Impact of COVID-19 on Mental Health Care Practitioners

App for independence: A feasibility randomized controlled trial of a digital health tool for schizophrenia spectrum disorders

BACKGROUND

Given the widespread adoption of smartphone technologies, digital health strategies to address schizophrenia spectrum disorders hold considerable promise. However, there are relatively few trials of digital health interventions for schizophrenia. The App for Independence (A4i) is a multi-function digital platform co-designed by people with schizophrenia, their families, and service providers.

HYPOTHESIS

This trial was designed to assess the feasibility of A4i.

STUDY DESIGN

The study was a single-blinded randomized trial. This trial was undertaken to generate feasibility data that might inform the design and utility of future effectiveness and implementation trials. The study took place in Toronto, Canada, with 91 participants randomized to 6 months of A4i use or treatment as usual. Feasibility metrics included recruitment, engagement and retention targets, qualitative and satisfaction data, and a secondary assessment of clinical, quality of life, and treatment adherence outcomes.

STUDY RESULTS

The COVID-19 pandemic markedly affected the recruitment of both primary participants and clinicians. Feasibility outcomes were difficult to interpret, though they presented some useful information for future trials. Engagement objectives were not achieved. However, A4i-user satisfaction ratings and qualitative feedback were positive, and technology engagement was fairly positive despite implementation challenges.

CONCLUSIONS

This study adds to emerging discourse regarding how technologies such as A4i are implemented. It suggests that digital technologies are of interest and are received positively by severe mental illness populations, though more work is needed to understand how they are implemented and the optimal methods for researching them.

'We tried our best... it wasn't great': a qualitative study of clinician experiences on child psychiatry wards at the height of COVID-19

Changing public health and hospital protocols during the height of the COVID-19 pandemic shaped the provision of inpatient mental health care. While a growing body of research explores the challenges of restrictions on adult psychiatric wards, the impact on clinical teams and epidemiological trends in youth mental health, no research has explored inpatient psychiatric hospital services for child and adolescent psychiatry during the pandemic. This study seeks to understand how clinicians in Canada working in child and adolescent mental health wards experienced caring for their patients while navigating pandemic hospital restrictions. Following a qualitative descriptive methodology and also drawing on institutional ethnography we generated data using two methods: 1) an online survey of clinicians across the country asking about experiences providing care and COVID restrictions and 2) in-depth, semi-structured interviews with clinicians. Data from 54 surveys and 14 interviews were analyzed using thematic analysis yielding two major themes. First, clinicians felt that clinical care was compromised with likely impact on patient outcomes. Second, respondents reported that the context of the pandemic provoked tensions and resistance within the clinical teams and the institution. Our findings have important implications not only for future public health crises, but also for rethinking how psychiatric care is provided and prioritized. This study points to the need for 1) mechanisms which support collaborative decision making at the institutional level, to ensure regulations are more flexible and can adapt to the needs of child mental health patients; and 2) that child psychiatry prioritize generating spaces of ethical reflection for clinical teams and institutional decision-makers so that paternalism does not trump principles of primum non-nocere (first, do no harm), autonomy and reciprocity.

Stress and burnout in the context of workplace psychosocial factors among mental health professionals during the later waves of the COVID-19 pandemic in Hungary

Background

While literature is abundant on the negative mental health impact of the COVID-19 outbreak, few studies focus on the Central and Eastern European region.

Objectives

We examined stress, burnout, and sleeping troubles among mental health professionals in the context of psychosocial risk factors related to participation in COVID care during the fourth and fifth waves.

Materials and methods

Mental health professionals (N=268) completed an online cross-sectional survey in Hungary, between November 2021 and April 2022. Of the respondents, 58.2% directly participated in COVID care. The main data collection instrument was the Copenhagen Psychosocial Questionnaire (COPSOQ II), including 20 subscales on work-related psychosocial factors and 3 outcome scales (stress, burnout, and sleeping troubles). We added a question on competence transgression, and items on sociodemographic and professional background.

Results

Participation in COVID care was associated with higher work pace (59.08 versus 49.78), more role conflicts (55.21 versus 45.93), lower scores on the influence at work (38.18 versus 51.79), predictability (44.71 versus 57.03), reward (55.82 versus 65.03), role clarity (70.19 versus 75.37), social support from supervisor (59.24 versus 65.55), job satisfaction (54.36 versus 62.84), trust regarding management (55.89 versus 67.86), justice and respect (44.51 versus 54.35) scales. Among those involved in COVID care, only the stress score was higher (47.96 vs. 42.35) in the total sample; however, among psychiatrists, both stress (52.16 vs. 38.60) and burnout scores (58.30 vs. 47.06) were higher. Stepwise multiple regression revealed that work-family conflict, emotional demands and workplace commitment were independent predictors of higher stress and burnout scores; furthermore, competence transgression had a significant effect on stress, and being a psychiatric specialist had a significant effect on burnout. These models explained 40.5% of the variance for stress and 39.8% for burnout.

Conclusion

During the fourth and fifth waves, although COVID care was more well-organized, psychiatrists, as specialist physicians responsible for the quality of the care, were still experiencing challenges regarding their competence and influence at work, which may explain their increased levels of stress and burnout.

Integrated Digital Mental Health Care: A Vision for Addressing Population Mental Health Needs

The unmet need for mental health care continues to rise across the world. This article synthesizes the evidence supporting the components of a hypothetical model of integrated digital mental health care to meet population-wide mental health needs. This proposed model integrates two approaches to broadening timely access to effective care: integrated, primary care-based mental health services and digital mental health tools. The model solves for several of the key challenges historically faced by digital health, through promoting digital literacy and access, the curation of evidence-based digital tools, integration into clinical practice, and electronic medical record integration. This model builds upon momentum toward the integration of mental health services within primary care and aligns with the principles of the Collaborative Care Model. Finally, the authors present the major next steps toward implementation of integrated digital mental health care at scale.

Using Collaborative Documentation to Support Person-Centered Care in Substance Use Settings

The delivery of person-centered care (PCC) is critical to promoting service engagement among individuals who use substances. Collaborative documentation (CD) is an emerging person-centered practice used in community mental health, but has not been evaluated in substance use settings. This qualitative study conducted focus groups with substance use treatment providers (n=22) in an outpatient clinic to examine the impact of CD on PCC and clinical quality. Rapid qualitative analysis methods were used to identify key themes. Participants reported that using CD reduced documentation time and helped build trust and better understand their clients. Using CD presented unique challenges and opportunities when used with mandated populations or those with complex symptoms. The importance of honoring clients' preference not to collaborate in care was a salient theme. Findings indicate that CD can promote PCC in substance use treatment. Targeted strategies to optimize CD for mandated and clinically complex populations are needed.

One Psychology Profession, Many Standards: A Narrative Review of Training, Licensing, and Practice Standards and Their Implications for International Mobility

This narrative review paper contrasts the professional prospects of psychologists in Japan and the U.S., discussing how divergent training, licensing, and practice standards appear to influence psychologists' profession in each country. Licensed psychologists in the U.S. practice with significant autonomy, which can be seen as a reflection of rigorous training requirements. In contrast, certified public psychologists in Japan complete a shorter-duration training regimen yet encounter more restrictive professional standards and greater financial challenges. These varying standards often create barriers to professional practice that impact psychologists on a global scale. Limited international mobility restricts opportunities for psychologists to learn abroad, exchange knowledge, and deliver culturally sensitive care to diverse populations, despite the need for such services among foreign individuals or immigrants in both countries. Furthermore, these disparities impede broader collaborative efforts to address global mental health challenges. Aligning training and licensing standards globally could enhance psychologists' international mobility, ensure consistent quality of care, and foster global collaboration. This alignment could improve access to culturally sensitive psychological services and help bridge the mental health care gap worldwide. This review emphasizes the necessity of further cross-cultural comparisons to understand the impact of training and licensing standards on clinical practice quality and accessibility. By presenting this comparative analysis, the study aims to inspire similar efforts, promoting global licensing reciprocity and the integration of professional psychology in an increasingly interconnected world.

A Qualitative Investigation of Burnout and Well-being Among Faculty and Residents in a Canadian Psychiatry Department

OBJECTIVE

This study used semi-structured interviews with faculty and residents in psychiatry to inform a qualitative, process-based understanding of well-being and related concepts, as well as to identify and critically explore strategies for maintaining well-being in psychiatry.

METHODS

Using interpretive description as a qualitative research methodology, semi-structured phone interviews were conducted with 12 faculty (nine clinical and three non-clinical) and five residents in a Canadian psychiatry department between September and December 2019, prior to the onset of the COVID-19 pandemic. Interviews were transcribed, coded, and subsequently analyzed for themes by the research team.

RESULTS

Fourteen women and three men completed the study, consisting of nine faculty members, five psychiatry residents, and three non-clinical PhD scientists. Four themes were developed from the interview data: (1) The nature of working in academic psychiatry, (2) professional identity as a double-edged sword, (3) feelings of isolation and powerlessness in the system, and (4) strategies to support well-being.

CONCLUSION

In the absence of many qualitative perspectives on well-being in academic psychiatry, the findings of this study can be used as a first step to inform future interventions and meaningful institutional change around well-being in psychiatry. The findings may help to enable conversations about well-being that embrace humanity and vulnerability as essential components of professional identity in psychiatry and provide opportunities for open discussion and support.

Trends, characteristics, and impact of global scientific production on mental health of health workers in the context of coronavirus disease 2019 (COVID-19)

BACKGROUND

Healthcare workers are under significant constant stress as a result of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study, therefore, was to analyze bibliometrically the impact, trend, and characteristics of scientific production related to the mental health of health professionals during the COVID-19 pandemic.

MATERIALS AND METHODS

A bibliometric analysis of the scientific production on the mental health of health professionals and COVID-19 in Scopus from December 2019 to December 2021 was performed. An advanced search was designed using Boolean operators in Scopus and applied in April 2022. The metadata was entered into Microsoft Excel for the elaboration of the tables, SciVal to obtain the bibliometric indicators, and VosViewer to plot collaborative networks.

RESULTS

A total of 1393 manuscripts, 1007 of which met the eligibility criteria, were found on the mental health of health workers and COVID-19. The country with the highest academic production was the United States and Harvard University with 27 manuscripts as the most productive institution. The scientific journal with the highest scientific production was the International Journal of Environmental Research and Public Health with 138 manuscripts and 1580 citations, and the author with the most citations per publication was Carnnasi Claudia with 69.8.

CONCLUSION

The countries with the highest economic income occupy the first places in scientific production on the mental health of health workers during the COVID-19 pandemic, with the United States as the leader. There is a gap in the scientific knowledge on the mental health of healthcare workers during the COVID-19 pandemic in middle- and low-income countries.