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Lemon CA, Svob C, Bonomo Y, Dhungana S, Supanya S, Sittanomai N, Diatri H, Haider II, Javed A, Chandra P, Herrman H, Hoven CW, Sartorius N. Priorities for research promoting mental health in the south and east of Asia. Lancet Reg Health Southeast Asia 2024; 23:100287. [PMID: 38404519 PMCID: PMC10884971 DOI: 10.1016/j.lansea.2023.100287] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 02/27/2024]
Abstract
Progress in promoting mental health, preventing mental illness, and improving care for people affected by mental illness is unlikely to occur if efforts remain separated from existing public health programs and the principles of public health action. Experts met recently to discuss integrating public health and mental health strategies in the south and east of Asia, especially in low- and middle-income countries. Areas of research identified as high priority were: 1) integrating mental health into perinatal care; 2) providing culturally-adjusted support for carers of people with mental and physical disorders; 3) using digital health technologies for mental health care in areas with limited resources and 4) building local research capacity. Selection of these areas was informed by their relative novelty in the region, ease of implementation, likely widespread benefit, and potential low costs. In this article, we summarise available evidence, highlight gaps and call for collaborations with research centres, leaders and persons with lived experience within and beyond the region.
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Affiliation(s)
- Christopher A. Lemon
- NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Connie Svob
- Department of Psychiatry, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, United States of America
| | - Yvonne Bonomo
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria, Australia
- Department of Addiction Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Saraswati Dhungana
- Department of Psychiatry, Institute of Medicine, Tribhuvan University, Nepal
| | - Suttha Supanya
- Somdet Chaopraya Institute of Psychiatry, Department of Mental Health, Bangkok, Thailand
| | - Napat Sittanomai
- Division of Child and Adolescent Psychiatry, Department of Paediatrics, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Hervita Diatri
- Department of Psychiatry, Faculty Medicine Universitas Indonesia and Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christina W. Hoven
- Department of Psychiatry, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, United States of America
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
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García F, Klagges M, Leyton F, Nogales I, Mickman C, Martínez C, Tomicic A. Mental telehealth in a public child and adolescent psychiatry unit during the pandemic: a qualitative implementation study. Medwave 2024; 24:e2777. [PMID: 38513231 DOI: 10.5867/medwave.2024.02.2777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Background The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. Methods This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. Results In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. Conclusions There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.
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Affiliation(s)
- Francisca García
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Melannie Klagges
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Fanny Leyton
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Ingrid Nogales
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Carolina Mickman
- Departamento de Pediatría, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Claudio Martínez
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile
| | - Alemka Tomicic
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile
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Matsushima T, Yoshikawa Y, Matsuo K, Kurahara K, Uehara Y, Nakao T, Ishiguro H, Kumazaki H, Kato TA. Development of depression assessment tools using humanoid robots -Can tele-operated robots talk with depressive persons like humans? J Psychiatr Res 2024; 170:187-194. [PMID: 38154335 DOI: 10.1016/j.jpsychires.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/26/2023] [Accepted: 12/06/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Depression is a common mental disorder and causes significant social loss. Early intervention for depression is important. Nonetheless, depressed patients tend to conceal their symptoms from others based on shame and stigma, thus hesitate to visit psychiatrists especially during early phase. We hypothesize that application of humanoid robots would be a novel solution. Depressed patients may feel more comfortable talking with such robots than humans. METHODS We recruited 13 patients with major depressive disorder (MDD) and 27 healthy volunteers as controls. Participants took both tele-operated humanoid robot and human interviews to evaluate severity of depression using the Hamilton Depression Rating Scale (HDRS). In addition, participants completed a self-administered questionnaire asking about their impressions of the robot interview. RESULTS Confidence interval and t-test analysis have revealed that the HDRS scores are equally reliable between robot and human interviews. No significant differences were observed between the two interviews regarding "nervousness about the interview" and "hesitancy to talk about depressed moods and suicidal ideation." Compared to human interviews, robot interviews yielded significantly lower scores on shame-related factors especially among patients with MDD. LIMITATION Small sample size, and the evaluator is male only. CONCLUSIONS This is the first report to show the reliability of tele-operated humanoid robot interviews for assessment of depression. Robot interviews are potentially equally reliable as human interviews. Robot interviews are suggested to be more appropriate in assessing shame-related suppressed emotions and hidden thoughts of depressed patients in clinical practice, which may reduce the stigma associated with depression.
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Affiliation(s)
- Toshio Matsushima
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Yoshikawa
- Department of Systems Innovation, Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | - Keitaro Matsuo
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keita Kurahara
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Youki Uehara
- Department of Systems Innovation, Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Ishiguro
- Department of Systems Innovation, Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | - Hirokazu Kumazaki
- Department of Neuropsychiatry, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Shekunov J, Swintak C, Somers K, Kolla BB, Ruble A, Bhatt-Mackin S, Topor D, Murray A, Romanowicz M. The Virtual Couch: a Curriculum on the Question of the Fundamentals of Remote Psychotherapy-Pilot Study. Acad Psychiatry 2024; 48:52-56. [PMID: 37365485 PMCID: PMC10799114 DOI: 10.1007/s40596-023-01805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE With a rise in remote clinical practice related to the COVID-19 pandemic, a novel remote psychotherapy curriculum was presented to psychiatry residents and fellows to address the urgent need to teach trainees how to adapt traditional psychotherapy skills to telepsychiatry settings. METHODS Trainees completed a survey before and after receiving the curriculum to assess remote psychotherapy skills and areas for growth. RESULTS Eighteen trainees (24% fellows, 77% residents) completed the pre-curriculum survey, and 28 trainees (26% fellows, 74% residents) completed the post-curriculum survey. Thirty-five percent of pre-curriculum participants indicated no experience with remote psychotherapy. Technology (24%) and patient engagement (29%) were identified as the greatest challenges in providing teletherapy pre-curriculum. Content related to patient care (69%) and technology (31%) was of most interest to pre-curriculum participants and identified as most helpful post-curriculum (53% and 26%, respectively). After receiving the curriculum, most trainees planned to make internal, provider-related changes to their remote teletherapy practice. CONCLUSIONS The remote psychotherapy curriculum was well received by psychiatry trainees who had limited experience with remote clinical practice prior to the pandemic.
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Affiliation(s)
| | | | | | | | - Anne Ruble
- Johns Hopkins University, Baltimore, MD, USA
| | | | - David Topor
- VA Boston Healthcare System, Boston, MA, USA
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Svob C, Lemon CA, Bonomo YA. Public health and mental health in the south and east of Asia: Review of opportunities for collaborative research and public health action. Asian J Psychiatr 2024; 92:103886. [PMID: 38159446 DOI: 10.1016/j.ajp.2023.103886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/16/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Connie Svob
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY 10032, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | | | - Yvonne A Bonomo
- Department of Medicine, University of Melbourne Australia, Australia
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McEwen FS, El Khatib H, Hadfield K, Pluess K, Chehade N, Bosqui T, Skavenski S, Murray L, Weierstall-Pust R, Karam E, Pluess M. Feasibility and acceptability of phone-delivered psychological therapy for refugee children and adolescents in a humanitarian setting. Confl Health 2024; 18:7. [PMID: 38218936 PMCID: PMC10787498 DOI: 10.1186/s13031-023-00565-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Refugee children are at high risk of mental health problems but face barriers to accessing mental health services, a problem exacerbated by a shortage of mental health professionals. Having trained lay counsellors deliver therapy via telephone could overcome these barriers. This is the first study to explore feasibility and acceptability of telephone-delivered therapy with refugee children in a humanitarian setting. METHODS An evidence-based intervention, Common Elements Treatment Approach, was adapted for telephone-delivery (t-CETA) and delivered by lay counsellors to Syrian refugee children in informal tented settlements in the Beqaa region of Lebanon. Following delivery of t-CETA, semi-structured interviews were conducted with counsellors (N = 3) and with children who received t-CETA (N = 11, 45% female, age 8-17 years) and their caregivers (N = 11, 100% female, age 29-56 years) (N = 25 interviews). Thematic content analysis was conducted separately for interviews with counsellors and interviews with families and results were synthesized. RESULTS Three themes emerged from interviews with counsellors and four themes from interviews with families, with substantial overlap between them. Synthesized themes were: counselling over the phone both solves and creates practical and logistical challenges; t-CETA is adapted to potential cultural blocks; the relationship between the counsellor and the child and caregiver is extremely important; the family's attitude to mental health influences their understanding of and engagement with counselling; and t-CETA works and is needed. Counselling over the phone overcame logistical barriers, such as poor transportation, and cultural barriers, such as stigma associated with attending mental health services. It provided a more flexible and accessible service and resulted in reductions in symptoms for many children. Challenges included access to phones and poor network coverage, finding an appropriate space, and communication challenges over the phone. CONCLUSIONS Despite some challenges, telephone-delivered therapy for children shows promising evidence of feasibility and acceptability in a humanitarian context and has the potential to increase access to mental health services by hard-to-reach populations. Approaches to addressing challenges of telephone-delivered therapy are discussed. Trial Registration ClinicalTrials.gov ID: NCT03887312; registered 22nd March 2019.
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Affiliation(s)
- Fiona S McEwen
- Biological and Experimental Psychology, School of Biological and Behavioural Science, G.E. Fogg Building, Queen Mary University of London, Mile End Road, London, UK
- Department of War Studies, King's College London, Strand, London, UK
| | - Hania El Khatib
- Biological and Experimental Psychology, School of Biological and Behavioural Science, G.E. Fogg Building, Queen Mary University of London, Mile End Road, London, UK
| | - Kristin Hadfield
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Karen Pluess
- Biological and Experimental Psychology, School of Biological and Behavioural Science, G.E. Fogg Building, Queen Mary University of London, Mile End Road, London, UK
| | | | - Tania Bosqui
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Department of Psychology, American University of Beirut, Beirut, Lebanon
| | | | - Laura Murray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Elie Karam
- Institute for Development, Research, Advocacy and Applied Care, Achrafieh, St. George Hospital Street, Beirut, Lebanon
- Saint Georges Hospital University Medical Center, Achrafieh, Beirut, Lebanon
- Saint Georges University of Beirut, Beirut, Lebanon
| | - Michael Pluess
- Biological and Experimental Psychology, School of Biological and Behavioural Science, G.E. Fogg Building, Queen Mary University of London, Mile End Road, London, UK.
- School of Psychology, University of Surrey, Guildford, UK.
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Reese JB, Ramtekkar U. Telebehavioral Health: Workforce, Access, and Future Implications. Child Adolesc Psychiatr Clin N Am 2024; 33:87-93. [PMID: 37981340 DOI: 10.1016/j.chc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Even before the COVID-19 pandemic, telebehavioral health (TBH) was proving itself to be a valuable, effective tool for service delivery. The widespread adoption of its use over the past 2 years for continuity of care should be considered one of the silver linings of the pandemic. It has the potential to be a particularly powerful tool for providing more equitable access to care for those in rural communities if barriers to broadband access can be addressed. In addition to providing an attractive, flexible method of service delivery for patients and families, TBH holds appeal to the workforce as well.
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Affiliation(s)
- Jennifer B Reese
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Ujjwal Ramtekkar
- Department of Psychiatry, University of Missouri School of Medicine, 3 Hospital Drive, Columbia, MO, USA.
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Ricklan SJ, Sohler N, Ezie CEC, Avalone L, Dinsell V, Lewis C, Fattal O, Balan S, McQuistion H, Pastore F, Sarcevic N, Swift R, Espejo G, Lorenz C. Impact of Telemedicine on Utilization of Psychiatric Resources in New York City during the COVID-19 Pandemic. Community Ment Health J 2024; 60:115-123. [PMID: 38105337 DOI: 10.1007/s10597-023-01210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/04/2023] [Indexed: 12/19/2023]
Abstract
This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.
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Affiliation(s)
- Sarah J Ricklan
- NYU Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA.
| | - Nancy Sohler
- CUNY School of Medicine, Harris Hall, 160 Convent Avenue, New York, 10031, NY, USA
| | - C E Chiemeka Ezie
- NYU Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Lynsey Avalone
- NYC Health and Hospitals, 125 Worth Street, New York, NY, 10013, USA
| | - Victoria Dinsell
- NYU Grossman School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Crystal Lewis
- NYU Grossman School of Medicine, One Park Ave, New York, NY, 10016, USA
| | - Omar Fattal
- NYC Health and Hospitals, 125 Worth Street, Office 423, New York, NY, 10013, USA
| | - Sabish Balan
- Harlem Hospital, 506 Lenox Avenue, New York, NY, 10037, USA
| | - Hunter McQuistion
- NYU Grossman School of Medicine, One Park Ave, 8th Floor, New York, NY, 10016, USA
| | - Frank Pastore
- North Central Bronx Hospital, 3424 Kossuth Avenue, New York, NY, 10467, USA
| | - Nermica Sarcevic
- Jacobi Hospital, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Ronnie Swift
- NY Health and Hospitals/Metropolitan, 1901 First Avenue, New York, NY, 10029, USA
| | - Gemma Espejo
- Montefiore Medical Center, 111 East 210th St, New York, NY, 10467, USA
| | - Carina Lorenz
- NYC Health and Hospitals-Bellevue, 462 1st Avenue, New York, NY, 10016, USA
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Manera V, Partos C, Beauchet O, Benoit M, Dupetit B, Elbaum J, Fabre R, Gindt M, Gros A, Guerchouche R, Klöppel S, König A, Martin A, Mouton A, Pancrazi MP, Politis A, Robert G, Sacco G, Sacconi S, Sawchuk K, Solari F, Thiebot L, Trimarchi PD, Zeghari R, Robert P. Teleconsultations for mental health: Recommendations from a Delphi panel. Internet Interv 2023; 34:100660. [PMID: 37655117 PMCID: PMC10465930 DOI: 10.1016/j.invent.2023.100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 07/14/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction The use of teleconsultations for mental health has drastically increased since 2020 due to the Covid19 pandemic. In the present paper, we aimed to analyze the advantages and disadvantages of teleconsultations for mental health compared to face-to-face consultations, and to provide recommendations in this domain. Methods The recommendations were gathered using a Delphi methodology. The expert panel (N = 21) included professionals from the health and ICT domains. They answered questions via two rounds of web surveys, and then discussed the results in a plenary meeting. Some of the questions were also shared with non-experts (N = 104). Results Both the experts and the non-experts with teleconsultation experience reported a general satisfaction concerning teleconsultations. A SWOT analysis revealed several strengths and opportunities of teleconsultations for mental health, but also several weaknesses and threats. The experts provided a set of practical recommendations for the preparation and organization of teleconsultations for mental health. Discussion Teleconsultations for mental health have the potential to allow access to care for patients in remote and isolated areas. Thus, their use will unlikely be discontinued after the end of the pandemic. In this context, we suggest that the collaboration among clinicians, researchers, and interface designers is crucial to improve usability and user experience for both clinicians and patients. The importance of teaching teleconsultation skills and informing the public on the features of teleconsultations (e.g., data privacy/security) is also highlighted.
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Affiliation(s)
- Valeria Manera
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Association Innovation Alzheimer, Nice, France
- Department of Speech Therapy (Departement d'Orthophonie, DON), Université Côte d'Azur, Nice, France
| | - Claudia Partos
- Budapest University of Technology and Economics, Budapest, Hungary
| | - Olivier Beauchet
- Departments of Medicine and geriatrics, University of Montreal, Montreal, Quebec, Canada
- Research Centre of the Geriatric University Institute of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Michel Benoit
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Université Cote d'Azur, Adult Psychiatry Department, Nice University Hospital, Nice, France
| | | | - Julia Elbaum
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service clinique gériatrique de soins ambulatoires, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
| | - Roxane Fabre
- Côte d'Azur University, Nice University Hospital, Public Health Department, Nice, France
| | - Morgane Gindt
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Nice Pediatric Psychotrauma Center (NPPC), Child And Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, Nice, France
| | - Auriane Gros
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Association Innovation Alzheimer, Nice, France
- Department of Speech Therapy (Departement d'Orthophonie, DON), Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Service clinique gériatrique de soins ambulatoires, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
| | - Rachid Guerchouche
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Association Innovation Alzheimer, Nice, France
- ki:elements GmbH, Saarbrücken, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Alexandra König
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Association Innovation Alzheimer, Nice, France
- ki:elements GmbH, Saarbrücken, Germany
| | | | - Aurélie Mouton
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Association Innovation Alzheimer, Nice, France
- Centre Hospitalier Universitaire de Nice, Service clinique gériatrique de soins ambulatoires, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
| | | | - Antonios Politis
- Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Gabriel Robert
- Academic Psychiatry Department, Guillaume Régnier Hospital, Rennes, France
- Empenn Inserm U1228, IRISA UMR 6074, Rennes University Hospital, France
| | - Guillaume Sacco
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Association Innovation Alzheimer, Nice, France
- Centre Hospitalier Universitaire de Nice, Service clinique gériatrique de soins ambulatoires, Centre Mémoire Ressources et Recherche, Université Côte d'Azur, Nice, France
| | - Sabrina Sacconi
- Université Cote d'Azur, Peripheral Nervous System and Muscle Department, Nice University Hospital, Nice, France
| | - Kim Sawchuk
- Department of Communication Studies, Concordia University, Montreal, QC, Canada
| | - Fabio Solari
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Italy
| | | | | | - Radia Zeghari
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Nice Pediatric Psychotrauma Center (NPPC), Child And Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, Nice, France
| | - Philippe Robert
- CobTeK laboratory, Université Côte d'Azur, Nice, France
- Association Innovation Alzheimer, Nice, France
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Hassan L, Eisner E, Berry K, Emsley R, Ainsworth J, Lewis S, Haddock G, Edge D, Bucci S. User engagement in a randomised controlled trial for a digital health intervention for early psychosis (Actissist 2.0 trial). Psychiatry Res 2023; 329:115536. [PMID: 37857132 DOI: 10.1016/j.psychres.2023.115536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
Digital Health Interventions (DHIs) can help support people with mental health problems. Achieving satisfactory levels of patient engagement is a crucial, yet often underexplored, pre-requisite for health improvement. Actissist is a co-produced DHI delivered via a smartphone app for people with early psychosis, based on Cognitive Behaviour Therapy principles. This study describes and compares engagement patterns among participants in the two arms of the Actissist 2.0 randomised controlled trial. Engagement frequency and duration were measured among participants using the Actissist app in the intervention arm (n = 87) and the ClinTouch symptom monitoring only app used as the control condition (n = 81). Overall, 47.1 % of Actissist and 45.7 % of ClinTouch users completed at least a third of scheduled alerts while active in the study. The mean frequency (77.1 versus 60.2 total responses) and the median duration (80 versus 75 days until last response) of engagement were not significantly higher among Actissist users compared to ClinTouch users. Older age, White ethnicity, using their own smartphone device and, among Actissist users, an increased sense of therapeutic alliance were significantly associated with increased engagement. Through exploiting detailed usage data, this study identifies possible participant-level and DHI-level predictors of engagement to inform the practical implementation of future DHIs.
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Affiliation(s)
- Lamiece Hassan
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Ainsworth
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; Research and Innovation, Greater Manchester Mental Health Foundation NHS Trust, Manchester, UK.
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11
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Howard A, Wang S, Adachi J, Yadama A, Bhat A. Facilitators of and barriers to perinatal telepsychiatry care: a qualitative study. BMJ Open 2023; 13:e071084. [PMID: 37802623 PMCID: PMC10565296 DOI: 10.1136/bmjopen-2022-071084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Perinatal mental health disorders such as anxiety, depression and bipolar disorder can negatively impact the health of women and their children without appropriate detection and treatment. Due to increases in mental health symptoms and transmission risks associated with in-person appointments, many clinics transitioned to providing telepsychiatry care during the COVID-19 pandemic. This study sought to identify the facilitators and barriers to receiving perinatal telepsychiatry care from the perspective of patients, clinic staff and psychiatrists. DESIGN Qualitative study based on analysis of in depth semistructured interviews. SETTING The study was conducted in a virtual specialty mental health clinic in an academic setting. PARTICIPANTS Eight patients who had been scheduled for an appointment with the perinatal telepsychiatry clinic between 14 May 2021 and 1 August 2021, seven of whom had attended their scheduled appointment with the clinic and one of whom had not, and five staff members including psychiatrists, navigators and clinic managers, participated in in-depth interviews. RESULTS Telepsychiatry was perceived by most as preferable to in-person care and easy to attend and navigate. Alternatively, technological difficulties, personal preference for in-person care and scheduling conflicts related to the perinatal period were identified as barriers by some. Participants identified communication between care staff and patients, online patient portals, and appointment reminders as important for facilitating appointment preparedness and attendance. CONCLUSIONS The findings from this study suggest that telepsychiatry services are perceived positively by patients and care staff and have the potential to improve access to mental healthcare for perinatal patients.
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Affiliation(s)
- Anna Howard
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sunny Wang
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Jamie Adachi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Alexa Yadama
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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12
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Hynie M, Oda A, Calaresu M, Kuo BCH, Ives N, Jaimes A, Bokore N, Beukeboom C, Ahmad F, Arya N, Samuel R, Farooqui S, Palmer-Dyer JL, McKenzie K. Access to Virtual Mental Healthcare and Support for Refugee and Immigrant Groups: A Scoping Review. J Immigr Minor Health 2023; 25:1171-1195. [PMID: 37407884 PMCID: PMC10509103 DOI: 10.1007/s10903-023-01521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O'Malley in Int J Soc Res Methodol 8:19-32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS' accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted.
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Affiliation(s)
- Michaela Hynie
- Department of Psychology, York University, Toronto, Canada.
- Centre for Refugee Studies, York University, 4700 Keele St., Toronto, ON, M3J1P3, Canada.
| | - Anna Oda
- Centre for Refugee Studies, York University, 4700 Keele St., Toronto, ON, M3J1P3, Canada
| | - Michael Calaresu
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - Ben C H Kuo
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Nicole Ives
- School of Social Work, McGill University, Montreal, Canada
| | - Annie Jaimes
- Department of Psychology, University of Quebec in Montreal, Montreal, Canada
| | - Nimo Bokore
- School of Social Work, Carleton University, Ottawa, Canada
| | | | - Farah Ahmad
- School of Health Policy and Management, York University, Toronto, Canada
| | - Neil Arya
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Rachel Samuel
- Counseling Psychology, Yorkville University, Fredericton, Canada
| | | | | | - Kwame McKenzie
- Wellesley Institute, Toronto, Canada
- Division of Health Equity, CAMH, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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13
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Biddle L, Derges J, Cliffe B, Gooberman-Hill R, Linton MJ, Moran P, Bould H. "Pouring their heart out in Sainsbury's": qualitative study of young people's, parents' and mental health practitioners' experiences of adapting to remote online mental health appointments during COVID-19. BMC Psychiatry 2023; 23:641. [PMID: 37658298 PMCID: PMC10474770 DOI: 10.1186/s12888-023-05126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, technologies such as videoconferencing were used to deliver mental health appointments remotely online. For many people, this was a change from previous methods of mental healthcare receipt and delivery. We aimed to explore in-depth how practitioners, young people and parents in the UK experienced this transition. METHODS We used qualitative methods to collect data, triangulating between free-text online survey data (n = 38), focus groups (n = 5) (3 young adult groups (total n = 11); 2 practitioner groups (total n = 7)), and semi-structured interviews (practitioners n = 8; parents n = 4). Data were analysed using reflexive thematic analysis. RESULTS Participants held mixed views about remote appointments, which were encompassed within the five themes of: home as clinic; disrupted therapeutic relationships; difficulties with engagement; uncontained risk; and scope of care provision. While appointments at home could be regarded as more comfortable, naturalistic and accessible, it was also recognised that remoteness compromised practitioner control with consequences for their ability to monitor patient engagement, manage risk and ensure confidentiality when others were present in the home. This could create an additional burden for parents as they tried to facilitate appointments but felt unsupported in this role. Relatedly, remoteness was seen to hinder interpersonal communication, formation of trust, communication of empathy and opportunities to observe body language, all of which were deemed important to building and maintaining effective therapeutic relationships. Despite this, others thought the anonymity of a remote exchange may allow earlier disclosure. There was disagreement as to whether remote provision narrowed or expanded the scope of practice. CONCLUSIONS While some had positive views of remote mental health appointments, others found them challenging. Findings highlight key areas requiring attention and mitigation in future offerings of remote provision, namely: risk management, parental burden, and problematic engagement.
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Affiliation(s)
- Lucy Biddle
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK.
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
- Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK.
- Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - Jane Derges
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - Bethany Cliffe
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rachael Gooberman-Hill
- Translational Health Sciences, Bristol University Medical School, Learning and Research Building, Southmead Hospital, Bristol, UK
- Elizabeth Blackwell Institute, University of Bristol, Royal Fort House, Bristol, UK
| | - Myles-Jay Linton
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
| | - Paul Moran
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK
- Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Helen Bould
- Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, UK
- Centre for Academic Mental Health, Bristol University Medical School, Oakfield House, Oakfield Road, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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14
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Kline CL, Hurst L, Marcus S, Malas N. A Review of Telepsychiatry for Pediatric Patients in the Emergency Setting. Curr Psychiatry Rep 2023; 25:429-436. [PMID: 37526863 DOI: 10.1007/s11920-023-01442-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize factors contributing to the current state of pediatric mental health access in ED settings and synthesize the existing literature on the use of telepsychiatry to extend access to care, with particular focus on feasibility and sustainability. RECENT FINDINGS Children are presenting to emergency departments (EDs) with mental health concerns at an increasing rate, while ED capacity to treat psychiatric needs in children remains insufficient. This growing problem is compounded by decreased access to outpatient care and inpatient psychiatric beds, resulting in exorbitantly long waiting times, or "boarding," of children in crisis. Telepsychiatry has emerged as a strategy to decrease boarding of pediatric patients in ED settings by utilizing remote psychiatric professionals to provide consultation and assessment. Telepsychiatry in ED settings is an effective strategy to increase access to care and decrease length of stay for pediatric patients.
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Affiliation(s)
- Christopher L Kline
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Laura Hurst
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sheila Marcus
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nasuh Malas
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.
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15
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Hagi K, Kurokawa S, Takamiya A, Fujikawa M, Kinoshita S, Iizuka M, Furukawa S, Eguchi Y, Kishimoto T. Telepsychiatry versus face-to-face treatment: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2023; 223:407-414. [PMID: 37655816 PMCID: PMC10895502 DOI: 10.1192/bjp.2023.86] [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: 01/23/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic has transformed healthcare significantly and telepsychiatry is now the primary means of treatment in some countries. AIMS To compare the efficacy of telepsychiatry and face-to-face treatment. METHOD A comprehensive meta-analysis comparing telepsychiatry with face-to-face treatment for psychiatric disorders. The primary outcome was the mean change in the standard symptom scale scores used for each psychiatric disorder. Secondary outcomes included all meta-analysable outcomes, such as all-cause discontinuation and safety/tolerability. RESULTS We identified 32 studies (n = 3592 participants) across 11 mental illnesses. Disease-specific analyses showed that telepsychiatry was superior to face-to-face treatment regarding symptom improvement for depressive disorders (k = 6 studies, n = 561; standardised mean difference s.m.d. = -0.325, 95% CI -0.640 to -0.011, P = 0.043), whereas face-to-face treatment was superior to telepsychiatry for eating disorder (k = 1, n = 128; s.m.d. = 0.368, 95% CI 0.018-0.717, P = 0.039). No significant difference was seen between telepsychiatry and face-to-face treatment when all the studies/diagnoses were combined (k = 26, n = 2290; P = 0.248). Telepsychiatry had significantly fewer all-cause discontinuations than face-to-face treatment for mild cognitive impairment (k = 1, n = 61; risk ratio RR = 0.552, 95% CI 0.312-0.975, P = 0.040), whereas the opposite was seen for substance misuse (k = 1, n = 85; RR = 37.41, 95% CI 2.356-594.1, P = 0.010). No significant difference regarding all-cause discontinuation was seen between telepsychiatry and face-to-face treatment when all the studies/diagnoses were combined (k = 27, n = 3341; P = 0.564). CONCLUSIONS Telepsychiatry achieved a symptom improvement effect for various psychiatric disorders similar to that of face-to-face treatment. However, some superiorities/inferiorities were seen across a few specific psychiatric disorders, suggesting that its efficacy may vary according to disease type.
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Affiliation(s)
| | - Shunya Kurokawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Mayu Fujikawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; and Department of Epileptology, Tohoku University School of Medicine, Miyagi, Japan
| | - Shotaro Kinoshita
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan; and Graduate School of Interdisciplinary Information Studies, University of Tokyo, Tokyo, Japan
| | - Mari Iizuka
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shota Furukawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan; and Tsutsuji Mental Hospital, Gunma, Japan
| | - Yoko Eguchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; and Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York, USA
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16
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Khademi M, Vaziri-Harami R, Mashadi AM, Seif P, Babazadehdezfoly A. The Effectiveness of Telephone-based Psychological Services to COVID-19. Clin Pract Epidemiol Ment Health 2023; 19:e174501792307270. [PMID: 37916207 PMCID: PMC10507215 DOI: 10.2174/17450179-v19-230824-2023-11] [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: 04/23/2023] [Revised: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 11/03/2023]
Abstract
Background The COVID-19 pandemic has disrupted the delivery of mental health services, leading to the development of telepsychiatry. Aim The present study investigates the effectiveness of telephone-delivered treatment for psychological disorders of COVID-19 survivors in Tehran, the capital of Iran. Methods In this non-randomized controlled trial, 91 COVID-19 survivors, primarily residents were enrolled. Participants completed a baseline questionnaire and a psychological screening questionnaire. The intervention included the telephone-based psychological services provided by trained psychiatric residents. The Post-Traumatic Stress Disorder (PTSD) Checklist (PCL) was administered to assess the presence of PTSD symptoms. Symptoms of anxiety and depression were measured by the Patient Health Questionnaire. Results The General Health Questionnaire (GHQ) adjusted mean difference was significantly lower in the intervention group than in the control group. There was a significant negative correlation between the Spost-GHQ score and history of going to the clinic and history of psychiatric disorders, but no relationship with the history of hospitalization. All participants completed the satisfaction form, with almost half of them being "satisfied" or "very satisfied" with the telehealth calls. Conclusion Telephonic delivery of psychological services showed an effective way of providing evidence-based psychological support during the pandemic. This telehealth program can offer much-needed assistance to individuals with COVID-19 improving their psychological wellbeing.
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Affiliation(s)
- Mojgan Khademi
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Vaziri-Harami
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Mahouram Mashadi
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Seif
- Department of Psychiatry, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Babazadehdezfoly
- Clinical Research Development Unit, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Galvin E, Desselle S, Gavin B, Quigley E, Flear M, Kilbride K, McNicholas F, Cullinan S, Hayden J. Stakeholder perspectives and experiences of the implementation of remote mental health consultations during the COVID-19 pandemic: a qualitative study. BMC Health Serv Res 2023; 23:623. [PMID: 37312119 DOI: 10.1186/s12913-023-09529-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Remote mental health consultations were swiftly implemented across mental health services during the COVID-19 pandemic. Research has begun to inform future design and delivery of telemental health services. Exploring the in-depth experiences of those involved is important to understand the complex, multi-level factors that influence the implementation of remote mental health consultations. The aim of this study was to explore stakeholder perspectives and experiences of the implementation of remote mental health consultations during the COVID-19 pandemic in Ireland. METHODS A qualitative study was conducted whereby semi-structured, individual interviews were undertaken with mental health providers, service users, and managers (n = 19) to acquire rich information. Interviews were conducted between November 2021 and July 2022. The interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). Data were analysed thematically using a deductive and inductive approach. RESULTS Six themes were identified. The advantages of remote mental health consultations were described, including convenience and increased accessibility to care. Providers and managers described varying levels of success with implementation, citing complexity and incompatibility with existing workflows as barriers to adoption. Providers' access to resources, guidance, and training were notable facilitators. Participants perceived remote mental health consultations to be satisfactory but not equivalent to in-person care in terms of quality. Views about the inferior quality of remote consultations stemmed from beliefs about the inhibited therapeutic relationship and a possible reduction in effectiveness compared to in-person care. Whilst a return to in-person services was mostly preferred, participants acknowledged a potential adjunct role for remote consultations in certain circumstances. CONCLUSIONS Remote mental health consultations were welcomed as a means to continue care during the COVID-19 pandemic. Their swift and necessary adoption placed pressure on providers and organisations to adapt quickly, navigating challenges and adjusting to a new way of working. This implementation created changes to workflows and dynamics that disrupted the traditional method of mental health care delivery. Further consideration of the importance of the therapeutic relationship and fostering positive provider beliefs and feelings of competence are needed to ensure satisfactory and effective implementation of remote mental health consultations going forward.
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Affiliation(s)
- Emer Galvin
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | | | - Blánaid Gavin
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | - Fiona McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland
- Children's Health Ireland, Crumlin, Dublin, Ireland
- Lucena Child and Adolescent Mental Health Service (CAMHS), Rathgar, Dublin, Ireland
| | - Shane Cullinan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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18
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Colombo MG, Joos S, Koch R. Implementing interprofessional video consultations with general practitioners and psychiatrists in correctional facilities in Germany: results from a mixed-methods study. BMC Health Serv Res 2023; 23:578. [PMID: 37277811 DOI: 10.1186/s12913-023-09592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/23/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Adequate health care in correctional facilities is often limited by staff shortage, which entails time-consuming consultations with physicians outside of these facilities. Video consultations (VC) have been implemented in many different health care settings and may also be useful in correctional facilities. As part of a pilot project, synchronous VC were implemented in five correctional facilities in Germany in June 2018. The aim of this study was to describe the implementation process from the providers' perspective and to identify factors promoting or inhibiting the implementation process of VC with a focus on interprofessional collaboration between nursing staff and telemedicine physicians. METHODS As part of the mixed-methods evaluation of the pilot project, site visits to the five correctional facilities were carried out. Nursing staff from the five correctional facilities (n=49) and telemedicine physicians (n=10) were asked to participate in interviews and a questionnaire survey. Interviews were analyzed using qualitative content analysis and questionnaires were evaluated using descriptive statistical methods. The results from both data sources were integrated and discussed in the framework of Normalization Process Theory. RESULTS Interviews were conducted with 24.5% (n=12) of nursing staff and 20.0% (n=2) of telemedicine physicians, while questionnaires were returned by 22.5% (n=11) of nursing staff and 33.3% (n=3) of telemedicine physicians. VC with general practitioners and psychiatrists were perceived as an additional support during times when physicians were absent from the correctional facilities. Allocating telemedicine physicians to specific correctional facilities might further improve interprofessional collaboration with nursing staff during VC. Inhibiting factors comprised the lack of integrating nursing staff into the implementation process, increased workload, insufficient training and the implementation of VC at an inconvenient time. CONCLUSIONS To summarize, VC are a promising supplement to face-to-face health care in correctional facilities despite several limitations. These might be compensated by improving interprofessional cooperation and by integrating telemedicine physicians into local health care teams.
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Affiliation(s)
- Miriam Giovanna Colombo
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstrasse 5, Tübingen, Baden-Württemberg, 72076, Germany.
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstrasse 5, Tübingen, Baden-Württemberg, 72076, Germany
| | - Roland Koch
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstrasse 5, Tübingen, Baden-Württemberg, 72076, Germany
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19
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Biagianti B, Lisi I, Di Liberto A, Turtulici N, Foti G, Zito S, Ginex V, Fornoni C, Gallo F, Cantù F, Tombola V, Di Fede V, Rossetti MG, Colombo E, Stocchetti N, Zanier ER, Bellani M, Bressi C, Brambilla P. Feasibility and preliminary efficacy of brief tele-psychotherapy for COVID-19 patients and their first-degree relatives. J Affect Disord 2023; 330:300-308. [PMID: 36934855 PMCID: PMC10022466 DOI: 10.1016/j.jad.2023.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/14/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic compromised the mental health of COVID-19 patients and their family members. Due to social distancing and lockdown measures, a remote, tele-psychotherapy program for former or current COVID-19 patients and their relatives was implemented. OBJECTIVE The primary goal of this project was to evaluate intervention feasibility. The secondary aim was to assess the impact of the intervention by means of pre-post psychological changes. METHODS After a phone-based eligibility screening and remote neuropsychological testing, participants completed online self-reports assessing baseline COVID-related psychopathology. Next, participants attended eight tele-psychotherapy sessions. After treatment, the online self-reports were completed again. RESULTS Of 104 enrolled participants, 88 completed the intervention (84.6 % completion rate). Significant pre-post improvements were observed for generalized anxiety (d = 0.38), depression (d = 0.37), insomnia (d = 0.43), post-traumatic psychopathology (d = 0.54), and general malaise (d = 0.31). Baseline cluster analysis revealed a subgroup of 41 subjects (47.6 %) with no psychopathology, and a second subgroup of 45 subject (52.3 %) with moderate severity. Thirty-three percent of the second group reached full symptom remission, while 66 % remained symptomatic after treatment. CONCLUSIONS Remote brief tele-psychotherapy for COVID-19 patients and their first-degree relatives is feasible and preliminary efficacious at reducing COVID-related psychopathology in a subgroup of patients. Further research is needed to investigate distinct profiles of treatment response.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychology, University of Milan Bicocca, 20126, Milano, Italy
| | - Ilaria Lisi
- Laboratory of Acute Brain Injury and Therapeutic Strategies, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy
| | - Asia Di Liberto
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Nunzio Turtulici
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giuseppe Foti
- Department of Psychology, University of Milan Bicocca, 20126, Milano, Italy
| | - Silvana Zito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Valeria Ginex
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Chiara Fornoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Gallo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Filippo Cantù
- Department of Psychology, University of Milan Bicocca, 20126, Milano, Italy
| | - Valentina Tombola
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Viviana Di Fede
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Gloria Rossetti
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa Colombo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Nino Stocchetti
- Department of Anaesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa R Zanier
- Laboratory of Acute Brain Injury and Therapeutic Strategies, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milano, Italy
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, 37134 Verona, Italy
| | - Cinzia Bressi
- Department of Psychology, University of Milan Bicocca, 20126, Milano, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Brambilla
- Department of Psychology, University of Milan Bicocca, 20126, Milano, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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20
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Achtyes ED, Glenn T, Monteith S, Geddes JR, Whybrow PC, Martini J, Bauer M. Telepsychiatry in an Era of Digital Mental Health Startups. Curr Psychiatry Rep 2023; 25:263-272. [PMID: 37166622 PMCID: PMC10172730 DOI: 10.1007/s11920-023-01425-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE OF REVIEW Telepsychiatry practiced by psychiatrists is evidence-based, regulated, private, and effective in diverse settings. The use of telemedicine has grown since the COVID-19 pandemic as people routinely obtain more healthcare services online. At the same time, there has been a rapid increase in the number of digital mental health startups that offer various services including online therapy and access to prescription medications. These digital mental health firms advertise directly to the consumer primarily through digital advertising. The purpose of this narrative review is to contrast traditional telepsychiatry and the digital mental health market related to online therapy. RECENT FINDINGS In contrast to standard telepsychiatry, most of the digital mental health startups are unregulated, have unproven efficacy, and raise concerns related to self-diagnosis, self-medicating, and inappropriate prescribing. The role of digital mental health firms for people with serious mental illness has not been determined. There are inadequate privacy controls for the digital mental health firms, including for online therapy. We live in an age where there is widespread admiration for technology entrepreneurs and increasing emphasis on the role of the patient as a consumer. Yet, the business practices of digital mental health startups may compromise patient safety for profits. There is a need to address issues with the digital mental health startups and to educate patients about the differences between standard medical care and digital mental health products.
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Affiliation(s)
- Eric D Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
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21
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Fast N, van Kessel R, Humphreys K, Ward NF, Roman-Urrestarazu A. The Evolution of Telepsychiatry for Substance Use Disorders During COVID-19: a Narrative Review. Curr Addict Rep 2023; 10:187-197. [PMID: 37266192 PMCID: PMC10126560 DOI: 10.1007/s40429-023-00480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/03/2023]
Abstract
Purpose of Review This article aims to review and synthesize the current research evidence regarding the efficacy of telepsychiatry-delivered substance use disorder treatment using a narrative review with a focus on the effects of remote healthcare delivery within the substance abuse treatment space. Recent Findings The COVID-19 pandemic exerted substantial pressures on all levels of society. Social isolation, loss of employment, stress, physical illness, overburdened health services, unmet medical needs, and rapidly changing pandemic restrictions had particularly severe consequences for people with mental health issues and substance use disorders. Since the start of the pandemic, addiction treatment (and medical treatment overall) using remote health platforms has significantly expanded to different platforms and delivery systems. The USA, in particular, reported transformational policy developments to enable the delivery of telehealth during the COVID-19 pandemic. However, systemic barriers such as a widespread lack of internet access and insufficient patient and provider digital skills remain. Summary Overall, telepsychiatry is a promising approach for the treatment of substance use disorders, but more randomized controlled trials are needed in the future to assess the evidence base of available interventions.
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Affiliation(s)
- Noam Fast
- START Treatment & Recovery Centers, New York City, USA
- Addiction Psychiatry Fellowship Faculty, Department of Psychiatry, Columbia University, New York City, USA
| | - Robin van Kessel
- Department of Health Policy, London School of Economics and Political Science, LSE Health, London, UK
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Natalie Frances Ward
- Department of International Development Studies, University of Amsterdam, Amsterdam, Netherlands
| | - Andres Roman-Urrestarazu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
- Cambridge Public Health, University of Cambridge, Cambridge, UK
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22
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Gittins Stone DI, Elkins RM, Gardner M, Boger K, Sperling J. Examining the Effectiveness of an Intensive Telemental Health Treatment for Pediatric Anxiety and OCD During the COVID-19 Pandemic and Pediatric Mental Health Crisis. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01500-5. [PMID: 36749490 PMCID: PMC9902833 DOI: 10.1007/s10578-023-01500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
Despite research supporting the efficacy of weekly outpatient videoconferencing-based cognitive behavioral therapy (VCBT), limited evidence exists about the benefits of leveraging VCBT for brief intensive formats. We examined the effectiveness of an intensive outpatient VCBT targeting pediatric anxiety and OCD. Quasi-experimental design was used to compare outcomes of intensive, in-person, group-based cognitive-behavioral therapy with medication management and caregiver guidance pre-pandemic, to a similar VCBT peri-pandemic (n = 130). Pretreatment and posttreatment assessments included patient- and caregiver-report of anxiety and functional impairment. Analyses of covariance were conducted, examining changes in anxiety and impairment between treatment groups, controlling for admission levels. No significant differences in posttreatment anxiety or impairment were observed between conditions. This study illustrates that intensive, group-based treatment for pediatric anxiety and OCD using VCBT is associated with comparable reductions in anxiety and impairment. It marks a crucial step toward providing broader access to quality care for youth in need.
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Affiliation(s)
| | - R Meredith Elkins
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | | | - Kathryn Boger
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Jacqueline Sperling
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
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23
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Sivakumar T, Basavarajappa C, Philip M, Kumar CN, Thirthalli J, Parthasarathy R. Impact of incentivizing ASHAs on the outcome of persons with severe mental illness in a rural South Indian community amidst the COVID-19 pandemic. Asian J Psychiatr 2023; 80:103388. [PMID: 36495728 PMCID: PMC9722235 DOI: 10.1016/j.ajp.2022.103388] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/03/2022] [Accepted: 09/12/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND & OBJECTIVES Task shifting has been recommended as a strategy to reach out to persons with mental illness and bridge the treatment gap. There is a need to explore task-shifting using existing health staff like Accredited Social Health Activists (ASHAs). We examined the impact of incentivizing ASHAs on the outcome of persons with severe mental illness (SMI) amidst the pandemic. METHODS One hundred eighty-four adults with SMI from Jagaluru taluk were enrolled and followed up for a year. They were assessed for disability, work performance, internalized stigma, and illness severity at baseline, six months, and 12 months follow-up. ASHA workers were incentivized to ensure follow-up consultations, address concerns regarding illness/ medication side effects and monitor medication adherence. RESULTS Out of the 184 recruited patients, 7 died (non-COVID-19 causes), 22 stopped treatment and did not report for follow-up consultations, 11 shifted to treatment from other centers, and in 1 case, there was a change in diagnosis. 143 (78%) patients with SMI completed the study amidst the COVID-19 pandemic. At one year follow-up, there was a significant reduction in disability, illness severity, self-stigma, and improved work performance. CONCLUSION Incentivization of ASHAs helped ensure continuity of care to persons with SMI despite lockdowns and COVID-19 exigencies. It is feasible to involve ASHAs in the treatment of persons with SMI.
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Affiliation(s)
- Thanapal Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India.
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - C Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Rajani Parthasarathy
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru 560009, India
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24
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Torales J, Vilallba-Arias J, Bogado JA, O'Higgins M, Almirón-Santacruz J, Ruiz Díaz N, García O, Amarilla-Salvioni D, Castaldelli-Maia JM, Ventriglio A, Barrios I. Satisfaction with Telepsychiatry during the COVID-19 pandemic: Patients' and psychiatrists' report from a University Hospital. Int J Soc Psychiatry 2023; 69:156-160. [PMID: 34991382 PMCID: PMC9936176 DOI: 10.1177/00207640211070762] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to important changes in the approach to patients worldwide. Different agencies have proposed and implemented telemedicine-based care services in order to ensure access to health care for all people. AIM The aim of this study was to determine the satisfaction of patients using the Telepsychiatry service offered by the Department of Psychiatry of the Hospital de Clínicas (National University of Asunción, Paraguay). METHODS A cross sectional and descriptive study has been conducted. Participants were recruited through a phone-based survey. Satisfaction with Telepsychiatry has been measured with an adapted version of a satisfaction survey in Teleneurology. As a complement, psychiatrists from the Hospital de Clínicas were also interviewed about their rate of satisfaction with Telepsychiatry. RESULTS A total of 530 patients were included, 51.3% of whom were women. The consultation satisfaction scale ranged between 2.15 and 4.30 with a mean score of 3.02 ± 0.32. Cronbach's alpha for the scale was .897, indicating a good internal consistency. Patients' satisfaction was higher for the perception of Telepsychiatry and lower for the doctor-patient relationship. Of the physicians, 87.5% were satisfied with the Telepsychiatry service. CONCLUSION The satisfaction overall score indicates patients' general satisfaction with the quality of care in Telepsychiatry, mainly regarding the perception of health care. and lower satisfaction with the doctor-patient relationship. Nine out of 10 psychiatrists felt satisfied with the Telepsychiatry service and considered that the degree of patient's satisfaction was acceptable during the Telepsychiatry consultation.
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Affiliation(s)
- Julio Torales
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay.,Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Jorge Vilallba-Arias
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay.,Department of Psychiatry (Santa Rosa Campus), School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray, Paraguay
| | - José Andrés Bogado
- Department of Psychiatry (Santa Rosa Campus), School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray, Paraguay
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - José Almirón-Santacruz
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Noelia Ruiz Díaz
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay.,Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Diego Amarilla-Salvioni
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Fundação do ABC, Santo André, Brazil.,Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Iván Barrios
- Department of Statistics (Santa Rosa Campus), School of Medical Sciences, National University of Asunción, Santa Rosa del Aguaray, Paraguay
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25
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Gentry MT, Murray AP, Altchuler SI, McKean AJ, Joyce JB, Hilty DM. Development and Implementation of a Virtual Clinical Skills Examination in General Psychiatry. Acad Psychiatry 2023; 47:48-52. [PMID: 35918600 PMCID: PMC9345010 DOI: 10.1007/s40596-022-01691-4] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE During the COVID-19 pandemic, psychiatry programs have administered the Clinical Skills Evaluation (CSE) through videoconferencing. The authors evaluated the feasibility and appropriateness of administering virtual CSEs. METHODS Virtual CSEs were administered to 11 general psychiatry residents on March 16, 2021. Teleconference software was used to connect faculty at work sites, residents at a simulation center, and volunteer patients at home. Before and after the CSE, residents and faculty were surveyed with Likert scale questions to evaluate their perceptions and experience. RESULTS All virtual CSEs were completed successfully. Nine residents (82%) and 12 faculty (92%) responded to both surveys. Most participants (range, 67-83%) indicated that the virtual CSE was appropriate for assessing patient health and resident skills. Most participants (range, 56-100%) reported that the opening and closing of the interview, informational and affective cues, and rapport were adequately assessed. All participants agreed that suicidal and homicidal risks could be adequately assessed. Most faculty and residents (76%) believed that unique skills were required for telehealth interviews. Before the CSE, more faculty than residents believed that they received adequate training for the virtual CSE (P=.02); afterward, most participants thought that training was adequate (P=.46). More faculty than residents reported increased convenience with virtual assessments (both surveys, P<.01). CONCLUSION Virtual CSEs were deemed feasible and appropriate. Further research is needed to identify the specific skills required to perform a virtual CSE and to clarify the potential limitations and benefits of this format.
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Affiliation(s)
| | - Andrew P Murray
- Mayo Clinic Health System - Northwest Wisconsin Region, Eau Claire, WI, USA
| | | | | | - Jeremiah B Joyce
- Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Donald M Hilty
- VA Northern California Health Care System, and University of California, Davis, Sacramento, CA, USA
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26
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Appleton R, Barnett P, Vera San Juan N, Tuudah E, Lyons N, Parker J, Roxburgh E, Spyridonidis S, Tamworth M, Worden M, Yilmaz M, Sevdalis N, Lloyd-Evans B, Needle JJ, Johnson S. Implementation strategies for telemental health: a systematic review. BMC Health Serv Res 2023; 23:78. [PMID: 36694164 PMCID: PMC9873395 DOI: 10.1186/s12913-022-08993-1] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in a rapid shift from traditional face-to-face care provision towards delivering mental health care remotely through telecommunications, often referred to as telemental health care. However, the manner and extent of telemental health implementation have varied considerably across settings and areas, and substantial barriers are encountered. There is, therefore, a need to identify what works best for service users and staff and establish the key mechanisms for efficient integration into routine care. OBJECTIVE We aimed to identify investigations of pre-planned strategies reported in the literature intended to achieve or improve effective and sustained implementation of telemental health approaches (including video calls, telephone calls, text messaging platforms or a combination of any of these approaches with face-to-face care), and to evaluate how different strategies influence implementation outcomes. METHODS A systematic review was conducted, with five databases searched for any relevant literature published between January 2010 and July 2021. Studies were eligible if they took place in specialist mental health services and focused on pre-planned strategies to achieve or improve the delivery of mental health care through remote communication between mental health professionals or between mental health professionals and service users, family members, unpaid carers, or peer supporters. All included studies were quality-assessed. Data were synthesised using the Expert Recommendations for Implementing Change (ERIC) compilation of implementation strategies and the taxonomy of implementation outcomes. RESULTS A total of 14 studies were identified as meeting the inclusion criteria from a total of 14,294 records of which 338 were assessed at full text. All ERIC implementation strategies were used by at least one study, the most commonly reported being 'Train and educate stakeholders'. All studies reported using a combination of several implementation strategies, with the mean number of strategies used per study of 3.5 (range 2-6), many of which were reported to result in an improvement in implementation over time. Few studies specifically investigated a single implementation strategy and its associated outcomes, making conclusions regarding the most beneficial strategy difficult to draw. CONCLUSIONS Using a combination of implementation strategies appears to be a helpful method of supporting the implementation of telemental health. Further research is needed to test the impact of specific implementation strategies on implementation outcomes.
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Affiliation(s)
- Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK.
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK.,Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Elizabeth Tuudah
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Natasha Lyons
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK
| | - Jennie Parker
- Lived Experience Researcher, NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK
| | - Emily Roxburgh
- Kingston iCope, Camden & Islington NHS Trust, London, UK
| | | | | | | | | | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK
| | - Justin J Needle
- Centre for Health Services Research, City, University of London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
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27
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Kolaas K, Berman AH, Hedman-Lagerlöf E, Zakrevska A, Epstein M, Hammarberg SAW, Axelsson E. Feasibility of a video-delivered mental health course for primary care patients: a single-group prospective cohort study. BMC Prim Care 2023; 24:28. [PMID: 36690940 PMCID: PMC9869530 DOI: 10.1186/s12875-023-01989-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND In many health care systems, primary care is tasked with offering psychological treatment for common mental disorders. Resources are often limited, which complicates widespread dissemination of traditional psychological treatments. Stepped care models where the less resource-intensive interventions are delivered first, can be employed, but often do not eliminate the need for a thorough diagnostic assessment, which can be time-consuming, has the potential to bottleneck patient intake, and can add to waiting times. Novel low-threshold formats are needed to improve access to mental health care in the primary care setting. METHODS This was a single-group prospective cohort study (N = 91). We assessed the feasibility of a video-delivered course as a first-line intervention for patients seeking help for mental health problems at a primary care center. The course had a transdiagnostic approach, suitable for both depression and anxiety disorders, and was based on cognitive behavioral techniques. Patients in need of psychosocial assessment, which usually entailed a four- to six-week wait, were referred by physicians or triage nurses. Study participants could start within a week, without the need for conventional diagnostic assessment, and were informed that they would be offered assessment after the course if needed. Key feasibility outcomes included participant satisfaction, attendance rates, the proportion of participants in need of additional clinical intervention after the course, and the rate of clinically significant improvement in anxiety and depression symptoms. RESULTS Participants scored a mean of 21.8 (SD = 4.0, 9-32, n = 86) on the Client Satisfaction Questionnaire-8; just below our target of 22. The mean attendance rate was 5.0/6 lectures (SD = 1.6, range: 0-6, n = 91). Forty-six percent (37/81) reported experiencing no need of further clinical intervention after the course. The rate of clinically significant improvement was 59% (27/46) for anxiety and 48% (22/46) for depression. No serious adverse event was reported. CONCLUSIONS Delivering a low-threshold online video-delivered mental health course in primary care appears to be feasible. Adjustments to further improve patient satisfaction are warranted, such as offering the choice of participating online or face-to-face. TRIAL REGISTRATION (ClinicalTrials.gov NCT04522713) August 21, 2020.
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Affiliation(s)
- Karoline Kolaas
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden.
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden.
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden.
| | - Anne H Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg Primary Health Care Clinic, Region Stockholm, Stockholm, Sweden
| | - Anastasiya Zakrevska
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Majken Epstein
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Af Winklerfelt Hammarberg
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Pourat N, Padilla-Frausto DI, Chen X, Lim D, Osterweil D, Batra RA. The Impact of a Primary Care Telepsychiatry Program on Outcomes of Managed Care Older Adults. J Am Med Dir Assoc 2023; 24:119-124.e4. [PMID: 36356654 DOI: 10.1016/j.jamda.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The goal of this study was to assess the outcomes of a primary-based telepsychiatry intervention program for older managed care enrollees with depression/anxiety and with limited access to in-person psychiatric care. DESIGN A pre-post design was used to examine service use (n = 218) and severity of depression (n = 204). Enrollment, claims, and depression and anxiety score data were obtained from the medical group. The implementation process and self-reported outcomes were examined. SETTING AND PARTICIPANTS The program was funded by the Senior Care Action Network (SCAN) group and implemented by a large medical group serving older adults who were identified as needing outpatient psychiatric care, including those with psychiatric hospitalizations, depression/anxiety disorders, comorbid substance use disorders, or other multiple comorbidities. METHODS Poisson regressions were used to examine changes in predicted rates of outpatient services, emergency department visits, and hospitalizations up to 24 months prior and 24 months following the first telepsychiatry visit. Changes in predicted severity of depression up to 2 quarters prior and 3 quarters following the first telepsychiatry visit were examined. RESULTS The number of outpatient services declined significantly by 0.24 per patient per 6-month time frame following the first telepsychiatry visit. The number of emergency department visits and hospitalizations also declined after the first visit (0.07 and 0.03 per patient per 6-month time frame, respectively). Depression severity scores also declined in the quarters following the first visit (1.52). The medical group reported improvements in both wait time for appointments and no-show rates with the integration of telepsychiatry in primary care. CONCLUSIONS AND IMPLICATIONS The telepsychiatry program lowered service use, depression severity, and increased better access to psychiatry care. The findings highlight the potential benefits of sustaining and expanding the telepsychiatry program by SCAN and other plans facing a limited supply of psychiatrists.
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Affiliation(s)
- Nadereh Pourat
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Xiao Chen
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA
| | - Dominic Lim
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
| | - Dan Osterweil
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA; Division of Geriatric Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Romilla A Batra
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
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Gutiérrez-Rojas L, Alvarez-Mon MA, Andreu-Bernabeu Á, Capitán L, de Las Cuevas C, Gómez JC, Grande I, Hidalgo-Mazzei D, Mateos R, Moreno-Gea P, De Vicente-Muñoz T, Ferre F. Telepsychiatry: The future is already present. Span J Psychiatry Ment Health 2023; 16:51-57. [PMID: 37689522 DOI: 10.1016/j.rpsm.2022.09.001] [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] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/02/2022] [Accepted: 09/02/2022] [Indexed: 09/11/2023]
Abstract
This review paper analyzes the state of knowledge on Telepsychiatry (TP) after the crisis caused by COVID and the resulting need to use new modalities of care. Six essential aspects of TP are addressed: patient's and mental health staff satisfaction, diagnostic reliability, effectiveness of TP interventions, cost-effectiveness in terms of opportunity cost (or efficiency), legal aspects inherent to confidentiality and privacy in particular and the attitude of professionals toward TP. Satisfaction with TP is acceptable among both patients and professionals, the latter being the most reluctant. Diagnostic reliability has been demonstrated, but requires further studies to confirm this reliability in different diagnoses and healthcare settings. The efficacy of TP treatments is not inferior to face-to-face care, as has been proven in specific psychotherapies. Finally, it should be noted that the attitude of the psychiatrist is the most decisive element that limits or facilitates the implementation of TP.
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Affiliation(s)
- Luis Gutiérrez-Rojas
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain; Department of Psychiatry, University of Granada, Granada, Spain.
| | - Miguel A Alvarez-Mon
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Álvaro Andreu-Bernabeu
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Luis Capitán
- Psychiatry Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carlos de Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Instituto Universitario de Neurociencia (IUNE) de la Universidad de La Laguna
| | | | - Iria Grande
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Raimundo Mateos
- University of Santiago de Compostela, Department of Psyhciatry and CHUS University Hospital, Psychogeriatric Unit, Santiago de Compostela, Spain
| | | | | | - Francisco Ferre
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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DeJong SM, Brooks D, Khan S, Reaves S, Busch B, Alicata D, Ramtekkar U, Vo LC, Pruitt D. The Impact of COVID-19 on Pediatric Telepsychiatry Training in Child and Adolescent Psychiatry Fellowships. Acad Psychiatry 2022; 46:740-745. [PMID: 34855156 PMCID: PMC8638234 DOI: 10.1007/s40596-021-01563-3] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This report summarizes findings from a 2020 survey of US child and adolescent psychiatry training programs that explored the impact of the COVID-19 pandemic on pediatric telepsychiatry training. The authors hypothesized that telepsychiatry training significantly increased during the pandemic, in part due to legal and regulatory waivers during the COVID-19 public health emergency. METHODS In August 2020, an anonymous, 28-question online survey was emailed to all (138) accredited child psychiatry fellowships on the Accreditation Council for Graduate Medical Education website. Forty-nine programs responded (36%). This analysis focuses on three of the 28 questions relevant to the hypotheses: characteristics of the program's training in telepsychiatry; perceived impediments to clinical training; and perceived impediments to didactic training pre-COVID onset vs. post-COVID onset, respectively. Total scores were created to investigate differences in training programs and impediments to including telepsychiatry pre- and post-COVID onset. Paired sample t-tests were used to compare means pre- and post-COVID onset. RESULTS Results provided support for significant differences between training components related to telepsychiatry pre- and post-COVID onset, with participants reporting more training components post-COVID onset (M = 5.69) than pre-COVID onset (M = 1.80); t(48) = 9.33, p < .001. Participants also reported significantly fewer barriers to providing clinical experiences in pediatric telepsychiatry post-COVID onset (M = 2.65) than pre-COVID onset (M = 4.90); t(48) = - 4.20, p < .001. CONCLUSIONS During the COVID-19 pandemic, pediatric telepsychiatry training in child psychiatry fellowships increased significantly. Perceived barriers to providing clinical, but not didactic, training decreased significantly.
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Affiliation(s)
- Sandra M DeJong
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
| | - Deborah Brooks
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shabana Khan
- New York University (NYU) Grossman School of Medicine, New York, NY, USA
| | - Samantha Reaves
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bianca Busch
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dan Alicata
- University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Ujjwal Ramtekkar
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Lan Chi Vo
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - David Pruitt
- University of Maryland School of Medicine, Baltimore, MD, USA
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31
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Eissazade N, Shalbafan M, Saeed F, Hemmati D, Askari S, Sayed Mirramazani M, Eftekhar Ardebili M, Gondek TM, Pinto da Costa M. The Impact of the COVID-19 Pandemic on Iranian Psychiatric Trainees' and Early Career Psychiatrists' Well-being, Work Conditions, and Education. Acad Psychiatry 2022; 46:710-717. [PMID: 35732923 PMCID: PMC9217116 DOI: 10.1007/s40596-022-01674-5] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study was conducted to investigate the impact of the COVID-19 pandemic on psychiatric trainees and early career psychiatrists in Iran. METHODS In this cross-sectional survey, the authors used a 24-item questionnaire inquiring about the sociodemographic characteristics of the participants, their views on the impact of the COVID-19 pandemic on their professional careers, methods of education, workplace environment, well-being and mental health, and the use of telepsychiatry in Iran. RESULTS A total of 159 responses were received. The majority (n=124, 78.0%) reported that "some but not all obligatory activities have been converted to online activities." Most of the participants (n=103, 64.8%) stated that the pandemic had not affected the duration of their training. Less than half (n=61, 38.4%) reported that their well-being had been affected rather negatively. Some (n=59, 37.1%) reported that their supervisors or coworkers had no significant impact on their well-being, whereas others (n=53, 33.3%) reported a rather positive impact. Almost half of the participants (n=78, 49.0%) did not have access to free psychological counseling. In addition, more than half (n=89, 56.0%) reported that there were no recommendations on how to proceed with telepsychiatry. CONCLUSIONS This study calls for improvements in the education and well-being of psychiatric trainees and early career psychiatrists in Iran amid the COVID-19 pandemic. Additional research should be carried out to maximize learning, provide mental health care, and use telepsychiatry.
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Affiliation(s)
| | | | - Fahimeh Saeed
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Dina Hemmati
- Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Askari
- Iran University of Medical Sciences, Tehran, Iran
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Galvin E, Desselle S, Gavin B, Quigley E, Flear M, Kilbride K, McNicholas F, Cullinan S, Hayden J. Patient and provider perspectives of the implementation of remote consultations for community-dwelling people with mental health conditions: A systematic mixed studies review. J Psychiatr Res 2022; 156:668-678. [PMID: 36399859 PMCID: PMC9637462 DOI: 10.1016/j.jpsychires.2022.10.051] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
Remote, or tele-, consultations became a necessary form of mental healthcare provision during the COVID-19 pandemic. As the prevalence of mental health problems rises, they may have a role in future mental health services. We aimed to review the literature on patient and provider perspectives on factors influencing the implementation of remote consultations for community-dwelling people with mental health conditions. We searched five electronic databases (PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO) for empirical research up to July 13th, 2022. Only studies of synchronous, interactive remote consultations conducted via video, phone, or live-messaging between patients and providers were included. Two reviewers independently assessed the quality of included studies using the Mixed Methods Appraisal Tool. We integrated qualitative and quantitative data from 39 studies into a single mixed-methods synthesis. We mapped reported factors to the domains of the Consolidated Framework for Implementation Research (CFIR). Acceptability was generally high among participants, despite concerns about the quality of care and the perceived impeded therapeutic relationship. A prominent facilitator was the increased accessibility and convenience of remote consultations, while lack of appropriate infrastructure and low patient comfort and competence were among the most prevalent barriers. This review highlights the importance of patient preferences and provider buy-in to the future of remote consultations.
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Affiliation(s)
- Emer Galvin
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | | | - Blánaid Gavin
- School of Medicine, University College Dublin, Dublin, Ireland.
| | - Etain Quigley
- National University of Ireland, Maynooth, Maynooth, Ireland.
| | - Mark Flear
- Queen's University Belfast, Belfast, United Kingdom.
| | | | | | - Shane Cullinan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - John Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Carretier E, Bastide M, Lachal J, Moro MR. Evaluation of the rapid implementation of telehealth during the COVID-19 pandemic: a qualitative study among adolescents and their parents. Eur Child Adolesc Psychiatry 2022; 32:963-973. [PMID: 36370315 PMCID: PMC9652600 DOI: 10.1007/s00787-022-02108-1] [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: 04/15/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic catalysed an abrupt explosion in the use telepsychiatry for the delivery of mental health services. We aimed to explore the experience of telemedicine use during this period among adolescent outpatients and inpatients and their parents. This qualitative study took place in a French adolescent medicine and psychiatry department during the first lockdown. Data collection by purposive sampling continued until we reached theoretical sufficiency. The interviews were analysed by applying Interpretative Phenomenological Analysis which is based on an iterative, inductive process. It included 20 participants: 10 adolescents and 10 parents. The analysis showed three themes: (1) facilitators of a switch from face-to-face to tele-consultation: (a) the context of health emergency, (b) the integration of parents in the treatment, (c) the choice between telephone or video consultation; (2) distance from the therapist's gaze and its consequences: (a) an obstacle to decrypting clinical nonverbal communication, (b) effectiveness depends on the severity of the adolescent's symptoms, (c) and on the previous quality of the therapeutic relationship; (3) awareness of the value of the face-to-face therapeutic space. In the post-COVID era, practitioners would benefit from combining both approaches, face-to-face and remote, based on the quality of the therapeutic alliance, the pathology, the parents' availability for in-person participation, and the patient's age. Future quantitative research will also be necessary to establish the extent to which the experiences described by the participants in this study reflect those of a broader population.
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Affiliation(s)
- Emilie Carretier
- Paris Cité University, PCPP, 92100, Boulogne-Billancourt, France. .,Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
| | | | - Jonathan Lachal
- Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France ,CHU de Clermont-Ferrand, Service de Psychiatrie de l’Enfant et de l’Adolescent, 63000 Clermont-Ferrand, France ,Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Marie Rose Moro
- Paris Cité University, PCPP, 92100 Boulogne-Billancourt, France ,Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France ,APHP, Cochin Hospital, Maison de Solenn, 75014 Paris, France
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Yazıcı S, Ahi ES, İlhan RS, Saka MC. The effect of the COVID-19 pandemic on health behavior and psychopathology in patients with psychotic disorders. Psychiatry Res 2022; 317:114845. [PMID: 36155276 DOI: 10.1016/j.psychres.2022.114845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/28/2022] [Revised: 09/04/2022] [Accepted: 09/10/2022] [Indexed: 01/04/2023]
Abstract
In our study we aimed to investigate the effect of the pandemic period on disease severity, medication adherence, suicidal behavior, physical health and health behavior in patients with psychotic disorders. 255 patients with any of the diagnoses of Schizophrenia, Schizoaffective Disorder, Delusional Disorder, Bipolar Disorder with psychotic features and Major Depressive Disorder with psychotic features were included, 200 were assessed by telephone and 55 face-to-face. The patient's sociodemographic status, cigarette-alcohol use, physical diseases, body weight, suicidal behaviors, and the effects of the pandemic period on general health were assessed. Clinical global impression scale(CGI) and modified medication adherence scale(MMS) were also administered. We showed that the MMS scores of the patients significantly decreased compared to the pre-pandemic period. In our study, suicidal behavior and decrease in medication adherence during the pandemic period were found to be correlated with higher scores of CGI- Severity and Improvement Scale. Our study is one of the few studies that addresses the effects of the pandemic period on patients with psychotic disorders. The results show that the pandemic period is associated with an increase in negative health behavior and clinical worsening in patients with psychotic disorders. In order to confirm these findings, more research is needed in this area.
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35
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Abstract
The purpose of the review was to investigate the changes in mental health services during the COVID-19 pandemic. A systematic review of qualitative, quantitative and mixed-methods studies was conducted from February 2021 to March 2022 using four databases and five languages. 29 studies reporting on mental health services in 63 countries were included. Findings were organised according to nine major topics: (1) lack of preparedness vs. timely response and flexible solutions, (2) changes in access, referrals, and admission, (3) impacts on outpatient, community and psychosocial services, (4) inpatient: reorganisation of hospital psychiatric units/acute wards, (5) diagnostic and therapeutic adaptations, (6) effects on medication, (7) infection control measures, (8), changes in patients' demands, engagement, and mental health, and (9) impacts on staff and team. Many services were closed intermittently or considerably reduced while telepsychiatric services were extensively expanded. Face-to-face services decreased, as did the work with therapeutic groups. Many inpatient units restructured their services to accommodate COVID-19 patients. While the digitalisation of services allowed for better access to services for some, restrictive measures hindered access for most. Staff experienced changes such as heightened impacts on their own mental health, burdens on patients and the pausing of professional training. Clearly, diverse findings of studies relate to different (national) contexts, type of service offered, but also to the time of the investigation, as studies noted several distinct phases of change during the pandemic. This review suggests directions for policy and service development, such as fostering community services and providing support services for particularly vulnerable populations.
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Affiliation(s)
| | - Stefanie Gersdorf
- Kunstakademie Düsseldorf, Eiskellerstraße 1, 40213, Düsseldorf, Germany.
| | - Katarina Stengler
- Zentrum für Seelische Gesundheit, Helios Park-Klinikum Leipzig Psychiatrische Kliniken, Morawitzstraße 2, 04289, Leipzig, Germany
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36
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Romo DU. [COVID-19 and telepsychiatry: a challenge for mental health management]. Rev Colomb Psiquiatr 2022:S0034-7450(22)00094-4. [PMID: 36101855 PMCID: PMC9458707 DOI: 10.1016/j.rcp.2022.08.005] [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] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/27/2022] [Accepted: 08/20/2022] [Indexed: 11/15/2022]
Abstract
Introduction Due to the COVID-19 pandemic, in-person psychiatric care decreased, but mental disorders, such as post-traumatic stress disorder, anxiety, depression, obsessive compulsive symptoms and insomnia increased. Our objective was to describe the usefulness, advantages, disadvantages and limitations of telemedicine used in psychiatric patients' clinical care before and during the COVID-19 pandemic. Methods A critical search was carried out on platforms such as PubMed, Cochrane, Lilacs and academic Google, in addition to an in-depth assessment of all the primary studies that answer our questions. Results Telepsychiatry is a tool that can help resolve the need for psychiatric care in a more comprehensive way. Advantages include cost reduction, enabling care provision to rural areas, the fact that its effectiveness is comparable to in-person care and its use is suitable in a variety of scenarios, and also that it helps reduce stigma and enables continuous training processes among medical staff. In the context of the current pandemic, it reduces the risk of transmission by maintaining biosecurity measures. However, there are also limitations in its use, such as the collection of medical insurance payments, mandatory in-person visits for examinations or procedures, difficulty in developing a doctor-patient relationship, and uncertainty about how to give informed consent and maintain the patient's privacy. Additionally, there is the difficulty in controlling the patient's environment, with the risk of the consultation taking place somewhere inappropriate, and the fact that there are certain populations which would not benefit from the use of telepsychiatry and areas where its use is made difficult by a greater digital gap. Based on these advantages and disadvantages, recommendations can be made when considering telepsychiatry as a medical care option.
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Shoib S, Armiya'u AY, Roza TH, Saeed F, Swed S, Arif N, Park C, Chandradasa M. Telepsychiatry for conflict-affected settings: Feasibility, ethics, barriers and prospects. Asian J Psychiatr 2022; 75:103203. [PMID: 35870308 DOI: 10.1016/j.ajp.2022.103203] [Citation(s) in RCA: 4] [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: 01/06/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/17/2023]
Abstract
Telehealth is being broadly developed in all fields of medicine, and online visits seem a particularly suitable alternative to in-person visits in outpatient psychiatry especially in conflict setting. Telepsychiatry has numerous advantages over in-person visits.
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Affiliation(s)
- Sheikh Shoib
- Jawaharlal Nehru Memorial hospital, Directorate of Health Services, Jammu and Kashmir, India.
| | - Aishatu Yusha'u Armiya'u
- Department of Psychiatry, College of Medical Sciences, Abubakar Tafawa Balewa University, University Teaching Hospital Bauchi state, Nigeria.
| | - Thiago Henrique Roza
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Fahimeh Saeed
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Nigar Arif
- Republican Psychiatric Hospital, Azerbaijan.
| | - Chan Park
- 2nd year Resident at UCLA-VA Psychiatry Residency Program, United States.
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Cerimele JM, Johnson M, Blanchard BE, Russo J, Unützer J, Fortney JC. Bipolar disorder in primary care: Medication treatment by co-located psychiatrists versus primary care clinicians supported by psychiatrists. Gen Hosp Psychiatry 2022; 78:108-110. [PMID: 35985201 PMCID: PMC10686540 DOI: 10.1016/j.genhosppsych.2022.08.001] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare medication treatment of individuals with bipolar disorder in two primary care-based integrated care models. METHODS Participants were randomized to 12-months of treatment with direct care by co-located psychiatrists in primary care, or collaborative care (primary care clinicians supported by psychiatrists). Medication data at initial and last treatment visits were extracted from the clinical registry for 191 patients diagnosed with bipolar disorder. RESULTS Participants receiving no medication treatment decreased from 28% to 11% (direct co-located) (χ2 = 10.9, p < .001) and 39% to 17% (collaborative care; χ2 = 16.9, p < .001). Last visit medication prescriptions for antipsychotic medication (approximately one-half of participants) increased significantly compared to initial visit and did not differ between arms. Anticonvulsant mood-stabilizing medication (approximately one-third of participants in both arms) was higher than lithium prescription (approximately 6% of participants) at last visit. CONCLUSION Similar patterns of medication treatment were observed in participants with bipolar disorder receiving either direct care from psychiatrists, or medication treatment by primary care clinicians supported by psychiatrists.
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Affiliation(s)
- Joseph M Cerimele
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America.
| | - Morgan Johnson
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America
| | - Brittany E Blanchard
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America
| | - Joan Russo
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America
| | - Jürgen Unützer
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America
| | - John C Fortney
- University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, United States of America; Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, United States of America
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39
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Bistre M, Juven-Wetzler A, Argo D, Barash I, Katz G, Teplitz R, Said MM, Kohn Y, Linkovski O, Eitan R. Comparable reliability and acceptability of telepsychiatry and face-to-face psychiatric assessments in the emergency room setting. Int J Psychiatry Clin Pract 2022; 26:228-233. [PMID: 34565277 DOI: 10.1080/13651501.2021.1979586] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to compare the reliability and acceptability of psychiatric interviews using telepsychiatry and face-to-face modalities in the emergency room setting. METHODS In this prospective observational feasibility study, psychiatric patients (n = 38) who presented in emergency rooms between April and June 2020, went through face-to-face and videoconference telepsychiatry interviews in a non-randomised varying order. Interviewers and a senior psychiatry resident who observed both interviews determined diagnosis, recommended disposition and indication for involuntary admission. Patients and psychiatrists completed acceptability post-assessment surveys. RESULTS Agreement between raters on recommended disposition and indication for involuntary admission as measured by Cohen's kappa was 'strong' to 'almost perfect' (0.84/0.81, 0.95/0.87 and 0.89/0.94 for face-to-face vs. telepsychiatry, observer vs. face-to-face and observer vs. telepsychiatry, respectively). Partial agreement between the raters on diagnosis was 'strong' (Cohen's kappa of 0.81, 0.85 and 0.85 for face-to-face vs. telepsychiatry, observer vs. face-to-face and observer vs. telepsychiatry, respectively).Psychiatrists' and patients' satisfaction rates, and psychiatrists' perceived certainty rates, were comparably high in both face-to-face and telepsychiatry groups. CONCLUSIONS Telepsychiatry is a reliable and acceptable alternative to face-to-face psychiatric assessments in the emergency room setting. Implementing telepsychiatry may improve the quality and accessibility of mental health services.Key pointsTelepsychiatry and face-to-face psychiatric assessments in the emergency room setting have comparable reliability.Patients and providers report a comparable high level of satisfaction with telepsychiatry and face-to-face modalities in the emergency room setting.Providers report a comparable level of perceived certainty in their clinical decisions based on telepsychiatry and face-to-face psychiatric assessments in the emergency room setting.
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Affiliation(s)
- Moises Bistre
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | | | - Daniel Argo
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Igor Barash
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Gregory Katz
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Ronen Teplitz
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | | | - Yoav Kohn
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Omer Linkovski
- The Jerusalem Mental Health Center, Jerusalem, Israel.,Psychology, Bar Ilan University, Israel
| | - Renana Eitan
- The Jerusalem Mental Health Center, Jerusalem, Israel.,Medical Neurobiology, The Hebrew University, Jerusalem, Israel.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Grover S, Naskar C, Sahoo S, Mehra A. Clinician's experience of telepsychiatry consultations. Asian J Psychiatr 2022; 75:103207. [PMID: 35944405 PMCID: PMC9356673 DOI: 10.1016/j.ajp.2022.103207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Chandrima Naskar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Siste K, Hanafi E, Adrian, Sen LT, Alison P, Beatrice E. Online dialectical behavioral therapy for adults with internet addiction: A quasi-experimental trial during the COVID-19 pandemic. Psychiatry Res 2022; 315:114698. [PMID: 35792416 DOI: 10.1016/j.psychres.2022.114698] [Citation(s) in RCA: 4] [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: 11/10/2021] [Revised: 06/19/2022] [Accepted: 06/25/2022] [Indexed: 11/20/2022]
Abstract
The pathological use of the Internet has surged during the pandemic, even though service provisions were negatively impacted. Telepsychiatry can be used as a solution to maintain psychiatric addiction services. This study examined the efficacy of online group dialectical behavioral therapy (DBT) for Internet addiction (IA), compared to cognitive behavioral therapy (CBT). Participants were divided into two arms for 8 weeks: the experimental arm received eight sessions of online DBT skill group training (n = 20), and the control arm received four sessions of online individual CBT (n = 20). All participants were required to complete a sociodemographic and Internet use survey, the Internet Addiction Test (IAT), and the University of Rhode Island Change Assessment (URICA). All participants completed the therapy. Of the 40 participants, six (15%) perceived the need for therapy and one (2.5%) participant had a history of seeking IA therapy. In the pre-post comparison, significant improvements were noted in the IAT and URICA scores as well as Internet use duration for both arms. No significant differences were observed across the arms and in the time-by-arm interaction. Online group DBT is a viable alternative to online CBT in an acute constrained setting, although further studies are required to scrutinize its long-term efficacy. Trial Registration: ISRCTN17273762.
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Rusu VA, van der Lans RM, Vermeiren RRJM, Hauber K, de Lijster JM, Lindauer RJL, Nugter A, Hoekstra PJ, Nooteboom LA. Training is not enough: child and adolescent psychiatry clinicians' impressions of telepsychiatry during the first COVID-19 related lockdown. Eur Child Adolesc Psychiatry 2022; 32:987-993. [PMID: 35986802 PMCID: PMC9391644 DOI: 10.1007/s00787-022-02042-2] [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: 09/19/2021] [Accepted: 06/25/2022] [Indexed: 11/03/2022]
Abstract
To ensure the continuity of care during the COVID-19 pandemic, clinicians in Child and Adolescent Psychiatry (CAP) were forced to immediately adapt in-person treatment into remote treatment. This study aimed to examine the effects of pre-COVID-19 training in- and use of telepsychiatry on CAP clinicians' impressions of telepsychiatry during the first two weeks of the Dutch COVID-19 related lockdown, providing a first insight into the preparations necessary for the implementation and provision of telepsychiatry during emergency situations. All clinicians employed by five specialized CAP centres across the Netherlands were invited to fill in a questionnaire that was specifically developed to study CAP clinicians' impressions of telepsychiatry during the COVID-19 pandemic. A total of 1065 clinicians gave informed consent and participated in the study. A significant association was found between pre-COVID-19 training and/or use of telepsychiatry and CAP clinicians' impressions of telepsychiatry. By far, the most favourable impressions were reported by participants that were both trained and made use of telepsychiatry before the pandemic. Participants with either training or use separately reported only slightly more favourable impressions than participants without any previous training or use. The expertise required to provide telepsychiatry is not one-and-the-same as the expertise that is honed through face-to-face consultation. The findings of this study strongly suggest that, separately, both training and (clinical) practice fail to sufficiently support CAP clinicians in the implementation and provision of telepsychiatry. It is therefore recommended that training and (clinical) practice are provided in conjunction.
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Affiliation(s)
- Vlad-Alexandru Rusu
- Curium LUMC, Oegstgeest, The Netherlands. .,Karakter, Wageningen, The Netherlands. .,de Bascule, Duivendrecht, The Netherlands. .,GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands. .,Accare, Assen, The Netherlands.
| | - R. M. van der Lans
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - R. R. J. M. Vermeiren
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - K. Hauber
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - J. M. de Lijster
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - R. J. L. Lindauer
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - A. Nugter
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - P. J. Hoekstra
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - L. A. Nooteboom
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
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Ibrahim FA, Malathesh BC, Gajera G, Pandey P, Nirisha P L, Jyrwa S, Kumar CN, Manjunatha N, Jain S, Bairy BK, Bada Math S. Chhattisgarh community mental healthcare tele-mentoring program (CHaMP): Digitally driven initiative to reach the unreached. Int J Soc Psychiatry 2022; 68:954-957. [PMID: 33860714 DOI: 10.1177/00207640211011191] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Harnessing technology is one accepted method to leapfrog the barrier of inadequate trained human resources for mental health. The Chhattisgarh Community Mental Healthcare Tele-Mentoring Program (CHaMP) is a collaborative digitally driven initiative of the Government of Chhattisgarh (GOC) and the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru the aim of which is to train the Primary Care Doctors (PCDs) and Rural Medical Assistants (RMA) to identify, screen and treat/refer cases of mental health disorders presenting to the primary care settings (n = 2150). The objective of this article is to give a brief overview of the initiative. METHODS CHaMP consists of the following modules: (a) a brief on-site training (b) eLearning and Skill Development (eLSD) and (c) Collaborative Video Consultation (CVC). The latter two are andragogic training methods delivered digitally. RESULTS AND CONCLUSION From August 2019 to May 2020, 501 PCDs and RMAs have been covered. During this time, they have cared 15,000 patients suffering from mental illness, which hitherto was not the case. Technology that is easily available and usable has the potential to overcome the big hurdle of inadequate mental health human resources in India.
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Affiliation(s)
- Ferose Azeez Ibrahim
- Dorothy Pattison Hospital, Black Country Healthcare NHS Foundation Trust, CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Barikar C Malathesh
- Telemedicine Centre, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Gopi Gajera
- CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Praveen Pandey
- CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Lakshmi Nirisha P
- Telemedicine Centre, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Sonakshi Jyrwa
- Department of Psychiatry, AIIMS Nagpur and Ex-Senior Resident, CHaMP initiative, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | | | - Sumi Jain
- NCDs and Mental Health, Government of Chhattisgarh, Raipur, Chhattisgarh, India
| | - Bhavya K Bairy
- NIMHANS Digital Academy, NIMHANS, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Community Psychiatry Services, NIMHANS, Bengaluru, Karnataka, India
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Grover S, Rai B, Chakravarty R, Sahoo S, Mehra A, Chakrabarti S, Basu D. Suicidal behavior in new patients presenting to the Telepsychiatry services in a Tertiary Care center: An exploratory study. Asian J Psychiatr 2022; 74:103152. [PMID: 35716578 PMCID: PMC9385195 DOI: 10.1016/j.ajp.2022.103152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to expansion of telepsychiatry services and formulation of telemedicine guidelines. However, the telemedicine guidelines are not very clear about psychiatric emergencies, such as suicidal behaviour, resulting in psychiatrists facing dilemma about handling such situations. AIM To evaluate the prevalence of suicidal behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre. METHODS 1065 new adult patients (aged > 18 years) registered with telepsychiatry services were assessed for suicidal behaviour, in the form of death wishes, suicidal ideations, plans, attempts (lifetime/recent) and non-suicidal self-injurious behaviour (NSSI) (lifetime/recent). RESULTS In terms of suicidal behaviour, in the last few weeks prior to assessment 14.4% of the patients had death wishes, 2.4% had thoughts of killing themselves, 0.9% had attempted suicide in the lifetime and 0.6% in the last few weeks, 1.1% had active suicidal ideations at the time of assessment, 0.6% had active suicidal plan, 1.3% had history of NSSI in the lifetime and 0.5% had NSSI behaviour in the last few weeks. Based on the current suicidal behaviour, 1.3% of the patients were asked to report to the emergency immediately, 0.5% were given an appointment within 72 h for follow-up, and 14.4% were explained high risk management. CONCLUSIONS Overall prevalence of suicidal behavior is relatively low in new patients seeking psychiatric help through telepsychiatry services.
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Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Bhavika Rai
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rahul Chakravarty
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Aseem Mehra
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Subho Chakrabarti
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Debasish Basu
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Duden GS, Gersdorf S, Trautmann K, Steinhart I, Riedel-Heller S, Stengler K. LeiP#netz 2.0: mapping COVID-19-related changes in mental health services in the German city of Leipzig. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1531-1541. [PMID: 35333930 PMCID: PMC8949643 DOI: 10.1007/s00127-022-02274-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/08/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The purpose of the study was to investigate the changes in psychosocial and psychiatric services in the German city of Leipzig during the COVID-19-pandemic. METHODS A participatory, mixed-methods study was used involving a quantitative online survey and qualitative semi-structured interviews with professionals. Quantitative findings were reported with descriptive statistics, and thematic analysis was conducted for qualitative data. RESULTS Fifty professionals from various mental health services participated in the survey and eleven professionals were interviewed. Quantitative findings showed that some services were closed intermittently and that there was a stiff increase in use of digital/telephonic service and a decrease in face-to-face services. Staff or funding did not change considerably during the pandemic. Psychosocial groups were suspended or reduced, while access to services became more difficult and professional training for staff was stopped. Thematic analysis of the interviews showed that professionals experienced different phases and levels of change during the pandemic, including changes on a structural level, on the users' level, and on the staff' level. Professionals particularly criticised the equivocality of COVID-19 regulations, a defective flow of information and lack of attention for mental healthcare in public policies. They also saw positive aspects, such as the capacity of users and the outpatient care system to adapt to the new situation. CONCLUSION This study suggests directions for policy and service development, such as communicating clearly in infection-control measures, fostering outpatient care and networks between services.
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Affiliation(s)
- Gesa Solveig Duden
- Leipzig Heart Institute GmbH, Leipzig, Germany.
- Community Psychology, University of Hagen (Fernuniversitaet), Hagen, Germany.
| | | | | | - Ingmar Steinhart
- Institute for Social Psychiatry, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Katarina Stengler
- Clinic for Psychiatry, Psychosomatics and Psychotherapy and Centre for Mental Health, Helios-Park-Hospital Leipzig, Leipzig, Germany
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Moeller AM, Hansen JP, Andersen PT. Patients' experiences of home-based psychotherapy via videoconference: A qualitative study. Arch Psychiatr Nurs 2022; 39:91-6. [PMID: 35688550 DOI: 10.1016/j.apnu.2022.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 06/21/2021] [Revised: 01/09/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022]
Abstract
The aim of this study is to explore adult outpatients' experiences with home-based psychotherapy via videoconferencing in a Danish mental health service. Participants found videoconferencing-based psychotherapy for preventive relapse sessions very useful, and they believed that it was possible to maintain a good therapeutic relationship via videoconferencing when they knew their therapist in advance. However, experiences with more in-depth psychotherapy are more unclear as some felt alienated and preferred other ways to communicate. In general, participants found videoconferencing-based psychotherapy to be less personal but worth considering when travel hassles outweigh the need for meeting in person.
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Narvaez RA. Benefits and challenges of telepsychiatry services in SouthEast Asian nations during the COVID-19 era: An integrative review. Asian J Psychiatr 2022; 73:103114. [PMID: 35489213 PMCID: PMC8994402 DOI: 10.1016/j.ajp.2022.103114] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/07/2022] [Indexed: 11/19/2022]
Abstract
COVID-19's long-term consequences on people's mental health include social isolation, job insecurity, illness and sorrow, physical separation, and disrupted access to normal health and mental treatment. Until recently, telepsychiatry has become increasingly mainstream in the delivery of mental health services under COVID-19 and have grown significantly in Western nations. However, telepsychiatry is not generally provided in Asian countries, particularly that of SouthEast countries. In this study, the reviewer made an integrative review of the available literature, in examining the benefits and challenges of telepsychiatry services of SouthEast Asian countries during the COVID-19 pandemic. This review utilized electronic resources such as PubMED, Google Scholar, Taylor and Francis, SAGE, IEEE, Springer, ScienceDirect, Wiley, and ACM. The review covered publications published from December 1, 2019, to December 1, 2021, as well as articles published in English and translated into English. Two (2) articles were included in this review. All the papers studied are classified as having a level of evidence VI. Both publications were based on research done in the Philippines. The total sample size for all papers analyzed was 149 respondents. The telepsychiatry platforms or systems employed in investigations vary. There was no continuous usage of a single telepsychiatry platform. Each research employed a different telepsychiatry service or system, depending on the technology available in the nation where the study was done. Findings in this review show that the concept or notion of telepsychiatry services within SouthEast Asian countries is exceptionally novel and needs further research in the medical and allied health discipline. For countries that are part of the SouthEast Asia, the critical issue today is how to sustain progress and how to increase and maintain care standards, at the same time utilizing telepsychiatry services in this aspect.
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Sivakumar T, Jadhav P, Allam A, Ramachandraiah S, Vanishree BNG, Meera J, Santhosha S, Doddur D, Janardhana AL, Basavarajappa C, Kumar CN, Thirthalli J. Continuity of Care for Persons With Serious Mental Illness in a Rural Rehabilitation Program During the COVID-19 Pandemic in India. Psychiatr Serv 2022; 73:830-833. [PMID: 34991340 DOI: 10.1176/appi.ps.202100462] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has posed challenges to community-based rehabilitation (CBR) for persons with mental illness, especially in resource-constrained settings. This column discusses the pandemic-related challenges faced by a rural CBR program in Jagaluru taluk (a subdistrict) in Karnataka, India. Thanks to stakeholder collaboration, task shifting with lay health workers, and implementation of telepsychiatry, the authors' clinical team could ensure uninterrupted medical care for persons with serious mental illness. Other CBR components were reduced because of pandemic-imposed resource and logistic constraints.
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Affiliation(s)
- Thanapal Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Prabhu Jadhav
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Abhishek Allam
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Sujai Ramachandraiah
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Byalya Nanje Gowda Vanishree
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Jyothi Meera
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Shivamurthy Santhosha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Dundappa Doddur
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Akkalapura Lokappa Janardhana
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
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Connolly SL, Sullivan JL, Lindsay JA, Shimada SL, Heyworth L, Weaver KR, Miller CJ. Factors influencing uptake of telemental health via videoconferencing at high and low adoption sites within the Department of Veterans Affairs during COVID-19: a qualitative study. Implement Sci Commun 2022; 3:66. [PMID: 35725642 PMCID: PMC9207848 DOI: 10.1186/s43058-022-00318-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic dramatically increased the use of telemental health via videoconferencing (TMH-V). While TMH-V has been found to be effective and satisfactory to both patients and providers, little is known regarding factors that influence site-level uptake. We examined facilitators and barriers to TMH-V uptake at higher and lower adoption sites within the US Department of Veterans Affairs (VA). METHODS We conducted twenty-four semi-structured qualitative interviews at four northeastern VA medical centers (two with higher TMH-V adoption and two with lower adoption). Six interviews were conducted per site (one member of mental health leadership, one facility telehealth coordinator/technician, and four mental health providers per site). We performed directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), followed by a matrix rating process to rank the degree of influence of each of the 19 included CFIR constructs at the four sites. Positive overall influences, negative overall influences, and differentiators were then identified based on patterns in ratings across sites. RESULTS Five CFIR constructs had positive overall influences across sites: Relative advantage, Patient needs and resources, Relative priority, Knowledge and beliefs, and Self-efficacy. Complexity had a negative overall influence across sites. Four constructs significantly differentiated between higher and lower adoption sites with regards to TMH-V use: Quality, Compatibility, Leadership engagement, and Champions. CONCLUSIONS Several positive overall influences on TMH-V uptake were identified across sites; respondents acknowledged multiple advantages of TMH-V (e.g., convenience), and providers' attitudes towards TMH-V improved as they gained experience. In contrast, complexity was a negative overall influence; TMH-V platforms and processes must be simple and user friendly to promote use. The emergence of Quality, Leadership engagement, and Champions as differentiators speaks to the importance of educating frontline staff and leadership at lower adoption sites about the evidence base demonstrating that TMH-V is high-quality care. Compatibility also emerged as a differentiator; if TMH-V is not easily integrated into provider workflows, uptake will falter. Future work should draw from these findings to develop implementation strategies aiming to increase TMH-V uptake at lower adoption sites, thereby increasing access to high-quality mental health care.
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Affiliation(s)
- Samantha L Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Jennifer L Sullivan
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA.,Brown University School of Public Health, Providence, RI, USA
| | - Jan A Lindsay
- Michael E. DeBakey VA Medical Center, HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Stephanie L Shimada
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.,Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leonie Heyworth
- Veterans Health Administration Office of Connected Care/Telehealth, Washington, D.C, USA.,Department of Health Sciences, University of California San Diego, San Diego, CA, USA
| | - Kendra R Weaver
- Clinical Operations, Veterans Health Administration Office of Mental Health and Suicide Prevention, Washington, D.C, USA
| | - Christopher J Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Abstract
The authors review the past and current challenges in psychotherapy training, research, and practice and the state of psychotherapy in the context of current training and funding, the COVID-19 pandemic, and the current era's pursuit of novelty. Where does the field stand, and where should it go?
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Affiliation(s)
- John C Markowitz
- Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Markowitz); Albert Einstein College of Medicine, Psychiatric Research Institute at Montefiore Einstein, New York City (Milrod)
| | - Barbara L Milrod
- Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Markowitz); Albert Einstein College of Medicine, Psychiatric Research Institute at Montefiore Einstein, New York City (Milrod)
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