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Huang L, Kern ML, Oades LG. Strengthening University Student Wellbeing: Language and Perceptions of Chinese International Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5538. [PMID: 32751837 PMCID: PMC7432493 DOI: 10.3390/ijerph17155538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
Students at the tertiary education level in Australia are at increased risk of experiencing high levels of psychological distress, with international students at particularly high risk for poor adjustment. As mental health and wellbeing strongly correlate with students' academic performance and general overseas experience, a growing number of studies focus on what universities can do to effectively support students' wellbeing. However, assumptions are made about what wellbeing is, strategies primarily focus on treating mental ill-health, and treatment approaches fail to account for cultural differences. This study aimed to explore how Chinese international students understand wellbeing, the language used about and for wellbeing, and activities that students believe strengthen their own and others' wellbeing. Eighty-four Chinese international students completed the online survey, and a subset of 30 students participated in semi-structured interviews. Data were analysed using thematic, phenomenographic, and language analyses. Physical health and mental health appeared as the key components that participants believed defined wellbeing, and intrapersonal activities were perceived as the primary approach used to strengthen wellbeing. Findings help broaden the understanding of wellbeing concept from the population of tertiary students, identify students' perspectives of activities that strengthen their wellbeing, offer a snapshot of the language used by Chinese students around wellbeing, and provide new data of population health through a wellbeing lens.
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Affiliation(s)
- Lanxi Huang
- Melbourne Graduate School of Education, University of Melbourne, Melbourne 3010, Australia; (M.L.K.); (L.G.O.)
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Tielman ML, Neerincx MA, Pagliari C, Rizzo A, Brinkman WP. Considering patient safety in autonomous e-mental health systems - detecting risk situations and referring patients back to human care. BMC Med Inform Decis Mak 2019; 19:47. [PMID: 30885190 PMCID: PMC6421702 DOI: 10.1186/s12911-019-0796-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/07/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Digital health interventions can fill gaps in mental healthcare provision. However, autonomous e-mental health (AEMH) systems also present challenges for effective risk management. To balance autonomy and safety, AEMH systems need to detect risk situations and act on these appropriately. One option is sending automatic alerts to carers, but such 'auto-referral' could lead to missed cases or false alerts. Requiring users to actively self-refer offers an alternative, but this can also be risky as it relies on their motivation to do so. This study set out with two objectives. Firstly, to develop guidelines for risk detection and auto-referral systems. Secondly, to understand how persuasive techniques, mediated by a virtual agent, can facilitate self-referral. METHODS In a formative phase, interviews with experts, alongside a literature review, were used to develop a risk detection protocol. Two referral protocols were developed - one involving auto-referral, the other motivating users to self-refer. This latter was tested via crowd-sourcing (n = 160). Participants were asked to imagine they had sleeping problems with differing severity and user stance on seeking help. They then chatted with a virtual agent, who either directly facilitated referral, tried to persuade the user, or accepted that they did not want help. After the conversation, participants rated their intention to self-refer, to chat with the agent again, and their feeling of being heard by the agent. RESULTS Whether the virtual agent facilitated, persuaded or accepted, influenced all of these measures. Users who were initially negative or doubtful about self-referral could be persuaded. For users who were initially positive about seeking human care, this persuasion did not affect their intentions, indicating that a simply facilitating referral without persuasion was sufficient. CONCLUSION This paper presents a protocol that elucidates the steps and decisions involved in risk detection, something that is relevant for all types of AEMH systems. In the case of self-referral, our study shows that a virtual agent can increase users' intention to self-refer. Moreover, the strategy of the agent influenced the intentions of the user afterwards. This highlights the importance of a personalised approach to promote the user's access to appropriate care.
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Affiliation(s)
- Myrthe L. Tielman
- Department of Interactive Intelligence, Delft University of Technology, van Mourik Broekmanweg 6, 2628 XE Delft, The Netherlands
| | - Mark A. Neerincx
- Department of Interactive Intelligence, Delft University of Technology, van Mourik Broekmanweg 6, 2628 XE Delft, The Netherlands
- TNO Perceptual and Cognitive Systems, Soesterberg, The Netherlands
| | | | - Albert Rizzo
- USC Institute of Creative Technologies, Playa Vista, California USA
| | - Willem-Paul Brinkman
- Department of Interactive Intelligence, Delft University of Technology, van Mourik Broekmanweg 6, 2628 XE Delft, The Netherlands
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Tielman ML, Neerincx MA, van Meggelen M, Franken I, Brinkman WP. How should a virtual agent present psychoeducation? Influence of verbal and textual presentation on adherence. Technol Health Care 2018; 25:1081-1096. [PMID: 28800346 PMCID: PMC5814660 DOI: 10.3233/thc-170899] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE With the rise of autonomous e-mental health applications, virtual agents can play a major role in improving trustworthiness, therapy outcome and adherence. In these applications, it is important that patients adhere in the sense that they perform the tasks, but also that they adhere to the specific recommendations on how to do them well. One important construct in improving adherence is psychoeducation, information on the why and how of therapeutic interventions. In an e-mental health context, this can be delivered in two different ways: verbally by a (virtual) embodied conversational agent or just via text on the screen. The aim of this research is to study which presentation mode is preferable for improving adherence. METHODS This study takes the approach of evaluating a specific part of a therapy, namely psychoeducation. This was done in a non-clinical sample, to first test the general constructs of the human-computer interaction. We performed an experimental study on the effect of presentation mode of psychoeducation on adherence. In this study, we took into account the moderating effects of attitude towards the virtual agent and recollection of the information. Within the paradigm of expressive writing, we asked participants (n= 46) to pick one of their worst memories to describe in a digital diary after receiving verbal or textual psychoeducation. RESULTS AND CONCLUSION We found that both the attitude towards the virtual agent and how well the psychoeducation was recollected were positively related to adherence in the form of task execution. Moreover, after controlling for the attitude to the agent and recollection, presentation of psychoeducation via text resulted in higher adherence than verbal presentation by the virtual agent did.
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Affiliation(s)
| | - Mark A Neerincx
- Delft University of Technology, Delft, The Netherlands.,TNO Perceptual and Cognitive Systems, Soesterberg, The Netherlands
| | | | - Ingmar Franken
- Erasmus University Rotterdam, Rotterdam, The Netherlands
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Tielman ML, Neerincx MA, Bidarra R, Kybartas B, Brinkman WP. A Therapy System for Post-Traumatic Stress Disorder Using a Virtual Agent and Virtual Storytelling to Reconstruct Traumatic Memories. J Med Syst 2017; 41:125. [PMID: 28699083 PMCID: PMC5506234 DOI: 10.1007/s10916-017-0771-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/29/2017] [Indexed: 11/29/2022]
Abstract
Although post-traumatic stress disorder (PTSD) is well treatable, many people do not get the desired treatment due to barriers to care (such as stigma and cost). This paper presents a system that bridges this gap by enabling patients to follow therapy at home. A therapist is only involved remotely, to monitor progress and serve as a safety net. With this system, patients can recollect their memories in a digital diary and recreate them in a 3D WorldBuilder. Throughout the therapy, a virtual agent is present to inform and guide patients through the sessions, employing an ontology-based question module for recollecting traumatic memories to further elicit a detailed memory recollection. In a usability study with former PTSD patients (n = 4), these questions were found useful for memory recollection. Moreover, the usability of the whole system was rated positively. This system has the potential to be a valuable addition to the spectrum of PTSD treatments, offering a novel type of home therapy assisted by a virtual agent.
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Affiliation(s)
| | - Mark A Neerincx
- Delft University of Technology, Delft, Netherlands
- TNO Human Factors, Soesterberg, Netherlands
| | | | - Ben Kybartas
- Delft University of Technology, Delft, Netherlands
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Collins A, Davies D, Menon S. Atypical neuroleptic malignant syndrome. BMJ Case Rep 2016; 2016:bcr-2016-214901. [PMID: 27298291 DOI: 10.1136/bcr-2016-214901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 57-year-old man was admitted to a psychiatric ward in a confused state. He had a 30-year history of lately stable schizophrenia and antipsychotic medication had recently been reduced. The clinical picture was characterised by confusion, agitation, autonomic instability, muscle rigidity and elevated creatine kinase. Despite no other identifiable cause, physicians were reluctant to accept a diagnosis of neuroleptic malignant syndrome (NMS) due to the absence of fever. Despite acute renal failure, the patient was repeatedly transferred between medical and psychiatric wards; diagnosis and management were delayed, with potentially catastrophic consequences. NMS is a rare, life-threatening neurological disorder that can present atypically and requires emergency medical rather than psychiatric care. Clinicians must proactively distinguish between medical emergencies (including acute confusional states/delirium) and mental illness. Prompt, accurate diagnosis, management on the appropriate ward and effective teamwork between specialties are essential to improve patient outcomes in this potentially fatal condition.
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Affiliation(s)
- Ann Collins
- Wales Deanery, Cardiff University, Cardiff, UK Cwm Taf University Health Board, Pontypridd, UK
| | - Drew Davies
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
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Wilks CR, Zieve GG, Lessing HK. Are Trials of Computerized Therapy Generalizable? A Multidimensional Meta-analysis. Telemed J E Health 2015; 22:450-7. [PMID: 26461235 DOI: 10.1089/tmj.2015.0129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Previous meta-analyses have established that computerized cognitive behavioral therapy (cCBT) is an effective, acceptable, and efficient method of delivering treatment for anxiety and depression. However, the potential generalizability of these conclusions to nonresearch settings has not yet been investigated. MATERIALS AND METHODS We conducted a multidimensional meta-analysis of randomized controlled trials of cCBT for anxiety and/or depressive disorders quantifying generalizability by examining the relationship between participant exclusion and treatment outcome. Thirty-six trials of cCBT were identified through systematic searches in six databases. The number of exclusion criteria and exclusion rate served as indices of participant exclusion. Outcome variables included between- and within-group effect sizes in addition to rates of clinically significant improvement. RESULTS Analyses were performed for all studies, depression studies (n = 11), and anxiety studies (n = 23). Pooling across all studies, we found a between-group effect size of 0.85 (95% confidence interval, 0.77-0.94). The mean number of exclusionary criteria was 12 (range, 2-24), and the mean exclusion rate was 0.49 (range, 0.08-0.92). Risk for suicide was the most common criterion for exclusion. Correlation analyses revealed a large relationship between number of exclusion criteria and proportion clinically changed in the treatment group for anxiety studies (r = 0.70). Results provide evidence for the limited effectiveness of cCBT for anxiety disorders in nonresearch samples. CONCLUSIONS As computerized therapy is developed to address barriers to dissemination, future trials should examine the effectiveness of cCBT for anxiety for patients with more complex clinical presentations.
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Affiliation(s)
- Chelsey R Wilks
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington , Seattle, Washington
| | - Garret G Zieve
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington , Seattle, Washington
| | - Hannah K Lessing
- Behavioral Research and Therapy Clinics, Department of Clinical Psychology, University of Washington , Seattle, Washington
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Speck RM, Foster JJ, Mulhern VA, Burke SV, Sullivan PG, Fleisher LA. Development of a Professionalism Committee Approach to Address Unprofessional Medical Staff Behavior at an Academic Medical Center. Jt Comm J Qual Patient Saf 2014; 40:161-7. [DOI: 10.1016/s1553-7250(14)40021-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Loch AA, Guarniero FB, Lawson FL, Hengartner MP, Rössler W, Gattaz WF, Wang YP. Stigma toward schizophrenia: do all psychiatrists behave the same? Latent profile analysis of a national sample of psychiatrists in Brazil. BMC Psychiatry 2013; 13:92. [PMID: 23517184 PMCID: PMC3608131 DOI: 10.1186/1471-244x-13-92] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 03/14/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An important issue concerning the worldwide fight against stigma is the evaluation of psychiatrists' beliefs and attitudes toward schizophrenia and mental illness in general. However, there is as yet no consensus on this matter in the literature, and results vary according to the stigma dimension assessed and to the cultural background of the sample. The aim of this investigation was to search for profiles of stigmatizing beliefs related to schizophrenia in a national sample of psychiatrists in Brazil. METHODS A sample of 1414 psychiatrists were recruited from among those attending the 2009 Brazilian Congress of Psychiatry. A questionnaire was applied in face-to-face interviews. The questionnaire addressed four stigma dimensions, all in reference to individuals with schizophrenia: stereotypes, restrictions, perceived prejudice and social distance. Stigma item scores were included in latent profile analyses; the resulting profiles were entered into multinomial logistic regression models with sociodemographics, in order to identify significant correlates. RESULTS Three profiles were identified. The "no stigma" subjects (n = 337) characterized individuals with schizophrenia in a positive light, disagreed with restrictions, and displayed a low level of social distance. The "unobtrusive stigma" subjects (n = 471) were significantly younger and displayed the lowest level of social distance, although most of them agreed with involuntary admission and demonstrated a high level of perceived prejudice. The "great stigma" subjects (n = 606) negatively stereotyped individuals with schizophrenia, agreed with restrictions and scored the highest on the perceived prejudice and social distance dimensions. In comparison with the first two profiles, this last profile comprised a significantly larger number of individuals who were in frequent contact with a family member suffering from a psychiatric disorder, as well as comprising more individuals who had no such family member. CONCLUSIONS Our study not only provides additional data related to an under-researched area but also reveals that psychiatrists are a heterogeneous group regarding stigma toward schizophrenia. The presence of different stigma profiles should be evaluated in further studies; this could enable anti-stigma initiatives to be specifically designed to effectively target the stigmatizing group.
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Affiliation(s)
- Alexandre Andrade Loch
- Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, ala norte, sala 1, São Paulo CEP 05403-000, Brazil
| | - Francisco Bevilacqua Guarniero
- Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, ala norte, sala 1, São Paulo CEP 05403-000, Brazil
| | - Fabio Lorea Lawson
- Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, ala norte, sala 1, São Paulo CEP 05403-000, Brazil
| | - Michael Pascal Hengartner
- Department of General and Social Psychiatry, Psychiatric University Hospital, University of Zurich, Militärstrasse 8, Zurich, 8004, Switzerland
| | - Wulf Rössler
- Department of General and Social Psychiatry, Psychiatric University Hospital, University of Zurich, Militärstrasse 8, Zurich, 8004, Switzerland
- Collegium Helveticum, a Joint Research Institute between the University of Zurich and the Swiss Federal Institute of Technology, Schmelzbergstrasse 25, Zurich, CH-8092, Switzerland
| | - Wagner Farid Gattaz
- Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, ala norte, sala 1, São Paulo CEP 05403-000, Brazil
| | - Yuan-Pang Wang
- Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, ala norte, sala 1, São Paulo CEP 05403-000, Brazil
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A qualitative study exploring experiences of discrimination associated with mental-health problems in Ireland. Epidemiol Psychiatr Sci 2012; 21:271-9. [PMID: 22794274 DOI: 10.1017/s2045796012000017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS Stigma and discrimination related to mental-health problems impacts negatively on people's quality of life, help seeking behaviour and recovery trajectories. To date, the experience of discrimination by people with mental-health problems has not been systematically explored in the Republic of Ireland. This study aimed to explore the experience impact of discrimination as a consequence of being identified with a mental-health problem. METHODS Transcripts of semi-structured interviews with 30 people about their experience of discrimination were subject to thematic analysis and presented in summary form. RESULTS People volunteered accounts of discrimination which clustered around employment, personal relationships, business and finance, and health care. Common experiences included being discounted or discredited, being mocked or shunned and being inhibited or constrained by oneself and others. CONCLUSIONS Qualitative research of this type may serve to illustrate the complexity of discrimination and the processes whereby stigma is internalised and may shape behaviour. Such an understanding may assist health practitioners reduce stigma, and identify and remediate the impact of discrimination.
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Abstract
Health care reform poses major challenges for psychiatric mental health care. Foremost among the challenges is a mandate for reimbursement based on performance-based outcomes. Clinicians can increase the efficiency of evidence-based practice searches by using the correct form of PICOT (population, intervention, comparator, outcome, time frame) question to focus the search, based on (a) diagnosis, (b) treatment, (c) prognosis, (d) etiology, (e) prevention, and (f) meaning. The correct form of a PICOT question focuses the literature search by requiring a minimum of sorting to find relevant studies. Quickly and effectively locating the critical evidence will help meet the performance standard mandates required by new health care reform legislation.
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Abstract
Stigmatising attitudes are not uncommon among mental health professionals who may be less than optimistic about outcomes for people with long-term mental health problems. These perceptions are probably related to the professionals' experiences, such as those working in the public sector dealing with clients in the most disturbed phases of mental illness. We provide an overview of stigma and some contemporary stigma conceptualisations and then explore some stigma-reducing strategies for mental health professionals. The way that mental health professionals work with patients can have an important effect on their recovery.
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Affiliation(s)
- Jan Horsfall
- Sydney South West Area Mental Health Service, Concord Hospital, Sydney, Australia
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Abstract
Computers can be used to deliver self-guided interventions and to provide access to live therapists at remote locations. These treatment modalities could help overcome barriers to treatment, including cost, availability of therapists, logistics of scheduling and traveling to appointments, stigma, and lack of therapist training in evidence-based treatments (EBTs). EBTs could be delivered at any time in any place to individuals who might otherwise not have access to them, improving public mental health across the United States. In order to fully exploit the opportunities to use computers for mental health care delivery, however, advances need to be made in four domains: (1) research, (2) training, (3) policy, and (4) industry. This article discusses specific challenges (and some possible solutions) to implementing computer-based distance therapy and self-guided treatments in the United States. It lays out both a roadmap and, in each of the four domains, the milestones that need to be met to reach the goal of making EBTs for behavioral health problems available to all Americans.
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Affiliation(s)
- James A Cartreine
- Harvard Medical School, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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