the treatment effect on the enjoyment but not the frequency of pleasant activities. LIMITATIONS BA measures have not been validated in a clinical context. CONCLUSIONS GP patients with mild to moderate depressive symptoms profited from access to an online adjunct intervention in terms of improved behavioral activation. The findings emphasize the usefulness of online interventions as supportive options in mental health care.
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Affiliation(s)
- E C Weitzel
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany.
| | - A Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - M Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - A Kersting
- Clinic of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - H H König
- Department of Health Economics and Health Services Research, Hamburg Centre for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - M Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - S G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
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Staeck R, Drüge M, Albisser S, Watzke B. Acceptance of E-mental health interventions and its determinants among psychotherapists-in-training during the first phase of COVID-19. Internet Interv 2022; 29:100555. [PMID: 35789691 PMCID: PMC9242936 DOI: 10.1016/j.invent.2022.100555] [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] [Received: 01/28/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although E-mental health (EMH) interventions have been shown to be effective in the treatment of mental health problems and empirical knowledge regarding EMH acceptance for different occupations in health care is established, little is known regarding EMH and psychotherapists-in-training. This seems particularly relevant as psychotherapists-in-training will shape the future health care system since they are as being the next generation of psychotherapists. With social distancing measures in place, COVID-19 has led to an increased demand for EMH, which is broadening the way psychological treatments are delivered. OBJECTIVE The present study aims to assess the acceptance of EMH and its determinants among psychotherapists-in-training of different EMH modalities and to retrospectively compare current acceptance with pre-COVID-19 times. METHODS Altogether, 29 training institutions in Switzerland and 232 training institutions in Germany were contacted, resulting in a sample of N = 216 psychotherapists-in-training (88.4 % female) who filled out the self-administered web-based questionnaire in summer 2020. The acceptance of EMH was assessed considering several different modalities (e.g., videoconference, guided self-help programs) as well as further possible predictors of EMH acceptance based on the Unified Theory of Acceptance and Use of Technology. Acceptance scores were categorized as low, moderate or high based on prior research and predicted using multiple regression. RESULTS Acceptance of EMH was moderate (M = 3.40, SD = 1.11) and increased significantly (t(215) = 12.03, p < .01; d = 0.88) compared to pre-COVID-19 (M = 2.67, SD = 1.11); however, acceptance varied significantly between modalities (F(2.6, 561.7) = 62.93, p < .01, partial η2 = 0.23), with videoconferencing being the most accepted and unguided programs the least. Stepwise regression including three of 14 variables (R2 = 0.55, F (14, 201) = 17.68, p < .001) identified performance expectancy, social influence and concerns about the therapeutic alliance as significant determinants of EMH acceptance. DISCUSSION Acceptance by psychotherapists-in-training was moderate and in line with prior research and comparable with other clinicians' acceptance scores. Performance expectancy, social influence and concerns about the therapeutic alliance were predictive of EMH acceptance, indicating their significance in the implementation of EMH in health care. CONCLUSION These findings underline the importance of the aforementioned determinants of EMH acceptance and the need for further studies investigating EMH acceptance in order to derive adequate educational programs and to facilitate dissemination among psychotherapists-in-training.
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Mondragón-Gómez R, Martínez-Vélez NA, Fernández-Torres M, Tiburcio Sainz M. Evaluation of Psychometric Properties of the Acceptability of ICT Use for Mental Health Care Questionnaire. Int J Ment Health Addict 2022; 21:1-12. [PMID: 35754860 PMCID: PMC9208255 DOI: 10.1007/s11469-021-00747-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/21/2022] Open
Abstract
The adoption of e-mental health strategies is determined by the acceptability of Information and Communication Technologies (ICT) to professionals, an issue barely explored in Mexico. The objective was to evaluate the psychometric properties of the Acceptability of ICT Use for Mental Health Care Questionnaire. A convenience sample of 492 Mexican mental health professionals answered the questionnaire on ICT use for mental health care. Internal consistency analyses, exploratory, and confirmatory factor analyses were performed. Around 73.4% of the sample are women, aged between 21 and 30 (32.1%), around 50% has completed graduate studies, and 88.3% is practicing psychologists. The questionnaire comprised 11 items grouped into three factors: perceived usefulness, risk perception, and subjective norm. The CFA indicated a good fit χ2 SB/gl = 443.38/206 = 2.15; CFI = 0.930; RMSEA = 0.068 (95% CI [0.059-0.077]). The instrument has adequate psychometric properties for evaluating the acceptability of ICT use for mental health care.
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Affiliation(s)
| | - Nora Angélica Martínez-Vélez
- Department of Social Sciences in Health, Direction of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Calzada Mexico-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, 14370 Mexico City, Mexico
| | - Morise Fernández-Torres
- Department of Social Sciences in Health, Direction of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Calzada Mexico-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, 14370 Mexico City, Mexico
| | - Marcela Tiburcio Sainz
- Department of Social Sciences in Health, Direction of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Calzada Mexico-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, 14370 Mexico City, Mexico
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12
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Koly KN, Saba J, Muzaffar R, Modasser RB, M TH, Colon-Cabrera D, Warren N. Exploring the potential of delivering mental health care services using digital technologies in Bangladesh: A qualitative analysis. Internet Interv 2022; 29:100544. [PMID: 35615404 PMCID: PMC9125629 DOI: 10.1016/j.invent.2022.100544] [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: 01/09/2022] [Revised: 04/20/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Bangladesh is a lower-middle-income country affected by a severe lack of mental health service availability due to a scarcity of mental health experts, limited mental health literacy, and community stigma. In other low and middle-income countries, the online provision of mental health care services has addressed issues affecting service availability, accessibility, mass awareness of services, and stigma. OBJECTIVE The current study sought to understand stakeholders' perceptions of the potential of digital media-based mental health care delivery in strengthening Bangladesh's mental health system. METHOD Online in-depth interviews were conducted with seven psychiatrists and eleven people with lived experiences of mental health issues. In addition, two online focus groups were conducted with ten psychologists and nine mental health entrepreneurs. A thematic analysis of the audio transcriptions was used to identify themes. RESULT Stakeholders perceived that the benefits of digital media-based mental health services included the potential of increasing the awareness, availability, and accessibility of mental health services. Participants recommended: the rehabilitation of existing pathways; the use of social media to raise awareness; and the implementation of strategies that integrate different digital-based services to strengthen the mental health system and foster positive mental health-seeking behaviors. CONCLUSION Growing mental health awareness, combined with the appropriate use of digital media as a platform for distributing information and offering mental services, can help to promote mental health care. To strengthen mental health services in Bangladesh, tailored services, increased network coverage, and training are required on digital mental health.
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Key Words
- Bangladesh
- CMD, Common Mental Health Disorders
- COREQ, Consolidated Reporting Criteria for Qualitative Studies
- COVID-19, Coronavirus Disease 2019
- DALYs, Disability-Adjusted Life-Years
- Digital technology
- E-mental health
- FGD, Focus Group Discussions
- HIC, High Income Country
- Health system
- IDI, In-Depth Interviews
- IRB, Institutional Review Board
- Internet
- KII, Key Informant Interviews
- LMIC, Low and Middle-Income Country
- MH, Mental Health
- Mental health
- PWLE, People with Lived Experiences of Mental Health Issues
- UHC, Universal Health Coverage
- WHO, World Health Organization
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Affiliation(s)
- Kamrun Nahar Koly
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh,Corresponding author at: Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh.
| | - Jobaida Saba
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Rasma Muzaffar
- Department of Public Health, North South University, Bashundhara, Dhaka 1229, Bangladesh
| | - Rifath Binta Modasser
- School of Public Health, Independent University Bangladesh (IUB), Bashundhara, Dhaka 1229, Bangladesh
| | - Tasdik Hasan M
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom,Action Lab, Department of Human Centred Computing, Faculty of Information Technology, Monash University, Melbourne, Australia,Department of Public Health, State University of Bangladesh, Dhaka, Bangladesh
| | - David Colon-Cabrera
- Department of Sociology and Anthropology, School of Social Sciences, Monash University, Australia
| | - Narelle Warren
- Department of Sociology and Anthropology, School of Social Sciences, Monash University, Australia
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13
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Wintner SR, Waters SE, Peechatka A, Gonzalez-Heydrich J, Kahn J. Evaluation of a scalable online videogame-based biofeedback program to improve emotion regulation: A descriptive study assessing parent perspectives. Internet Interv 2022; 28:100527. [PMID: 35360088 PMCID: PMC8960945 DOI: 10.1016/j.invent.2022.100527] [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] [Received: 05/27/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Individuals and families increasingly turn to e-mental health apps for education, diagnosis, and treatment of mental health disorders and to promote mental wellness. These apps provide significant increases in convenience from existing services, since they can augment or replace services with on-demand access within the home. This raises important questions about self-selection of interventions. Who uses these applications? How do individuals perceive their own progress within applications? This study is a retrospective data analysis-based evaluation of a commercially available e-mental health program that includes biofeedback video games that help children build emotion regulation skills by demonstrating and prompting children to practice bodily focused emotion regulation techniques. The e-mental health program also provided parent psychoeducation-focused coaching at the time of the evaluation. Data collection instruments used to inform the retrospective study included parent intake surveys, gameplay engagement data, and notes from parent coaching calls. The evaluation revealed families presenting for common symptoms associated with emotion regulation deficits, as opposed to a wellness cohort looking for additional support. Families near-universally activated and engaged with the intervention, willing to carry out an extended "dose" of the e-mental health program in their home. Parents self-reported their perceptions of their children's emotion regulation progress, primarily in terms of children's increased use of emotion regulation skills, improved emotion awareness and communication, calmer demeanor, greater confidence, and improved relationships. More work is needed to understand the corresponding clinical progress from this in-home training, as well as its implications for how emotion regulation skills grow.
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Affiliation(s)
- Suzanne R. Wintner
- Neuromotion Labs, Inc., 186 Lincoln Street, Boston, MA 02111, United States of America
- Corresponding author.
| | - Sarah E. Waters
- Neuromotion Labs, Inc., 186 Lincoln Street, Boston, MA 02111, United States of America
| | - Alyssa Peechatka
- Neuromotion Labs, Inc., 186 Lincoln Street, Boston, MA 02111, United States of America
| | - Joseph Gonzalez-Heydrich
- Boston Children's Hospital, Developmental Medicine Center, 300 Longwood Avenue, Fegan, 10th Floor, Boston, MA 02115, United States of America
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America
| | - Jason Kahn
- Neuromotion Labs, Inc., 186 Lincoln Street, Boston, MA 02111, United States of America
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Eckert M, Efe Z, Guenthner L, Baldofski S, Kuehne K, Wundrack R, Thomas J, Saee S, Kohls E, Rummel-Kluge C. Acceptability and feasibility of a messenger-based psychological chat counselling service for children and young adults ("krisenchat"): A cross-sectional study. Internet Interv 2022; 27:100508. [PMID: 35242589 PMCID: PMC8857586 DOI: 10.1016/j.invent.2022.100508] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adolescence represents a vulnerable period to experience personal crises or mental health problems. However, many concerns stay unnoticed due to the hesitance of young people to seek help and the unavailability and inaccessibility of appropriate help services. Contemporary interventions have been developed incorporating with target group specific needs and preferred modes of communication. krisenchat (German for "crisis chat") is a German low-threshold chat-based psychosocial crisis counselling service that is available around-the-clock. Despite the growing number of online support services, there is a dearth of research regarding the acceptability, usability, and feasibility. METHODS The present cross-sectional study analyzed retrospective anonymous data on sociodemographic variables, utilization behavior, and user satisfaction of all krisenchat users between May 2020 and July 2021. Predictors of user satisfaction were identified using exploratory multiple regression analysis. Subgroup analyses were conducted using chi-square-tests to identify differences in user satisfaction. RESULTS Data of N = 6962 users was included in the analysis. More than 50% of those reported not having contacted the professional health care system before. The mean user of krisenchat was 17 years old (M = 16.6, SD = 3.5), female (female: 83.4%, male: 14.7%, diverse: 1.8%), and first approached the service at 4 PM (M = 4:03 PM, SD = 5:44 h). More than 60% of the users contacted the service between 4 PM and 12 AM, 10% even between 12 AM and 8 AM. The most frequent chat topics were concerns regarding psychiatric symptoms (60.1%), psychosocial (34.0%) or emotional distress (30.2%). The majority of the users (64.7%) reported high levels of satisfaction and 88.3% a high likelihood (60% or more) of recommending krisenchat to others. Also, the results indicate that the number of messages and their respective length differed between users and counsellors, with users writing several, but shorter messages and counsellors replying with fewer, but longer messages. CONCLUSION The results of the present study imply a high acceptability and feasibility of krisenchat. Overall, there is a high need for a 24/7 messenger-based chat counselling service in crises for children and young adults. Currently, there is no other online service for youth that is available after 7 PM or at weekends, which indicates the great importance of krisenchat and its function to bridge a current gap in the mental health care system. A need for further research emerges e.g., for subgroup differences regarding utilization patterns and also for further insights regarding help-seeking behavior via social media in youth. STUDY REGISTRATION DRKS00026671.
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Affiliation(s)
- Melanie Eckert
- Krisenchat gGmbH, Berlin, Germany,Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Zeki Efe
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Lukas Guenthner
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Katharina Kuehne
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Richard Wundrack
- Krisenchat gGmbH, Berlin, Germany,Department of Psychology, Chair of Personality Psychology, Humboldt University zu Berlin, Germany
| | | | | | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany,Department of Psychiatry and Psychotherapy, University Leipzig Medical Center, Leipzig, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany,Department of Psychiatry and Psychotherapy, University Leipzig Medical Center, Leipzig, Germany,Corresponding author at: Klinik und Poliklinik für Psychiatrie und Psychotherapie, Semmelweisstr 10, Haus 13, 04103 Leipzig, Germany.
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15
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Phillips EA, Himmler S, Schreyögg J. Preferences of psychotherapists for blended care in Germany: a discrete choice experiment. BMC Psychiatry 2022; 22:112. [PMID: 35151294 PMCID: PMC8841060 DOI: 10.1186/s12888-022-03765-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/07/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Digital treatment formats are emerging within mental health care. Evidence suggests that mental health care providers and recipients prefer a combination of digital and traditional elements within psychotherapy treatment formats, also called blended care (BC), over standalone digital formats. We examined the attitudes and preferences of licensed psychotherapists in Germany regarding such BC applications. METHODS We fielded a survey among psychotherapists, including questions about attitudes, previous experiences, and expectations regarding BC, as well as a discrete choice experiment. Attributes for the experiment were developed using a stepwise qualitative approach. A Bayesian D-efficient design was used to generate the choice tasks. The choice data were analyzed by applying mixed logit models. RESULTS The survey was completed by 200 psychotherapists. Attitudes towards BC were mainly positive, with strong reported intentions to use BC formats. In the choice experiment, recommendation from a professional society for a BC online component was the most important characteristic. Greater effectiveness and a larger share of face-to-face vs. online time were also desired features, while a financial incentive to use BC was less relevant.
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Affiliation(s)
- Elena A. Phillips
- grid.9026.d0000 0001 2287 2617Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | - Sebastian Himmler
- Erasmus School of Health Policy & Management Health Economics, Burg. Oudlaan 50, 3062 Rotterdam, PA Netherlands
| | - Jonas Schreyögg
- grid.9026.d0000 0001 2287 2617Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
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16
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Timakum T, Xie Q, Song M. Analysis of E-mental health research: mapping the relationship between information technology and mental healthcare. BMC Psychiatry 2022; 22:57. [PMID: 35078432 PMCID: PMC8787445 DOI: 10.1186/s12888-022-03713-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/22/2021] [Accepted: 01/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND E-mental healthcare is the convergence of digital technologies with mental health services. It has been developed to fill a gap in healthcare for people who need mental wellbeing support that may not otherwise receive psychological treatment. With an increasing number of e-mental healthcare and research, this study aimed to investigate the trends of an e-mental health research field that integrates interdisciplinary fields and to examine the information technologies is being used in mental healthcare. To achieve the research objectives, bibliometric analysis, information extraction, and network analysis were applied to analyze e-mental health research data. METHODS E-mental health research data were obtained from 3663 bibliographic records from the Web of Science (WoS) and 3172 full-text articles from PubMed Central (PMC). The text mining techniques used for this study included bibliometric analysis, information extraction, and visualization. RESULTS The e-mental health research topic trends primarily involved e-health care services and medical informatics research. The clusters of research comprised 16 clusters, which refer to mental sickness, e-health, diseases, information technology (IT), and self-management. The information extraction analysis revealed a triple relation with IT and biomedical domains. Betweenness centrality was used as a measure of network graph centrality, based on the shortest path to rank the important entities and triple relation; nodes with higher betweenness centrality had greater control over the network because more information passes through that node. The IT entity-relations of "mobile" had the highest score at 0.043466. The top pairs were related to depression, mobile health, and text message. CONCLUSIONS E-mental related publications were associated with various research fields, such as nursing, psychology, medical informatics, computer science, telecommunication, and healthcare innovation. We found that trends in e-mental health research are continually rising. These trends were related to the internet of things (IoT) and mobile applications (Apps), which were applied for mental healthcare services. Moreover, producing AI and machine learning for e-mental healthcare were being studied. This work supports the appropriate approaches and methods of e-mental health research that can help the researcher to identify important themes and choose the best fit with their own survey work.
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Affiliation(s)
- Tatsawan Timakum
- grid.440397.d0000 0001 0516 2525Department of Information Sciences, Chiang Mai Rajabhat University, Chiang Mai, Thailand
| | - Qing Xie
- grid.464445.30000 0004 1790 3863School of Management, Shenzhen Polytechnic, Shenzhen, Guangdong China
| | - Min Song
- Department of Library and Information Science, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-749, Republic of Korea.
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17
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Sander J, Bolinski F, Diekmann S, Gaebel W, Günther K, Hauth I, Heinz A, Kleiboer A, Riper H, Trost N, Vlijter O, Zielasek J, Gerlinger G. Online therapy: an added value for inpatient routine care? Perspectives from mental health care professionals. Eur Arch Psychiatry Clin Neurosci 2022; 272:107-18. [PMID: 33725165 DOI: 10.1007/s00406-021-01251-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/03/2021] [Indexed: 11/04/2022]
Abstract
Internet-delivered interventions can be effective in treating mental disorders. However, their rate of use in German psychiatric inpatient routine care is low. The current study aimed to investigate the attitude of mental health care professionals working in inpatient care regarding internet-delivered interventions, including presumed benefits, barriers and facilitators. In total, 176 health professionals from ten inpatient psychiatric hospitals throughout Germany were surveyed on site. The professionals' attitude towards internet-delivered interventions in inpatient care was assessed by an adapted version of the 'Attitude toward Telemedicine in Psychiatry and Psychotherapy' (ATTiP) questionnaire. To identify benefits, barriers and facilitators, we developed open-response questions that were based on the 'Unified Theory of Acceptance and Use of Technology' (UTAUT) and analyzed by a qualitative content analysis. Professionals reported little experience or knowledge about internet-delivered interventions. Their attitude towards internet-delivered interventions in psychiatric inpatient care was rather indifferent. The most frequently mentioned potential benefits were an optimised treatment structure and patient empowerment; the most frequently anticipated barriers were too severe symptoms of patients, the feared neglect of face-to-face contacts and insufficient technical equipment; and the most frequently mentioned facilitators were high usability of the internet-based intervention, a sufficient functional level of the patient and further education of staff. For successful implementation in the inpatient sector, internet-delivered interventions must be adapted to the special needs of severely mentally ill patients and to the hospital management systems and workflow. In addition, technical preconditions (internet access, devices) must be met. Last, further education of mental health care professionals is needed.
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18
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Lüdtke T, Rüegg N, Moritz S, Berger T, Westermann S. Insight and the number of completed modules predict a reduction of positive symptoms in an Internet-based intervention for people with psychosis. Psychiatry Res 2021; 306:114223. [PMID: 34826711 DOI: 10.1016/j.psychres.2021.114223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/09/2019] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Abstract
Emerging evidence suggests that Internet-based interventions for people with psychosis (ICBTp) are feasible and efficacious. However, predictors of adherence and treatment outcomes are largely unknown. To narrow this research gap, we conducted secondary analyses on data from a randomized controlled trial, which evaluated an eight-week ICBTp intervention targeting topics, such as voice hearing, mindfulness, and others. In n = 100 participants with psychosis, we aimed at identifying sociodemographic, psychopathological, and treatment-related predictor variables of post-treatment symptoms and adherence (i.e., at least four completed modules). We followed a two-stage approach. First, we conducted regression analyses to examine the effect of single candidate predictors on post-treatment symptoms as well as adherence. Subsequently, we selected variables that met a significance threshold of p < .1 and entered them into linear and logistic multiple regression models. Whereas no variable was able to predict adherence, the number of completed modules was negatively associated with self-reported delusion severity at post-treatment. Additionally, higher pre-treatment insight predicted fewer hallucinations after treatment. Because this was one of the first studies to investigate predictors in ICBTp, more research is needed to customize future interventions to the needs of users.
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Affiliation(s)
- Thies Lüdtke
- Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany; Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Nina Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Stefan Westermann
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany.
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Boß L, Angerer P, Dragano N, Ebert D, Engels M, Heber E, Kuhlmann R, Ruhle S, Schwens C, Wulf IC, Lehr D. Comparative effectiveness of guided internet-based stress management training versus established in-person group training in employees - study protocol for a pragmatic, randomized, non-inferiority trial. BMC Public Health 2021; 21:2177. [PMID: 34837999 PMCID: PMC8626923 DOI: 10.1186/s12889-021-12229-y] [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] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Occupational stress is a major public health challenge that requires a variety of evidence-based preventative approaches to increase their reach within the working population. Behavioral stress management interventions are considered an established approach for occupational stress prevention. Both in-person group-based stress management training (gSMT) and individual Internet-based training (iSMT) have been shown to be effective at reducing stress in employees. However, there remains a lack of evidence on the comparative efficacy of the newer digital format compared to well-established, in-person, group-based training. This study aims (1) to directly compare an evidence-based iSMT with an established gSMT on stress in employees, (2) to analyze the two conditions from a cost perspective, and (3) to explore moderators of the comparative efficacy. METHODS In a randomized, controlled, non-inferiority trial employees from the general working population will be allocated to iSMT or gSMT. The primary outcome will be perceived stress, assessed using the Perceived Stress Scale, three months after randomization. The non-inferiority margin for the primary outcome measure will be set at 2 points (Cohen's d = 0.29). This trial will also compare the two interventions from a health economics perspective, and conduct explorative analyses to identify potential effect moderators. DISCUSSION To reach a larger proportion of the working population, well-established gSMT should be complemented with interventions that fit today's society's increasingly digital lifestyle. The current trial will provide evidence supporting the responsible implementation of Internet-based stress management training if the digital format proves to at least be non-inferior to established group-based training. Additional explorative moderator analyses may guide future practices to aid in matching select programs with select users. TRIAL REGISTRATION German Register of Clinical Studies (DRKS): DRKS00024892, date of registration: 2021-04-09. Protocol version: 02, 16-10-2021.
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Affiliation(s)
- Leif Boß
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lüneburg, Lüneburg, Germany.
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - David Ebert
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Miriam Engels
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Elena Heber
- GET.ON Institut für Online Gesundheitstrainings GmbH, Hamburg, Germany
| | - Rebekka Kuhlmann
- Chair of Business Administration, in particular Work, Human Resource Management and Organization Studies, Faculty of Business Administration and Economics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sascha Ruhle
- Chair of Business Administration, in particular Work, Human Resource Management and Organization Studies, Faculty of Business Administration and Economics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Schwens
- Endowed Chair for Interdisciplinary Management Science, School of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
| | - Ines Catharina Wulf
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lüneburg, Lüneburg, Germany
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Oti O, Pitt I. Online mental health interventions designed for students in higher education: A user-centered perspective. Internet Interv 2021; 26:100468. [PMID: 34703772 PMCID: PMC8524143 DOI: 10.1016/j.invent.2021.100468] [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: 08/04/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Digital mental health interventions have been posited as a way of reducing the burden on mental health services in higher education institutions. However, low adherence and high attrition rates present a challenge that limits the effectiveness of these interventions. User-centered design has been proposed as a suitable approach in improving the adherence of users to these interventions. OBJECTIVE The objective of this scoping review was to examine digital mental health interventions that have been designed specifically for students in higher education. It aimed to summarize the published literature on digital mental health interventions which take a user-centered approach in developing interventions for students in higher education. METHODS A scoping review of peer-reviewed research papers from the following electronic databases was conducted: Embase, ACM digital library, Web of Science, IEEE Explore, SCOPUS, EBSCO Host (including APA PyscInfo, CINAHL PLUS, APA PsycArticles, Medline), PubMed and Google Scholar. Databases were searched from inception until 13 Jan and 14 Jan 2021. Of the 755 articles that were identified, 57 articles were selected for full review. 34 articles were excluded for not matching the inclusion criteria. RESULTS 23 studies were included in this review. The included interventions targeted various areas of mental health including depression, anxiety, overall wellbeing, and mental health awareness. The interventions were commonly delivered through mobile apps, web-based apps, and desktop apps. In addition, we explore design methodologies applied in the development of the interventions: we note significant stakeholder engagement in the studies, the inclusion of multiple stakeholder types (students, health care professionals, university staff, and young people in the general population), and limited use of design frameworks. Finally, in exploring user engagement, attrition rates and user acceptance, we find that most of the studies have not progressed enough (i.e., at pilot/prototype stages of development) to determine the impact of design methodologies on the success of these interventions. CONCLUSION Our review revealed a need for further research on the impact of user-centered design practices on the success of digital mental health interventions in this population. Further, we provide recommendations that researchers/designers in this field of research should take into consideration when designing online mental health interventions for students in higher education. Some of the recommendations include: add personalization; improve user interfaces; take adequate steps to ensure anonymity/privacy/security; include peer engagement; and include access to mental health professionals.
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21
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Chan EC, Wallace K, Yang EH, Roper L, Aryal G, Lodhi RJ, Baskys A, Isenberg R, Carnes P, Green B, Aitchison KJ. Internal consistency and concurrent validity of self-report components of a new instrument for the assessment of suicidality, the Suicide Ideation and Behavior Assessment Tool (SIBAT). Psychiatry Res 2021; 304:114128. [PMID: 34343876 DOI: 10.1016/j.psychres.2021.114128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/17/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
This study aimed to assess the internal consistency of self-report components of the Suicide Ideation and Behavior Assessment Tool (SIBAT) and validate it with relevant elements of the Mini International Neuropsychiatric Interview (MINI). The SIBAT is a newly developed instrument for the evaluation of suicidality. In this study, we invited university students and trainees participating in a study of addictions to complete the self-report component of the SIBAT as an add-on study. We evaluated the internal consistency of the self-report component of the SIBAT and validated it against the suicidality component of the MINI. Data were analysed using both complete case analysis and multiple imputation. SIBAT data were collected for 394 participants, 314 of whom had also completed the MINI. The internal consistency of modules 2, 3, and 5 of the SIBAT was high. Each item from module 5 had a statistically significant association with the corresponding item from the MINI. The sum of scores from modules 2 and 3 had a moderate correlation with the assessment of suicide risk determined by the MINI, and a strong correlation with the total score of SIBAT module 5. The completion median time of modules 2, 3 and 5 was 14.3 min.
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Affiliation(s)
- Eric C Chan
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
| | - Keanna Wallace
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Esther H Yang
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Leslie Roper
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Garima Aryal
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Rohit J Lodhi
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrius Baskys
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Graduate College of Biomedical Sciences and University Medical Center, Western University of Health Sciences, Pomona, California, United States; Memory Disorders and Genomic Medicine Clinic, Riverside, California, United States
| | - Richard Isenberg
- American Foundation for Addiction Research, Psychological Counseling Services, Scottsdale, Arizona, United States
| | - Patrick Carnes
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Bradley Green
- Department of Psychology, University of Texas at Tyler, Tyler, United States
| | - Katherine J Aitchison
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada.
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Tsiouris A, Mayer A, Nölke C, Ruckes C, Labitzke N, Wiltink J, Beutel ME, Zwerenz R. An emotion-based online intervention for reducing anxiety and depression in cancer patients: Study protocol for a randomized controlled trial. Internet Interv 2021; 25:100410. [PMID: 34401369 PMCID: PMC8350615 DOI: 10.1016/j.invent.2021.100410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/26/2020] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A cancer diagnosis can cause severe emotional distress and affect quality of life as well as social relationships. The transition from inpatient to outpatient treatment is burdened by stressful uncertainties and a gap of psycho-oncological care. In addition, further barriers, such as information deficits or fear of stigmatization, might hinder cancer patients to use psycho-oncological face-to-face interventions. Online interventions can be a low-threshold adjunct to existing face-to-face services. This study aims to evaluate the effect of the online self-help program epos (emotion-based psycho-oncological online self-help) on improving symptoms of anxiety and depression in German-speaking cancer patients. METHODS A randomized controlled trial (RCT) is carried out in a parallel group design. N = 325 patients will be enrolled in the trial, randomly assigned to an intervention and a control group. While the intervention group has access to nine modules of epos, the control group gets access to an informational website. Participants will complete online questionnaires at baseline (T0), after the intervention (T1) and three-month follow-up (T2). Primary outcome is a combined measure of depression and anxiety. Secondary outcomes include psychological distress, anxiety, depression, quality of life, emotional control, posttraumatic growth, and satisfaction with epos. Participants are at least 18 years old, have a cancer diagnosis, currently receive cancer treatment or aftercare, have sufficient German language competence, and have access to the Internet. Exclusion criteria are severe mental comorbidities (i.e. severe depression, suicidality) or somatic comorbidities (i.e. visual disabilities). DISCUSSION The results of this study will provide information about acceptability, feasibility, and efficacy of epos in improving symptoms of depression and anxiety in cancer patients and thus contribute to the research on web-based interventions. If found efficacious, epos will improve psycho-oncological care in cancer patients in transition from inpatient to outpatient care and in those who struggle to find adequate psycho-oncological support due to other (perceived) barriers.
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Affiliation(s)
- Angeliki Tsiouris
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- Corresponding author at: Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.
| | - Anna Mayer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Charlotte Nölke
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials, University Medical Center Mainz, Mainz, Germany
| | - Nicole Labitzke
- Center for Audiovisual Production, Johannes Gutenberg-University, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Wilson J, Heinsch M, Betts D, Booth D, Kay-Lambkin F. Barriers and facilitators to the use of e-health by older adults: a scoping review. BMC Public Health 2021; 21:1556. [PMID: 34399716 PMCID: PMC8369710 DOI: 10.1186/s12889-021-11623-w] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Limited attention has been paid to how and why older adults choose to engage with technology-facilitated health care (e-health), and the factors that impact on this. This scoping review sought to address this gap. Methods Databases were searched for papers reporting on the use of e-health services by older adults, defined as being aged 60 years or older, with specific reference to barriers and facilitators to e-health use. Result 14 papers were included and synthesised into five thematic categories and related subthemes. Results are discussed with reference to the Unified Theory of Acceptance and Use of Technology2. The most prevalent barriers to e-health engagement were a lack of self-efficacy, knowledge, support, functionality, and information provision about the benefits of e-health for older adults. Key facilitators were active engagement of the target end users in the design and delivery of e-health programs, support for overcoming concerns privacy and enhancing self-efficacy in the use of technology, and integration of e-health programs across health services to accommodate the multi-morbidity with which older adults typically present. Conclusion E-health offers a potential solution to overcome the barriers faced by older adults to access timely, effective, and acceptable health care for physical and mental health. However, unless the barriers and facilitators identified in this review are addressed, this potential will not be realised. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11623-w.
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Affiliation(s)
- Jessica Wilson
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Milena Heinsch
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - David Betts
- School of Humanities and Social Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Debbie Booth
- University Library, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Frances Kay-Lambkin
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia
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24
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Murphy JK, Khan A, Sun Q, Minas H, Hatcher S, Ng CH, Withers M, Greenshaw A, Michalak EE, Chakraborty PA, Sandanasamy KS, Ibrahim N, Ravindran A, Chen J, Nguyen VC, Lam RW. Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: a rapid scoping review. Int J Equity Health 2021; 20:161. [PMID: 34253198 PMCID: PMC8274266 DOI: 10.1186/s12939-021-01484-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background The COVID-19 pandemic is expected to have profound mental health impact, including in the Asia Pacific Economic Cooperation (APEC) region. Some populations might be at higher risk of experiencing negative mental health impacts and may encounter increased barriers to accessing mental health care. The pandemic and related restrictions have led to changes in care delivery, including a rapid shift to the use of e-mental health and digital technologies. It is therefore essential to consider needs and opportunities for equitable mental health care delivery to the most at-risk populations. This rapid scoping review: 1) identifies populations in the APEC region that are at higher risk of the negative mental health impacts of COVID-19, 2) identifies needs and gaps in access to standard and e-mental health care among these populations, and 3) explores the potential of e-mental health to address these needs. Methods We conducted a rapid scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched Medline, Embase and PsychInfo databases and Google Scholar using a search strategy developed in consultation with a biomedical librarian. We included records related to mental health or psychosocial risk factors and COVID-19 among at-risk groups; that referred to one or more APEC member economies or had a global, thus generalizable, scope; English language papers, and papers with full text available. Results A total of 132 records published between December 2019 and August 2020 were included in the final analysis. Several priority at-risk populations, risk factors, challenges and recommendations for standard and e-mental health care were identified. Results demonstrate that e-mental health care can be a viable option for care delivery but that specific accessibility and acceptability considerations must be considered. Options for in-person, hybrid or “low-tech” care must also remain available. Conclusions The COVID-19 pandemic has highlighted the urgent need for equitable standard and e-mental health care. It has also highlighted the persistent social and structural inequities that contribute to poor mental health. The APEC region is vast and diverse; findings from the region can guide policy and practice in the delivery of equitable mental health care in the region and beyond.
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Affiliation(s)
- Jill K Murphy
- Department of Psychiatry, Faculty of Medicine; APEC Digital Hub for Mental Health, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
| | - Amna Khan
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Qiumeng Sun
- Sol Price School of Public Policy, University of Southern California, 650 Childs Way, Los Angeles, CA, 90089, USA
| | - Harry Minas
- Global and Cultural Mental Health, Level 4, 207 Bouverie Street, Melbourne, Australia.,The University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, 3010, Australia
| | - Simon Hatcher
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Chee H Ng
- Healthscope Chair of Psychiatry, Department of Psychiatry, The University of Melbourne, Carlton, Victoria, 3010, Australia
| | - Mellissa Withers
- USC Keck School of Medicine, USC Institute on Inequalities in Global Health, Los Angeles, USA.,APRU Global Health Program, 2001 N Soto Street SSB 318G, Los Angeles, CA, 90089, USA
| | - Andrew Greenshaw
- Department of Psychiatry, Scientific Director, APEC Digital Hub for Mental Health, Faculty of Medicine & Dentistry, 4-142M Katz Group Centre for Pharmacy and Health Research, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada
| | - Erin E Michalak
- APEC Digital Hub for Mental Health, University of British Columbia, 420-5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Promit Ananyo Chakraborty
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Karen Sharmini Sandanasamy
- Mental Health, Substance Abuse and Violence Injury Prevention, Non-Communicable Disease Section, Disease Control Division, Ministry of Health, Level 2, Block E3, Putrajaya, Malaysia.,Precinct 1, Federal Government Administrative Complex, 62590, Putrajaya, Malaysia
| | - Nurashikin Ibrahim
- Mental Health, Substance Abuse and Violence Injury Prevention, Non-Communicable Disease Section, Disease Control Division, Ministry of Health, Level 2, Block E3, Putrajaya, Malaysia.,Precinct 1, Federal Government Administrative Complex, 62590, Putrajaya, Malaysia
| | - Arun Ravindran
- Global Mental Health Affairs & The Office of Fellowship Training, Department of Psychiatry, Graduate Faculty, Institute of Medical Sciences, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, M6J 1H4, Canada
| | - Jun Chen
- Office for Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Rd, Xuhui District, Shanghai, China
| | - Vu Cong Nguyen
- Institute of Population, Health and Development, ICON4 Tower, 243a Đường La Thành, Láng Thượng, Đống Đa, Hà Nội, 117222, Vietnam
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada.,APEC Digital Hub for Mental Health, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
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Classen B, Tudor K, du Preez E, Day E, Ioane J, Rodgers B. An Integrative Review of Contemporary Perspectives on Videoconference-Based Therapy-Prioritising Indigenous and Ethnic Minority Populations in the Global South. ACTA ACUST UNITED AC 2021; 6:545-558. [PMID: 33898737 PMCID: PMC8058578 DOI: 10.1007/s41347-021-00209-3] [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] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/14/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
An integrative literature review was undertaken as a means of drawing together contemporary perspectives on the outcomes and affordances of videoconference-based therapy. This review was conducted in a way which placed emphasis on the need for mental healthcare strategies which are mindful of the cultural and social needs of indigenous and ethnic minority populations, particularly those situated in the Global South. The review was undertaken using an inverse funnelling approach which sought to prioritise literature on videoconference-based therapy literature which specifically focused on indigenous and ethnic minority populations. A series of general and population specific searches across relevant health databases were supplemented by a simultaneous search of Google Scholar. The PICOS search tool was used in developing the search terms, and data was processed using an inductive approach to thematic analysis. A final dataset of 43 articles were included in the review. This body of literature encompassed an international range of studies and included perspectives informed by quantitative, qualitative and mixed methods research. Four key themes were identified across the reviewed literature: indigenous and ethnic minority populations, therapeutic relationships, clinical outcomes and technical and logistical considerations. Based on our findings, there is reason to believe that videoconference-based therapy can be made to be just as effective as offline, face-to-face modes of delivery. However, research into the efficacy, impact and cultural implications of this technology in relation to indigenous and ethnic minority populations represents a significant gap within contemporary literature.
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Affiliation(s)
- Ben Classen
- Auckland University of Technology, Auckland, New Zealand
| | - Keith Tudor
- Auckland University of Technology, Auckland, New Zealand
| | | | - Elizabeth Day
- Auckland University of Technology, Auckland, New Zealand
| | - Julia Ioane
- Auckland University of Technology, Auckland, New Zealand
| | - Brian Rodgers
- Auckland University of Technology, Auckland, New Zealand
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Dingwall KM, Sweet M, Cass A, Hughes JT, Kavanagh D, Howard K, Barzi F, Brown S, Sajiv C, Majoni SW, Nagel T. Effectiveness of Wellbeing Intervention for Chronic Kidney Disease (WICKD): results of a randomised controlled trial. BMC Nephrol 2021; 22:136. [PMID: 33866968 PMCID: PMC8054368 DOI: 10.1186/s12882-021-02344-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background End stage kidney disease (ESKD) is associated with many losses, subsequently impacting mental wellbeing. Few studies have investigated the efficacy of psychosocial interventions for people with ESKD and none exist for Indigenous people, a population in which the ESKD burden is especially high. Methods This three-arm, waitlist, single-blind randomised controlled trial examined efficacy of the Stay Strong App in improving psychological distress (Kessler distress scale; K10), depressive symptoms (adapted Patient Health Questionnaire; PHQ-9), quality of life (EuroQoL; EQ. 5D) and dialysis adherence among Indigenous Australians undergoing haemodialysis in central and northern Australia (Alice Springs and Darwin), with follow up over two 3-month periods. Effects of immediate AIMhi Stay Strong App treatment were compared with those from a contact control app (The Hep B Story) and treatment as usual (TAU). Control conditions received the Stay Strong intervention after 3 months. Results Primary analyses of the full sample (N = 156) showed statistically significant decreases in K10 and PHQ-9 scores at 3 months for the Hep B Story but not for the Stay Strong app or TAU. Restricting the sample to those with moderate to severe symptoms of distress or depression (K10 > =25 or PHQ-9 > =10) showed significant decreases in K10 and PHQ-9 scores for both Stay Strong and Hep B Story. No significant differences were observed for the EQ-5D or dialysis attendance. Conclusions Findings suggest that talking to people about their wellbeing and providing information relevant to kidney health using culturally adapted, locally relevant apps improve the wellbeing of people on dialysis. Further research is required to replicate these findings and identify active intervention components. Trial registration ACTRN12617000249358; 17/02/2017.
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Affiliation(s)
- Kylie M Dingwall
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, 0870, Australia.
| | - Michelle Sweet
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, 0870, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, NT, 0811, Australia.,Department of Nephrology, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia
| | - David Kavanagh
- Centre for Children's Health Research and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Federica Barzi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Sarah Brown
- Western Desert Nganampa Walytija Palyantjaku Tjutaku, Alice Springs, NT, 0870, Australia
| | - Cherian Sajiv
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory Department of Health, Alice Springs, NT, 0870, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia.,Department of Nephrology, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
| | - Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
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Rubeis G. E-mental health applications for depression: an evidence-based ethical analysis. Eur Arch Psychiatry Clin Neurosci 2021; 271:549-55. [PMID: 31894391 DOI: 10.1007/s00406-019-01093-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/18/2019] [Indexed: 12/23/2022]
Abstract
E-mental health applications (apps) are an increasingly important factor for the treatment of depression. To assess the risks and benefits for patients, an in-depth ethical analysis is necessary. The objective of this paper is to determine the ethical implications of app-based treatment for depression. An evidence-based ethical analysis was conducted. The material was meta-reviews and randomized control studies (RCTs) on app-based treatment. Based on the empirical data, an ethical analysis was conducted using the 3-ACES-approach by Thornicroft and Tansella. Apps may empower autonomy, offer an uninterrupted series of contacts over a period of time, show evidence-based benefits for patients with subclinical and mild-to-moderate-symptoms, are easily accessible, may be used for coordinating information and services within an episode of care, and are on the whole cost-effective. Their risks are that they are not suitable for the whole range of severity of mental illnesses and patient characteristics, show severe deficits in the data privacy policy, and a big variability in quality standards. The use of apps in depression treatment can be beneficial for patients as long as (1) the usefulness of an app-based treatment is assessed for each individual patient, (2) apps are chosen according to symptom severity as well as characteristics like the patient's level of self-reliance, their e-literacy, and their openness vis-à-vis apps, (3) manufacturers improve their privacy policies and the quality of apps.
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Parolin LAL, Benzi IMA, Fanti E, Milesi A, Cipresso P, Preti E. Italia Ti Ascolto [Italy, I am listening]: an app-based group psychological intervention during the COVID-19 pandemic. Res Psychother 2021; 24:517. [PMID: 33937116 PMCID: PMC8082536 DOI: 10.4081/ripppo.2021.517] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/20/2021] [Indexed: 11/22/2022]
Abstract
The onset of the coronavirus disease 2019 (COVID-19) pandemic impacted individuals' psychological wellbeing resulting in heightened perceived stress, anxiety, and depression. However, a significant issue in accessing psychological care during a lockdown is the lack of access to in-person interventions. In this regard, research has shown the efficacy and utility of psychological app-based interventions. 'Italia Ti Ascolto' (ITA) has been developed as a population tailored internet-based intervention to offer an online professional solution for psychological support needs. The ITA app is available on iOS and Android systems. Users completed a baseline assessment on emotion regulation strategies (cognitive reappraisal and expressive suppression), psychological stress, anxiety, depression, and perceived social support. Participants could select among several one-hour long clinical groups held by expert psychotherapists. After every session, people were asked to complete a quick users' satisfaction survey. Our contribution presents ITA's intervention protocol and discusses preliminary data on psychological variables collected at baseline. Data showed significant associations between emotion regulation strategies, symptoms of depression and anxiety, and level of stress. Moreover, the role of perceived social support is considered. Future developments and implications for clinical practice and treatment are discussed.
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Affiliation(s)
| | | | | | | | - Pietro Cipresso
- IRCCS Istituto Auxologico Italiano, Milan
- Catholic University of the Sacred Heart, Milan, Italy
| | - Emanuele Preti
- University of Milano-Bicocca, Milan
- Bicocca Center for Applied Psychology, Milan
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29
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Gieselmann A, Podleschka C, Rozental A, Pietrowsky R. Communication Formats and Their Impact on Patient Perception and Working Mechanisms: A Mixed-Methods Study of Chat-Based vs. Face-to-Face Psychotherapy for Insomnia. Behav Ther 2021; 52:430-441. [PMID: 33622511 DOI: 10.1016/j.beth.2020.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/20/2019] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 11/25/2022]
Abstract
The application of Internet-based interventions within stepped-care models raises the question of when patients should receive Internet-based treatment and when patients should receive face-to-face (FtF) treatment. To address this question, the patient perception and effects of working mechanisms were evaluated after brief psychotherapy for insomnia applying a mixed-methods approach. Treatment was either delivered through a text-based chat or it was delivered FtF. Almost half of the patients who received the chat-based treatment indicated that chat-based communication was appropriate for them when dealing with sleep difficulties, but that they would prefer FtF communication for more sensitive topics. Results from the therapists' evaluations of working mechanisms yielded that these working mechanisms were more strongly associated with treatment outcome in the FtF condition than they were in the chat-based condition. To understand and to interpret the results, media richness theory may be a useful tool: More severely impaired patients and patients with more complex concerns may need more complex (richer) communication formats for treatment delivery. Such heuristics may help to better justify treatment recommendations and optimize media choice in Internet-based interventions, e.g., by defining moments when human interaction is needed and moments when communication could be conducted by nonhuman chatbots.
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Van Daele T, Best P, Bernaerts S, Van Assche E, De Witte NAJ. Dropping the E: The potential for integrating e-mental health in psychotherapy. Curr Opin Psychol 2021; 41:46-50. [PMID: 33743399 DOI: 10.1016/j.copsyc.2021.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/11/2021] [Accepted: 02/12/2021] [Indexed: 12/28/2022]
Abstract
E-mental health, or the use of technology in mental healthcare, has been the focus of research for over two decades. Over that period, the evidence base for the potential of technology to improve psychotherapeutic practice has grown steadily. This sharply contrasts with the actual use of e-mental health by psychotherapists, which has remained limited. In this article, we aim to illustrate how and when different technological tools and applications can play a role in psychotherapy. At the same time, we also highlight current limitations and discuss challenges for future research. A specific, yet hypothetical case, is used to guide this narrative review and make proposed applications tangible and concrete.
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Affiliation(s)
- Tom Van Daele
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Molenstraat 8, Antwerp, Belgium; School of Social Sciences, Education and Social Work, Queen's University Belfast, BT7 1NN Belfast, United Kingdom.
| | - Paul Best
- School of Social Sciences, Education and Social Work, Queen's University Belfast, BT7 1NN Belfast, United Kingdom
| | - Sylvie Bernaerts
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Molenstraat 8, Antwerp, Belgium
| | - Eva Van Assche
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Molenstraat 8, Antwerp, Belgium
| | - Nele A J De Witte
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Molenstraat 8, Antwerp, Belgium
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Abstract
BACKGROUND The prevalence of mental illnesses in the population has enormously increased during the corona pandemic due to the accompanying burdens and distress. Therefore, it is important to continue with the provision of psychotherapeutic treatment even in times of social distancing. As a result, psychotherapists were soon confronted with the need to expand their traditional treatment setting and offer remote treatment. OBJECTIVE Which digital treatment options are available to psychotherapists since the pandemic, also with respect to the legal regulations? To what extent and how did they use video-based or telephone-based psychotherapy? What is the current stage of research regarding the effectiveness of video(telephony)? How can therapeutic alliance be built into video(telephony) settings? How can psychotherapists successfully apply their personal therapeutic method to different patient groups (children, adolescents, adults) in the new digital setting? METHODS These questions are answered based on a literature search and clinical considerations. RESULTS The majority of psychotherapists have immediately adapted to remote treatment. This has been supported by the government by expanding existing regulations in order to continue treatment with current and new patients without physical contact during the pandemic crisis. Survey studies have shown that psychotherapists consider the effectiveness of digital treatment settings to be lower than the traditional setting. CONCLUSION Further training is necessary to educate psychotherapists in the theory, practice and self-awareness for quality assurance in the video(telephony) setting.
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Affiliation(s)
- Christiane Eichenberg
- Institut für Psychosomatik, Fakultät für Medizin, Sigmund Freud PrivatUniversität Wien, Freudplatz 3, 1020 Wien, Österreich
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Shala M, Morina N, Burchert S, Cerga-Pashoja A, Knaevelsrud C, Maercker A, Heim E. Cultural adaptation of Hap-pas-Hapi, an internet and mobile-based intervention for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. Internet Interv 2020; 21:100339. [PMID: 32983906 PMCID: PMC7495109 DOI: 10.1016/j.invent.2020.100339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/29/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Internet- and mobile-based mental health interventions have the potential to narrow the treatment gap in ethnic groups. Little evidence exists on the cultural adaptation of such interventions. Cultural adaptation of evidence-based interventions distinguishes between surface and deep structure adaptation. Surface refers to matching materials (e.g., illustrations, language) or methods of treatment delivery to the target population, whereas deep structure adaptation considers cultural concepts of distress (CCD). So far, CCD have only been considered to a limited extent in cultural adaptation of psychological interventions, and there is a lack of well documented adaptation procedures. AIMS With a cross-disciplinary and mixed-method approach, following a new conceptual framework for cultural adaptation of scalable psychological interventions, this study aimed to develop both surface and deep structure adaptations of an internet- and mobile-based intervention called Hap-pas-Hapi for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. METHODS A qualitative ethnopsychological study was conducted to examine the target group's CCD. Focus group discussions, an online survey, and individual key informant interviews were utilised to evaluate the original intervention, adaptation drafts and the final adapted intervention. A reporting system was developed to support the decision-making process and to report all adaptations in a transparent and replicable way. RESULTS The ongoing involvement of target population key informants provided valuable feedback for the development of a more person-centred intervention, which might enhance treatment acceptance, motivation and adherence. DISCUSSION This study provides empirical and theory-based considerations and suggestions for future implementation that may foster acceptability and effectiveness of culturally adapted evidence-based interventions.
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Affiliation(s)
- Mirëlinda Shala
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, University of Zurich, Switzerland
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Arlinda Cerga-Pashoja
- Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Eva Heim
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
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Raphiphatthana B, Sweet M, Puszka S, Dingwall K, Nagel T. Evaluation of a three-phase implementation program in enhancing e-mental health adoption within Indigenous primary healthcare organisations. BMC Health Serv Res 2020; 20:576. [PMID: 32576266 PMCID: PMC7313213 DOI: 10.1186/s12913-020-05431-y] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 06/15/2020] [Indexed: 01/25/2023] Open
Abstract
Background A three-phase implementation program was carried out to support Indigenous primary healthcare organisations in Australia to integrate e-mental health approaches into the day-to-day practice. The present study aimed to evaluate the process and the effectiveness of the program. Methods A concurrent triangulation design was employed to collect and compare quantitative and qualitative data from organisations that participated in the implementation program (case studies) to those that participated in training only (non-case studies). Quantitative methods, i.e., t-tests and descriptive statistics, were used to measure outcomes relating to the frequency of e-mental health usage and levels of organisational readiness. Qualitative data were analysed separately, using theoretical thematic analysis, to gain an in depth understanding of the implementation process. The findings were integrated and interpreted within the implementation science literature. Results The case studies evidenced greater use of e-mental health approaches than the non-case studies. They also demonstrated increased organisational readiness over the course of the implementation program. The program helped organisations to work and improve on essential aspects within the organisation so that they better supported e-mental health adoption. The key areas addressed were Information Technology resources and infrastructure, leadership and support, policy and protocols around e-mental health utilisation and its integration into practice. Conclusions By addressing and improving essential aspects relating to e-mental health implementation, the program helped organisations to increase organisational readiness and enhance uptake of e-mental health approaches.
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Affiliation(s)
- Buaphrao Raphiphatthana
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
| | - Michelle Sweet
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Stefanie Puszka
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Kylie Dingwall
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Tricia Nagel
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
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Nagel T, Sweet M, Dingwall KM, Puszka S, Hughes JT, Kavanagh DJ, Cass A, Howard K, Majoni SW. Adapting wellbeing research tools for Aboriginal and Torres Strait Islander people with chronic kidney disease. BMC Nephrol 2020; 21:130. [PMID: 32293331 PMCID: PMC7161120 DOI: 10.1186/s12882-020-01776-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease is an increasingly common health problem for Aboriginal and Torres Strait Islander people. It is associated with multiple concurrent psychosocial stressors frequently resulting in negative impacts on emotional and social wellbeing. There is need for well-designed intervention studies to provide evidence of effective treatment for comorbid depression or other mental illness in this setting. Attention to early phase piloting and development work is recommended when testing complex interventions. This paper documents feasibility testing and adaptation of an existing culturally responsive brief wellbeing intervention, the Stay Strong App, and three commonly used wellbeing outcome measures, in preparation for a clinical trial testing effectiveness of the intervention. METHODS The Stay Strong App, which has not been used in the setting of Chronic Kidney Disease before, is reviewed and adapted for people with comorbid wellbeing concerns through expert consensus between research team and an Expert Panel. The outcome measures (Kessler 10, Patient Health Questionnaire 9, and EuroQoL) are valid, reliable, and commonly used tools to assess various aspects of wellbeing, which have also not been used in this context before. Feasibility and acceptability are examined and developed through 3 stages: Pilot testing in a purposive sample of five haemodialysis patients and carers; translation of outcome measures through collaboration between the Aboriginal Interpreter Service, Aboriginal and Torres Strait Islander research officers and the research team; and conversion of translated outcome measures to electronic format. RESULTS Research team and expert panel consensus led to adaptation of the Stay Strong App for renal patients through selective revision of words and images. Pilot testing identified challenges in delivery of the wellbeing measures leading to word changes and additional prompts, integration of audio translations in 11 local Indigenous languages within an interactive Outcome Measures App, and related research protocol changes. CONCLUSION Modelling the complex intervention prior to full-scale testing provided important information about the design of both the outcome measures and the intervention. These changes are likely to better support success in conduct of the clinical trial and future implementation of the intervention in clinical settings.
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Affiliation(s)
- Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
| | - Michelle Sweet
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Kylie M Dingwall
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Stefanie Puszka
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, 0811, Australia
| | - David J Kavanagh
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Top End Renal Services, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia
- Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
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Bolinski F, Boumparis N, Kleiboer A, Cuijpers P, Ebert D, Riper H. The effect of e-mental health interventions on academic performance in university and college students: A meta-analysis of randomized controlled trials. Internet Interv 2020; 20:100321. [PMID: 32382515 PMCID: PMC7201188 DOI: 10.1016/j.invent.2020.100321] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 02/27/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mental health symptoms are common among college and university students and these can affect their academic performance. E-mental health interventions have proven effective in addressing mental health complaints but their effect on academic performance has not been synthesized yet. OBJECTIVES To synthesize the evidence from randomized controlled trials for the effectiveness of e-mental health interventions on academic performance in college and university students compared to inactive controls. DATA SOURCES AND ELIGIBILITY CRITERIA We searched six databases (PubMed, Cochrane library, CINAHL, ERIC, PsycINFO, Web of Science) during the period January 2000 until September 2019 for randomized controlled trials that reported on e-mental health interventions (guided or unguided) for college and university students and measured academic performance (e.g. grade point average). STUDY APPRAISAL AND SYNTHESIS METHODS Study and participant characteristics and the academic performance measures at post-intervention were extracted. The latter were pooled and Hedges' g was calculated as the effect size. Heterogeneity and publication bias were investigated. RESULTS Six studies containing 2428 participants were included in the meta-analysis. These focussed on either mood and anxiety or alcohol and tobacco use. The pooling of data resulted in a small but non-significant effect of g = 0.26 (95% CI, -0.00, 0.52; p = .05) on academic performance, favouring e-mental health interventions over inactive controls. Interventions had positive effects on depression (g = -0.24) and anxiety (g = -0.2). Heterogeneity was high. DISCUSSION Despite the small and non-significant effect, our meta-analysis points to a promising direction for the effectiveness of e-mental health interventions on academic performance. Yet, these results must be interpreted with caution, as heterogeneity was high and few studies on the effectiveness of e-mental health interventions for students reported academic performance measures.
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Affiliation(s)
- F. Bolinski
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - N. Boumparis
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - A. Kleiboer
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - P. Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - D.D. Ebert
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - H. Riper
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
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Clough BA, Eigeland JA, Madden IR, Rowland D, Casey LM. Development of the eTAP: A brief measure of attitudes and process in e-interventions for mental health. Internet Interv 2019; 18:100256. [PMID: 31890610 PMCID: PMC6926169 DOI: 10.1016/j.invent.2019.100256] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/23/2018] [Revised: 05/22/2019] [Accepted: 05/27/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Considerable evidence supports the efficacy of e-interventions for mental health treatment and support. However, client engagement and adherence to these interventions are less than optimal and remain poorly understood. OBJECTIVE The aim of the current study was to develop and investigate the psychometric properties of the e-Therapy Attitudes and Process questionnaire (eTAP). Based on the Theory of Planned Behaviour (TPB), the eTAP was designed to measure factors related to client engagement in e-interventions for mental health. METHODS Participants were 220 adults who reported current use of an e-intervention for mental health support. Participants completed the eTAP and related measures, with a subsample of 49 participants completing a one-week follow up assessment. RESULTS A 16-item version of the eTAP produced a clear four-factor structure, explaining 70.25% of variance. The factors were consistent with the TPB, namely, Intention, Subjective Norm, Attitudes, and Perceived Behavioural Control. Internal consistency of the total and subscales was high, and adequate to good one-week test retest reliability was found. Convergent and divergent validity of the total and subscales was supported, as was the predictive validity. Specifically, eTAP Intentions correctly predicted engagement in e-interventions with 84% accuracy and non-engagement with 74% accuracy. CONCLUSIONS The eTAP was developed as a measure of factors related to engagement and adherence with e-interventions for mental health. Psychometric investigation supported the validity and reliability of the eTAP. The eTAP may be a valuable tool to understand, predict, and guide interventions to increase engagement and adherence to e-interventions for mental health.
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Affiliation(s)
- Bonnie A. Clough
- School of Applied Psychology, Griffith University, Australia
- Menzies Health Institute Queensland, Australia
| | | | | | - Dale Rowland
- School of Applied Psychology, Griffith University, Australia
- Menzies Health Institute Queensland, Australia
| | - Leanne M. Casey
- School of Applied Psychology, Griffith University, Australia
- Menzies Health Institute Queensland, Australia
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Rohrbach PJ, Dingemans AE, Spinhoven P, Van den Akker-Van Marle E, Van Ginkel JR, Fokkema M, Moessner M, Bauer S, Van Furth EF. A randomized controlled trial of an Internet-based intervention for eating disorders and the added value of expert-patient support: study protocol. Trials 2019; 20:509. [PMID: 31420063 PMCID: PMC6697984 DOI: 10.1186/s13063-019-3574-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 07/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background E-mental health has become increasingly popular in interventions for individuals with eating disorders (EDs). It has the potential to offer low-threshold interventions and guide individuals to the needed care more promptly. Featback is such an Internet-based intervention and consists of psychoeducation and a fully automated monitoring and feedback system. Preliminary findings suggest Featback to be (cost-)effective in reducing ED symptomatology. Additionally, e-mail or chat support by a psychologist did not enhance the effectiveness of Featback. Support by an expert patient (someone with a lived experience of an ED) might be more effective, since that person can effectively model healthy behavior and enhance self-efficacy in individuals struggling with an ED. The present study aims to replicate and build on earlier findings by further investigating the (cost-)effectiveness of Featback and the added value of expert-patient support. Methods The study will be a randomized controlled trial with a two-by-two factorial design with repeated measures. The four conditions will be (1) Featback, in which participants receive automated feedback on a short monitoring questionnaire weekly, (2) Featback with weekly e-mail or chat support from an expert patient, (3) weekly support from an expert patient, and (4) a waiting list. Participants who are 16 years or older and have at least mild self-reported ED symptoms receive a baseline measure. Subsequently, they are randomized to one of the four conditions for 8 weeks. Participants will be assessed again post-intervention and at 3, 6, 9, and 12 months follow-up. The primary outcome measure will be ED psychopathology. Secondary outcome measures are experienced social support, self-efficacy, symptoms of anxiety and depression, user satisfaction, intervention usage, and help-seeking attitudes and behaviors. Discussion The current study is the first to investigate e-mental health in combination with expert-patient support for EDs and will add to the optimization of the delivery of Internet-based interventions and expert-patient support. Trial registration Netherlands Trial Register, NTR7065. Registered on 7 June 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3574-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pieter J Rohrbach
- GGZ Rivierduinen Eetstoornissen Ursula, Postbox 405, Sandifortdreef 19, 2300 AK, Leiden, the Netherlands.
| | - Alexandra E Dingemans
- GGZ Rivierduinen Eetstoornissen Ursula, Postbox 405, Sandifortdreef 19, 2300 AK, Leiden, the Netherlands.,Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Leiden, the Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Elske Van den Akker-Van Marle
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Markus Moessner
- Center for Psychotherapy Research, University of Heidelberg, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University of Heidelberg, Heidelberg, Germany
| | - Eric F Van Furth
- GGZ Rivierduinen Eetstoornissen Ursula, Postbox 405, Sandifortdreef 19, 2300 AK, Leiden, the Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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Dreier M, Ludwig J, Härter M, von dem Knesebeck O, Baumgardt J, Bock T, Dirmaier J, Kennedy AJ, Brumby SA, Liebherz S. Development and evaluation of e-mental health interventions to reduce stigmatization of suicidality - a study protocol. BMC Psychiatry 2019; 19:152. [PMID: 31101103 PMCID: PMC6525463 DOI: 10.1186/s12888-019-2137-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/30/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Worldwide, approximately 800,000 persons die by suicide every year; with rates of suicide attempts estimated to be much higher. Suicidal persons often suffer from a mental disorder but stigma, lack of available and suitable support, and insufficient information on mental health limit help seeking. The use of internet-based applications can help individuals inform themselves about mental disorders, assess the extent of their own concerns, find local treatment options, and prepare for contact with health care professionals. This project aims to develop and evaluate e-mental health interventions to improve knowledge about suicidality and to reduce stigmatization of those affected. In developing these interventions, a representative telephone survey was conducted to detect knowledge gaps and stigmatizing attitudes in the general population. METHODS First, a national representative telephone survey with N = 2000 participants in Germany was conducted. Second, e-mental health interventions are developed to address knowledge gaps and public stigma detected in the survey. These comprise an evidence-based health information package about suicidality, information on regional support services, a self-administered depression test-including suicidality-and an interactive online intervention including personal stories. The development is based on a trialogical exchange of experience between persons affected by suicidality, relatives of affected persons, and clinical experts. Australian researchers who developed an e-mental health intervention for individuals affected by rural suicide were invited to a workshop in order to contribute their knowledge and expertise. Third, the online intervention will be evaluated by a mixed methods design. DISCUSSION From representative telephone survey data, content can be developed to address specific attitudes and knowledge via the e-mental health interventions. These interventions will be easily accessed and provide an opportunity to reach people who tend not to seek professional services, prefer to inform themselves in advance and/or wish to remain anonymous. Evaluation of the online intervention will provide information on any changes in participants' self-stigma and perceived-stigma of suicidality, and any increase in participants' knowledge on suicidality or self-efficacy expectations. TRIAL REGISTRATION German Clinical Trial Register DRKS00015071 on August 6, 2018.
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Affiliation(s)
- Mareike Dreier
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246, Hamburg, Germany.
| | - Julia Ludwig
- 0000 0001 2180 3484grid.13648.38Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- 0000 0001 2180 3484grid.13648.38Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | - Olaf von dem Knesebeck
- 0000 0001 2180 3484grid.13648.38Department of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Baumgardt
- 0000 0001 2180 3484grid.13648.38Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Bock
- 0000 0001 2180 3484grid.13648.38Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- 0000 0001 2180 3484grid.13648.38Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | - Alison J. Kennedy
- National Centre for Farmer Health, School of Medicine, Deakin Unversity, Waurn Ponds, Victoria Australia
| | - Susan A. Brumby
- National Centre for Farmer Health, School of Medicine, Deakin Unversity, Waurn Ponds, Victoria Australia ,Western District Health Service, Hamilton, Victoria Australia
| | - Sarah Liebherz
- 0000 0001 2180 3484grid.13648.38Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
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Dingwall KM, Nagel T, Hughes JT, Kavanagh DJ, Cass A, Howard K, Sweet M, Brown S, Sajiv C, Majoni SW. Wellbeing intervention for chronic kidney disease (WICKD): a randomised controlled trial study protocol. BMC Psychol 2019; 7:2. [PMID: 30621791 PMCID: PMC6325814 DOI: 10.1186/s40359-018-0264-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background Incidence of end stage kidney disease (ESKD) for Indigenous Australians is especially high in remote and very remote areas of Australia (18 and 20 times the rate of comparable non-Indigenous people). Relocating away from family and country for treatment, adjusting to life with a chronic condition and time lost to dialysis cause grief and sadness which have immense impact on quality of life and challenges treatment adherence. We describe the first randomised controlled trial to address both chronic disease and mental health in Indigenous people with ESKD, which is the first to test the effectiveness of a culturally adapted e-mental health intervention in this population. It builds on an existing program of mental health research with demonstrated efficacy – the Aboriginal and Islander Mental Health Initiative (AIMhi) – to test the newly developed electronic motivational care planning (MCP) therapy – the AIMhi Stay Strong App. Methods This is a 3-arm, waitlist, single-blind randomised controlled trial testing the efficacy of the Stay Strong App in improving psychological distress, depressive symptoms, quality of life and treatment adherence among Indigenous clients undergoing haemodialysis for ESKD in Alice Springs and Darwin with follow up over two periods of 3 months (total of 6 months observation). The study compares the efficacy of MCP using the AIMhi Stay Strong App with two control groups (control app intervention and treatment as usual) on participant-reported psychological distress (the primary outcome) using the Kessler Distress Scale (K10); depressive symptoms using the adapted Patient Health Questionnaire (PHQ-9); quality of life using the EuroQoL instrument (EQ5D) and adherence to dialysis treatment planning through file audit. Participants are randomised to receive MCP either at baseline (early treatment) or after 3 months (delayed treatment). The study also examines the cost effectiveness of this therapy in this setting through examination of health care service utilisation across groups during the first 3 months. Discussion This project will contribute much needed evidence on the efficacy of an electronic wellbeing intervention for Indigenous people with ESKD – a group in which distress is likely to be unacceptably high, yet relatively untreated. Trial registration Australian New Zealand Clinical Trial Registry; ACTRN12617000249358; Date registered: 17/02/2017.
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Affiliation(s)
- Kylie M Dingwall
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 4066, Alice Springs, NT, 0870, Australia.
| | - Tricia Nagel
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, 0811, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, NT, 0811, Australia
| | - David J Kavanagh
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Alan Cass
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Michelle Sweet
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 4066, Alice Springs, NT, 0870, Australia
| | - Sarah Brown
- Western Desert Nganampa Walytija Palyantjaku Tjutaku, Alice Springs, NT, 0870, Australia
| | - Cherian Sajiv
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory Department of Health, Alice Springs, NT, 0870, Australia.,Top End Renal Services, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Flinders University, Adelaide, SA, 5042, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 4066, Alice Springs, NT, 0870, Australia.,Top End Renal Services, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
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Beentjes TAA, Goossens PJJ, Vermeulen H, Teerenstra S, Nijhuis-van der Sanden MWG, van Gaal BGI. E-IMR: e-health added to face-to-face delivery of Illness Management & Recovery programme for people with severe mental illness, an exploratory clustered randomized controlled trial. BMC Health Serv Res 2018; 18:962. [PMID: 30541536 PMCID: PMC6292084 DOI: 10.1186/s12913-018-3767-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND E-mental health holds promise for people with severe mental illness, but has a limited evidence base. This study explored the effect of e-health added to face-to-face delivery of the Illness Management and Recovery Programme (e-IMR). METHOD In this multi-centre exploratory cluster randomized controlled trial, seven clusters (n = 60; 41 in intervention group and 19 in control group) were randomly assigned to e-IMR + IMR or IMR only. Outcomes of illness management, self-management, recovery, symptoms, quality of life, and general health were measured at baseline (T0), halfway (T1), and at twelve months (T2). The data were analysed using mixed model for repeated measurements in four models: in 1) we included fixed main effects for time trend and group, in 2) we controlled for confounding effects, in 3) we controlled for interaction effects, and in 4) we performed sub-group analyses within the intervention group. RESULTS Notwithstanding low activity on e-IMR, significant effects were present in model 1 analyses for self-management (p = .01) and recovery (p = .02) at T1, and for general health perception (p = .02) at T2, all in favour of the intervention group. In model 2, the confounding covariate gender explained the effects at T1 and T2, except for self-management. In model 3, the interacting covariate non-completer explained the effects for self-management (p = .03) at T1. In model 4, the sub-group analyses of e-IMR-users versus non-users showed no differences in effect. CONCLUSION Because of confounding and interaction modifications, effectiveness of e-IMR cannot be concluded. Low use of e-health precludes definite conclusions on its potential efficacy. Low use of e-IMR calls for a thorough process evaluation of the intervention. TRIAL REGISTRATION The Dutch Trial Register ( NTR4772 ).
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Affiliation(s)
- Titus A A Beentjes
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Center for Nursing Research, Saxion University of Applied Science, Deventer/Enschede, the Netherlands. .,Dimence Group Mental Health Care Centre, Deventer, the Netherlands.
| | - Peter J J Goossens
- Dimence Group Mental Health Care Centre, Deventer, the Netherlands.,Department of Public Health, Faculty of Medicine and Health Sciences, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Hester Vermeulen
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Group Biostatistics, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Betsie G I van Gaal
- Titus Beentjes, IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, the Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Abi Ramia J, Harper Shehadeh M, Kheir W, Zoghbi E, Watts S, Heim E, El Chammay R. Community cognitive interviewing to inform local adaptations of an e-mental health intervention in Lebanon. Glob Ment Health (Camb) 2018; 5:e39. [PMID: 30637112 PMCID: PMC6315334 DOI: 10.1017/gmh.2018.29] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 04/11/2018] [Revised: 08/03/2018] [Accepted: 08/30/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Lebanon has a need for innovative approaches to increase access to mental health care to meet the country's current high demand. E-mental health has been included in its national mental health strategy while in parallel the World Health Organization has produced an online intervention called 'Step-by-Step' to treat symptoms of depression that is being tested in Lebanon over the coming years. AIM The primary aim of this study is to conduct bottom-up, community-driven qualitative cognitive interviewing from a multi-stakeholder perspective to inform the cultural adaptation of an Internet-delivered mental health intervention based on behavioural activation in Lebanon. METHODS National Mental Health Programme staff conducted a total of 11 key informant interviews with three mental health professionals, six front-line workers in primary health care centres (PHCCs) and two community members. Also, eight focus group discussions, one with seven front-line workers and seven others with a total of 66 community members (Lebanese, Syrians and Palestinians) were conducted in several PHCCs to inform the adaptation of Step-by-Step. Results were transcribed and analysed thematically by the project coordinator and two research assistants. RESULTS Feedback generated from the cognitive interviewing mainly revolved around amending the story, illustrations and the delivery methods to ensure relevance and sensitivity to the local context. The results obtained have informed major edits to the content of Step-by-Step and also to the model of provision. Notably, the intervention was made approximately 30% shorter; it includes additional videos of content alongside the originally proposed comic book-style delivery; there is less emphasis on total inactivity as a symptom of low mood and more focus on enjoyable activities to lift mood; the story and ways to contact participants to provide support were updated in line with local gender norms; and many of the suggested or featured activities have been revised in line with suggestions from community members. CONCLUSIONS These findings promote and advocate the use of community-driven adaptation of evidence-based psychological interventions. Some of the phenomena recorded mirror findings from other research about barriers to care seeking in the region and so changes made to the intervention should be useful in improving utility and uptake of 'Step-by-Step'.
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Affiliation(s)
- J. Abi Ramia
- National Mental Health Programme (NMHP)|Ministry of Public Health, Lebanese University Central Directorate, Museum Square, 9800, Beirut, Lebanon
| | - M. Harper Shehadeh
- Faculty of Medicine, The Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - W. Kheir
- National Mental Health Programme (NMHP)|Ministry of Public Health, Lebanese University Central Directorate, Museum Square, 9800, Beirut, Lebanon
| | - E. Zoghbi
- Public Health, Universite Libanaise Faculte des Sciences, Beirut, Lebanon
| | - S. Watts
- Medical School, University of Sydney – Sydney Medical School Nepean, Sydney, New South Wales, Australia
| | - E. Heim
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - R. El Chammay
- National Mental Health Programme (NMHP)|Ministry of Public Health, Lebanese University Central Directorate, Museum Square, 9800, Beirut, Lebanon
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Abu Rahal Z, Vadas L, Manor I, Bloch B, Avital A. Use of information and communication technologies among individuals with and without serious mental illness. Psychiatry Res 2018; 266:160-167. [PMID: 29864616 DOI: 10.1016/j.psychres.2018.05.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 12/21/2017] [Revised: 04/08/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
Abstract
Growing interest surrounds the use ofinformation and communication technologies (ICTs) for mental-health-related purposes, yet little is known about rates of ICT use among the psychiatric population and those with severe mental illness. This study examines ICT accessibility among the psychiatric population, focusing on serious and non-serious mental illness (SMI and non-SMI). Patients (N = 427) from all service branches of the Psychiatry Department at Emek Medical Centerwere recruited orally or through advertisement. Responders completed a self-report survey regarding accessibility and use of ICTs (i.e., computer, internet, Facebook, mobile phone, smartphone). Results revealed that 59.3% of respondents used computers, 77.3% used the internet, 92.7% owned a mobile phone, 67.9% owned a smartphone, and 63% used Facebook. Over half of participants who used ICTs reported doing so at least once per day. SMI and non-SMI respondents differed significantly in their use and access to a computer, the internet, Facebook, and smartphones. Results suggest that mental illness is not a barrier to using and accessing technology; however, when differentiating between SMI and non-SMI, illness severity is a barrier to potential ICT utilization. These results may encourage policy makers to design ICTs that suit the needs of individuals with SMI.
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Affiliation(s)
- Ziyad Abu Rahal
- Psychiatry Department, Emek Medical Center, Afula, Israel; Clalit Health Services, Northern District, Israel
| | - Limor Vadas
- Psychiatry Department, Emek Medical Center, Afula, Israel
| | - Iris Manor
- Attention Deficit Hyperactivity Disorder Clinic, Geha Medical Center, Petah Tikva, Israel
| | - Boaz Bloch
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Psychiatry Department, Emek Medical Center, Afula, Israel
| | - Avi Avital
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Psychiatry Department, Emek Medical Center, Afula, Israel.
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Christ C, de Waal MM, van Schaik DJF, Kikkert MJ, Blankers M, Bockting CLH, Beekman ATF, Dekker JJM. Prevention of violent revictimization in depressed patients with an add-on internet-based emotion regulation training (iERT): study protocol for a multicenter randomized controlled trial. BMC Psychiatry 2018; 18:29. [PMID: 29394919 PMCID: PMC5797346 DOI: 10.1186/s12888-018-1612-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 09/06/2017] [Accepted: 01/17/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Psychiatric patients are at high risk of becoming victim of a violent crime compared to the general population. Although most research has focused on patients with severe mental illness, depressed patients have been demonstrated to be prone to victimization as well. Victimization is associated with more severe symptomatology, decreased quality of life, and high risk of revictimization. Hence, there is a strong need for interventions that focus on preventing violent revictimization. Since emotion dysregulation is associated with both victimization and depression, we developed an internet-based Emotion Regulation Training (iERT) to reduce revictimization in depressed patients. This study aims to evaluate the clinical and cost-effectiveness of iERT added to Treatment As Usual (TAU) in reducing incidents of violent revictimization among depressed patients with a recent history of victimization. Furthermore, this study aims to examine secondary clinical outcomes, and moderators and mediators that may be associated with treatment outcomes. METHODS In a multicenter randomized controlled trial with parallel group design, patients with a major depressive disorder and a history of violent victimization over the past three years (N = 200) will be allocated to either TAU + iERT (N = 100) or TAU only (N = 100), based on computer-generated stratified block randomization. Assessments will take place at baseline, 8 weeks, 14 weeks, and 6 months after start of treatment, and 12, 24, and 36 months after baseline. The primary outcome measure is the total number of violent victimization incidents at 12 months after baseline, measured with the Safety Monitor: an adequate self-report questionnaire that assesses victimization over the preceding 12 months. Secondary outcome measures and mediators include emotion dysregulation and depressive symptomatology. An economic evaluation with the societal perspective will be performed alongside the trial. DISCUSSION This study is the first to examine the effectiveness of an intervention aimed at reducing violent revictimization in depressed patients. If effective, iERT can be implemented in mental health care, and contribute to the well-being of depressed patients. Furthermore, the results will provide insight into underlying mechanisms of revictimization. TRIAL REGISTRATION The study is registered at the Netherlands Trial Register ( NTR5822 ). Date of registration: 4 April 2016.
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Affiliation(s)
- Carolien Christ
- Department of Psychiatry, VU University Medical Center/ GGZ inGeest, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands. .,Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Marleen M. de Waal
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,0000000084992262grid.7177.6Academic Medical Center, Department of Psychiatry, Amsterdam Institute for Addiction Research, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Digna J. F. van Schaik
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, VU University Medical Center/ GGZ inGeest, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aAmsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Martijn J. Kikkert
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,0000000084992262grid.7177.6Academic Medical Center, Department of Psychiatry, Amsterdam Institute for Addiction Research, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,0000 0001 0835 8259grid.416017.5Trimbos Institute – Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands
| | - Claudi L. H. Bockting
- 0000000120346234grid.5477.1Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, University Utrecht, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Aartjan T. F. Beekman
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, VU University Medical Center/ GGZ inGeest, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aAmsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Jack J. M. Dekker
- Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands ,0000 0004 1754 9227grid.12380.38Department of Clinical Psychology, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, BT 1081 Amsterdam, The Netherlands
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Cavanagh K, Churchard A, O'Hanlon P, Mundy T, Votolato P, Jones F, Gu J, Strauss C. A Randomised Controlled Trial of a Brief Online Mindfulness-Based Intervention in a Non-clinical Population: Replication and Extension. Mindfulness (N Y) 2018; 9:1191-1205. [PMID: 30100934 PMCID: PMC6061247 DOI: 10.1007/s12671-017-0856-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 12/11/2022]
Abstract
Building on previous research, this study compared the effects of two brief, online mindfulness-based interventions (MBIs; with and without formal meditation practice) and a no intervention control group in a non-clinical sample. One hundred and fifty-five university staff and students were randomly allocated to a 2-week, self-guided, online MBI with or without mindfulness meditation practice, or a wait list control. Measures of mindfulness, perceived stress, perseverative thinking and anxiety/depression symptoms within were administered before and after the intervention period. Intention to treat analysis identified significant differences between groups on change over time for all measured outcomes. Participation in the MBIs was associated with significant improvements in all measured domains (all ps < 0.05), with effect sizes in the small to medium range (0.25 to 0.37, 95% CIs 0.11 to 0.56). No significant changes on these measures were found for the control group. Change in perseverative thinking was found to mediate the relationship between condition and improvement on perceived stress and anxiety/depression symptom outcomes. Contrary to our hypotheses, no differences between the intervention conditions were found. Limitations of the study included reliance on self-report data, a relatively high attrition rate and absence of a longer-term follow-up. This study provides evidence in support of the feasibility and effectiveness of brief, self-guided MBIs in a non-clinical population and suggests that reduced perseverative thinking may be a mechanism of change. Our findings provide preliminary evidence for the effectiveness of a mindfulness psychoeducation condition, without an invitation to formal mindfulness meditation practice. Further research is needed to confirm and better understand these results and to test the potential of such interventions.
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Affiliation(s)
- Kate Cavanagh
- 1School of Psychology, University of Sussex, Falmer, East Sussex BN1 9QH UK
| | - Alasdair Churchard
- 1School of Psychology, University of Sussex, Falmer, East Sussex BN1 9QH UK
| | - Puffin O'Hanlon
- 1School of Psychology, University of Sussex, Falmer, East Sussex BN1 9QH UK
| | - Thomas Mundy
- 1School of Psychology, University of Sussex, Falmer, East Sussex BN1 9QH UK
| | - Phoebe Votolato
- 1School of Psychology, University of Sussex, Falmer, East Sussex BN1 9QH UK
| | - Fergal Jones
- 2Sussex Partnership NHS Foundation Trust, Hove, BN3 7HZ UK.,3School of Psychology, Politics and Sociology, Canterbury Christ Church University, Kent, UK
| | - Jenny Gu
- 1School of Psychology, University of Sussex, Falmer, East Sussex BN1 9QH UK
| | - Clara Strauss
- 1School of Psychology, University of Sussex, Falmer, East Sussex BN1 9QH UK.,2Sussex Partnership NHS Foundation Trust, Hove, BN3 7HZ UK
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Wallin E, Maathz P, Parling T, Hursti T. Self-stigma and the intention to seek psychological help online compared to face-to-face. J Clin Psychol 2018; 74:1207-1218. [PMID: 29315545 DOI: 10.1002/jclp.22583] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The present study aims to investigate the impact of help-seeking self-stigma on the preference and intention to seek psychological treatment delivered online compared to face-to-face. DESIGN This study uses survey data from two Swedish samples. Sample 1 consists of 267 students (78.7% women) with a mean age of 24.5 (SD = 6.1). Sample 2 consists of 195 primary care patients (56.9% women) with a mean age of 45.3 (SD = 17.7). RESULTS The number of participants who preferred online treatment was higher if seeking psychological help for a perceived stigmatized problem compared to mental health problems in general. The odds ratios for choosing treatment online over face-to-face were 6.41, 95% CI [4.05, 10.14] in Sample 1 and 11.19, 95% CI [5.29, 23.67] in Sample 2. In addition, findings suggest that higher levels of help-seeking self-stigma predicted higher intention to seek treatment online compared to face-to-face. CONCLUSIONS Our results suggest that online interventions may facilitate help-seeking among individuals deterred by stigma.
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Abstract
Evidence-based treatment and manualized psychotherapy have a recent but rich history. As interest and research have progressed, defining the role of treatment manuals in resident training and clinical practice has become more important. Although there is not a universal definition of treatment manual, most clinicians and researchers agree that treatment manuals are an essential piece of evidence-based therapy, and that despite several limitations, they offer advantages in training residents in psychotherapy. Requirements for resident training in psychotherapy have changed over the years, and treatment manuals offer a simple and straightforward way to meet training requirements. In a search limited to only depression, two treatment manuals emerged with the support of research regarding both clinical practice and resident training. In looking toward the future, it will be important for clinicians to remain updated on further advances in evidence based manualized treatment as a tool for training residents in psychotherapy, including recent developments in online and smartphone based treatments.
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Affiliation(s)
- Joshua Pagano
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University, Cherry Hospital, 201 Stevens Mill Rd, Goldsboro, NC, 27530, USA.
| | - Brandon N Kyle
- Division of Behavioral Medicine, Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Mail Stop 694, Greenville, NC, 27834, USA
| | - Toni L Johnson
- Department of Psychiatry and Behavioral Medicine, Psychiatric Outpatient Clinic, 905 Johns Hopkins Drive, Greenville, NC, 27834, USA
| | - Sy Atezaz Saeed
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University, 905 Johns Hopkins Drive, Greenville, NC, 27834, USA
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Saltzman LY, Solomyak L, Pat-Horenczyk R. Addressing the Needs of Children and Youth in the Context of War and Terrorism: the Technological Frontier. Curr Psychiatry Rep 2017; 19:30. [PMID: 28447296 DOI: 10.1007/s11920-017-0786-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper reviews recent literature on the mental health needs of youth in the context of war and terrorism. A human rights lens is used to explore issues of accessibility and sustainability in service utilization during times of crisis. The authors present the evolution of services over the last several decades, progressing through individual, school-based, and community-wide interventions by exploring models that focus on symptom reduction and building resilience. This paper highlights the benefits and limitations of traditional intervention methods and proposes a new frontier of intervention development and research. The authors focus on the emerging field of e-mental health services and specifically highlight the utility of virtual reality games in treating trauma-exposed youth. The rapid and easily accessible nature of e-mental health models is presented as one potential solution to barriers in accessibility that can help promote the human rights of youth exposed to war and terrorism.
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Schuster R, Leitner I, Carlbring P, Laireiter AR. Exploring blended group interventions for depression: Randomised controlled feasibility study of a blended computer- and multimedia-supported psychoeducational group intervention for adults with depressive symptoms. Internet Interv 2017; 8:63-71. [PMID: 30135830 PMCID: PMC6096250 DOI: 10.1016/j.invent.2017.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 12/30/2016] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Blended interventions aim to capitalise on the strengths of both computer-based and face-to-face therapy. Studies on this innovative treatment format remain scare. This especially accounts for the group treatment of depression. METHOD The present study applied eclectic psychotherapy methods to an adult sample exhibiting a variety of depressive symptoms (N = 46). Participants were recruited by a newspaper inlet and randomised either to a treatment or a waiting list condition. Computer supported components were multimedia group sessions, e-learning, online videos and worksheets, remote therapist-patient communication and online pre-post-assessment. RESULTS Large between-group effect sizes on primary outcome depressiveness (CES-D) (F(1,44) = 4.88, p = 0.032; d = 0.87) and secondary outcome personal resources (resource scales) (F(1,44) = 9.04, p = 0.004; d = 0.73 to F(1,44) = 8.82 p = 0.005, d = 1.15) were found in the intention to treat analysis (ANOVA). Subjective evaluation of the intervention revealed high treatment adherence (91%) and high perceived relevance of supportive computer and multimedia components. Participants rated computer and multimedia components comparable to treatment elements such as group interaction or specific cognitive behavioural exercises, and 25% associated the utilisation of those components with treatment success. Depressiveness and age did not predict the utilisation and the appraisal of computer and multimedia components. DISCUSSION Results provide preliminary support for the acceptability and feasibility of the investigated blended treatment in a group with non-specific depressive symptoms. However, small sample size and lack of diagnostics restrict generalizability. Additional research in clinical settings is needed.
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Affiliation(s)
| | | | - Per Carlbring
- Department of Psychology, Stockholm University, Sweden
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Gaebel W, Großimlinghaus I, Mucic D, Maercker A, Zielasek J, Kerst A. EPA guidance on eMental health interventions in the treatment of posttraumatic stress disorder (PTSD). Eur Psychiatry 2017; 41:140-152. [PMID: 28242486 DOI: 10.1016/j.eurpsy.2017.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/20/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
Abstract
The aim of this EPA guidance was to develop recommendations on eMental health interventions in the treatment of posttraumatic stress disorder (PTSD). A systematic literature search was performed and 40 articles were retrieved and assessed with regard to study characteristics, applied technologies, therapeutic approaches, diagnostic ascertainment, efficacy, sustainability of clinical effects, practicability and acceptance, attrition rates, safety, clinician-supported vs. non-supported interventions and active vs. waiting-list controls. The reviewed studies showed a great heterogeneity concerning study type, study samples, interventions and outcome measures. Based on these findings, five graded recommendations dealing with symptom reduction, acceptability, type of administration, clinician support, self-efficacy and coping were developed.
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Affiliation(s)
- W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; LVR Institute for Healthcare Research, Cologne, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | - I Großimlinghaus
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; LVR Institute for Healthcare Research, Cologne, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - D Mucic
- Treatment Centre Little Prince, Copenhagen, Denmark
| | - A Maercker
- Psychopathology and Clinical Intervention, University of Zürich, Zürich, Switzerland
| | - J Zielasek
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; LVR Institute for Healthcare Research, Cologne, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - A Kerst
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
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Topooco N, Riper H, Araya R, Berking M, Brunn M, Chevreul K, Cieslak R, Ebert DD, Etchmendy E, Herrero R, Kleiboer A, Krieger T, García-Palacios A, Cerga-Pashoja A, Smoktunowicz E, Urech A, Vis C, Andersson G. Attitudes towards digital treatment for depression: A European stakeholder survey. Internet Interv 2017; 8:1-9. [PMID: 30135823 PMCID: PMC6096292 DOI: 10.1016/j.invent.2017.01.001] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [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: 08/09/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The integration of digital treatments into national mental health services is on the agenda in the European Union. The E-COMPARED consortium conducted a survey aimed at exploring stakeholders' knowledge, acceptance and expectations of digital treatments for depression, and at identifying factors that might influence their opinions when considering the implementation of these approaches. METHOD An online survey was conducted in eight European countries: France, Germany, Netherlands, Poland, Spain, Sweden, Switzerland and The United Kingdom. Organisations representing government bodies, care providers, service-users, funding/insurance bodies, technical developers and researchers were invited to participate in the survey. The participating countries and organisations reflect the diversity in health care infrastructures and e-health implementation across Europe. RESULTS A total of 764 organisations were invited to the survey during the period March-June 2014, with 175 of these organisations participating in our survey. The participating stakeholders reported moderate knowledge of digital treatments and considered cost-effectiveness to be the primary incentive for integration into care services. Low feasibility of delivery within existing care services was considered to be a primary barrier. Digital treatments were regarded more suitable for milder forms of depression. Stakeholders showed greater acceptability towards blended treatment (the integration of face-to-face and internet sessions within the same treatment protocol) compared to standalone internet treatments. Organisations in countries with developed e-health solutions reported greater knowledge and acceptability of digital treatments. CONCLUSION Mental health stakeholders in Europe are aware of the potential benefits of digital interventions. However, there are variations between countries and stakeholders in terms of level of knowledge about such interventions and their feasibility within routine care services. The high acceptance of blended treatments is an interesting finding that indicates a gradual integration of technology into clinical practice may fit the attitudes and needs of stakeholders. The potential of the blended treatment approach, in terms of enhancing acceptance of digital treatment while retaining the benefit of cost-effectiveness in delivery, should be further explored. FUNDING The E-COMPARED project has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 603098.
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Affiliation(s)
- Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Corresponding author at: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, The Netherlands
| | - Ricardo Araya
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Roman Cieslak
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warszawa, Poland
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ernestina Etchmendy
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
| | - Rocío Herrero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Universitat Jaume I, Castellón, Spain
| | - Annet Kleiboer
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, The Netherlands
| | - Tobias Krieger
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Azucena García-Palacios
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Universitat Jaume I, Castellón, Spain
| | - Arlinda Cerga-Pashoja
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ewelina Smoktunowicz
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warszawa, Poland
| | - Antoine Urech
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, The Netherlands
- EMGO + Institute, VU Medical Centre Amsterdam, VU Amsterdam, The Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
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