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Domínguez M, Sánchez-Balcells S, Vila-Badia R, Bergadà-Sánchez E, Vilaplana M, Ochoa S, Huerta-Ramos ME, Del Cacho N, Usall J, Peláez T, Coromina M. Perspective of patients with first-episode psychosis, their relatives, and mental health professionals on the design and usability of an app in clinical practice. Early Interv Psychiatry 2024; 18:355-365. [PMID: 37743354 DOI: 10.1111/eip.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
AIM Therapeutic non-compliance remains the main difficulty for people with psychotic disorders, standing around 50% in people with schizophrenia. Lack of treatment adherence, either partial or total, to medication has economic and clinical consequences. E-health technologies may be a promising therapeutic tool to improve adherence, with the subsequent reduction in clinical and economic burden. Our aims were to know the preferences on how technologies in mental health treatment should be for use in clinical practice, and to learn about the opinion and preferences on the use of technologies in mental health treatment from the perspectives of patients with FEP, their relatives, and mental health professionals. METHODS Forty-one patients with a diagnosis of first-episode psychosis (FEP), 18 relatives and 49 mental health professionals were included in the study. They completed an online survey related to the use, availability and user-skill of online platforms and apps created by a group of experts in psychosis and in the use of technologies. Data were summarized in frequencies, percentages, and means, and Chi-square tests were used to calculate differences between-groups. RESULTS An app directed to people with psychosis would be well received by users if it contains psychoeducational material, offers reminders for scheduled visits and treatment and allows online consultations. CONCLUSIONS Co-creating an app with users, their families and mental health professionals allows incorporating their preferences to increase its use, improve outpatient care and creating an app that is viable in clinical practice.
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Affiliation(s)
- Marta Domínguez
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Sara Sánchez-Balcells
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
| | - Regina Vila-Badia
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Esther Bergadà-Sánchez
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
| | - Miriam Vilaplana
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Maria Elena Huerta-Ramos
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Nuria Del Cacho
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Trini Peláez
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Marta Coromina
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Doctor Antoni Pujadas, Sant Boi de Llobregat, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
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Khosravi M, Azar G. A systematic review of reviews on the advantages of mHealth utilization in mental health services: A viable option for large populations in low-resource settings. Glob Ment Health (Camb) 2024; 11:e43. [PMID: 38690573 PMCID: PMC11058521 DOI: 10.1017/gmh.2024.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/29/2024] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
Global mental health services face challenges such as stigma and a shortage of trained professionals, particularly in low- and middle-income countries, which hinder access to high-quality care. Mobile health interventions, commonly referred to as mHealth, have shown to have the capacity to confront and solve most of the challenges within mental health services. This paper conducted a comprehensive investigation in 2024 to identify all review studies published between 2000 and 2024 that investigate the advantages of mHealth in mental health services. The databases searched included PubMed, Scopus, Cochrane and ProQuest. The quality of the final papers was assessed and a thematic analysis was performed to categorize the obtained data. 11 papers were selected as final studies. The final studies were considered to be of good quality. The risk of bias within the final studies was shown to be in a convincing level. The main advantages of mHealth interventions were categorized into four major themes: 'accessibility, convenience and adaptability', 'patient-centeredness', 'data insights' and 'efficiency and effectiveness'. The findings of the study suggested that mHealth interventions can be a viable and promising option for delivering mental health services to large and diverse populations, particularly in vulnerable groups and low-resource settings.
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Affiliation(s)
- Mohsen Khosravi
- Department of Healthcare Management, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ghazaleh Azar
- Department of Consultation and Mental Health, Yasuj University of Medical Sciences, Yasuj, Iran
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Telephone-Delivered Interventions for Suicide Prevention in Schizophrenia and Related Disorders: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11030432. [PMID: 36767007 PMCID: PMC9913894 DOI: 10.3390/healthcare11030432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Suicide is a health problem among patients diagnosed with schizophrenia. Telehealth technology has become an emerging intervention that may offer opportunities to reach this at-risk group. However, to consider the implementation of telehealth systems in the prevention of suicidal behaviors in patients diagnosed with schizophrenia, a review of the evidence is required. The present aim was to explore the effectiveness of telephone-based suicide prevention programs among patients with schizophrenia and related disorders. METHODS A bibliographic search was carried out in the PubMed, PsycInfo, Scopus and Web of Science electronic databases following PRISMA guidelines. Two reviewers performed the selection, data extraction and methodological quality assessment. A total of 352 articles were retrieved, of which five studies met the eligibility criteria. RESULTS Globally, an adherence was observed ranging from 78 to 100%. Three studies reported a reduction in suicidal ideation and two studies showed a reduction in the risk of relapse observed in the intervention group compared to a control group. CONCLUSIONS In accordance with the limited data available, the use of a telephone contact approach appears to be feasible and effective in schizophrenia patients with suicidal behaviors. The preliminary evidence also suggests that this system appears to reduce suicidal ideation. Further research is required to design evidence-based future interventions and to determine whether this approach can improve patient outcomes.
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The effect of the COVID-19 pandemic on health behavior and psychopathology in patients with psychotic disorders. Psychiatry Res 2022; 317:114845. [PMID: 36155276 PMCID: PMC9472751 DOI: 10.1016/j.psychres.2022.114845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [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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A new era in psychiatry: the impacts of COVID-19 and the shift to telepsychiatry on clinical practice and clinician well-being. JOURNAL OF ENABLING TECHNOLOGIES 2022. [DOI: 10.1108/jet-11-2021-0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PurposeThe COVID-19 pandemic has actively changed the face of all medical disciplines, including mental health practices. In a matter of days from the introduction of the lockdown, clinicians have to adapt to new working models with many changing the consultation methods clinicians have utilized for years. To best understand the wider clinical impact, a limited study was carried out to assess the effect of coronavirus disease 2019 (COVID-19) on psychiatric clinical practice.Design/methodology/approachA qualitative study was performed to analyze the impact of COVID-19 on clinician practice at a UK secure care mental health facility. A four-question free-text survey was distributed online to all physicians and seven responses were analyzed using thematic analysis.FindingsFour key themes were identified – use of technology, the importance of face-to-face contact, work/life balance and mental well-being.Practical implicationsOverall, the results of the study reported that although some negative changes to the traditional work–life balance were identified, the clinicians found remote working within a secure care setting cultivated a more efficient working environment while allowing for more effective social distance practices.Originality/valueThis study highlighted some of the challenges faced by clinicians employed in a secure care mental health setting following the introduction of lockdown measures in the UK associated with the COVID-19 pandemic. The study will also inform future work practices, including the potential of longer term remote working in this sector.
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Ghaemi SN, Sverdlov O, van Dam J, Campellone T, Gerwien R. A Smartphone-Based Intervention as an Adjunct to Standard-of-Care Treatment for Schizophrenia: Randomized Controlled Trial. JMIR Form Res 2022; 6:e29154. [PMID: 35343910 PMCID: PMC9002609 DOI: 10.2196/29154] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/10/2021] [Accepted: 12/18/2021] [Indexed: 01/29/2023] Open
Abstract
Background Antipsychotic medications have limited benefits in schizophrenia, and cognitive behavioral therapy may be beneficial as an adjunct. There may be potential for implementing mobile cognitive behavioral therapy–based treatment for schizophrenia in addition to standard antipsychotic medications. Objective This study aims to determine whether PEAR-004, a smartphone-based investigational digital therapeutic, improves the symptoms of an acute psychotic exacerbation of schizophrenia when it is added to standard treatments. Methods This was a 12-week, multicenter, randomized, sham-controlled, rater-blinded, parallel group proof‑of‑concept study of 112 participants with moderate acute psychotic exacerbation in schizophrenia. This study was conducted in 6 clinical trial research sites in the United States from December 2018 to September 2019. The primary outcome, change in Positive and Negative Syndrome Scale (PANSS) from baseline to week 12 or the last available visit, was analyzed using the mixed-effects regression model for repeated measures, applied to an intent-to-treat sample. Results The total PANSS scores slightly decreased from baseline over the study period in both groups; the treatment difference at day 85 between PEAR-004 and sham was 2.7 points, in favor of the sham (2-sided P=.09). The secondary scales found no benefit, except for transient improvement in depressive symptoms with PEAR-004. Application engagement was good, and patient and clinical investigator satisfaction was high. No safety concerns were observed. There was some evidence of study site heterogeneity for the onboarding processes and directions on PEAR-004 product use at baseline and throughout the study. However, these differences did not affect the efficacy results. Conclusions In the largest-to-date randomized, sham-controlled study of a digital therapeutic in schizophrenia, PEAR-004 did not demonstrate an effect on the primary outcome—total PANSS scores—when compared with a nonspecific digital sham control. The secondary and exploratory results also did not demonstrate any notable benefits, except for possible temporary improvement in depressive symptoms. This study provided many useful scientific and operational insights that can be used in the further clinical development of PEAR-004 and other investigational digital therapeutics. Trial Registration ClinicalTrials.gov NCT03751280; https://clinicaltrials.gov/ct2/show/NCT03751280
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Affiliation(s)
- S Nassir Ghaemi
- Novaris Institutes for Biomedical Research, Cambridge, MA, United States
| | | | - Joris van Dam
- Novaris Institutes for Biomedical Research, Cambridge, MA, United States
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Carpenter-Song E, Acquilano SC, Noel V, Al-Abdulmunem M, Torous J, Drake RE. Individualized Intervention to Support Mental Health Recovery Through Implementation of Digital Tools into Clinical Care: Feasibility Study. Community Ment Health J 2022; 58:99-110. [PMID: 33611684 PMCID: PMC7897361 DOI: 10.1007/s10597-021-00798-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Abstract
Myriad digital tools exist to support mental health but there are multiple barriers to using these tools in routine care. This study aimed to assess the feasibility of an intervention incorporating a support role to help the clinical team identify and use technology to promote recovery. The technology specialist intervention is 3 months in duration and comprises four stages: goal setting, researching and evaluating tools, demonstrating and selecting tools, and ongoing support. We implemented the intervention in a community mental health center and a dual diagnosis treatment program, working with eight clients and their case managers. Clients and case managers willingly engaged with the technology specialist and found the intervention beneficial. Integration and collaboration with the care team facilitated implementation of the technology specialist in these real-world settings. Clients reported that the intervention made it easy to try a digital tool. Six of the eight participants stated that they made substantial progress toward their goals. The technology specialist is a promising new role for mental health care delivery to augment traditional services and enhance individualized recovery.
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Affiliation(s)
| | - Stephanie C Acquilano
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Valerie Noel
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Montréal, QC, Canada.,Douglas Hospital Research Centre, Montréal, QC, Canada
| | | | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Chepke C, Shaughnessy LW, Brunton S, Farmer JG, Rosenzweig AS, Grossberg GT, Wright WL. Using Telemedicine to Assess and Manage Psychosis Among Outpatients with Neurodegenerative Disease. Int J Gen Med 2021; 14:10271-10280. [PMID: 34992442 PMCID: PMC8711560 DOI: 10.2147/ijgm.s335739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
The presence of hallucinations and delusions in patients with neurodegenerative disease correlates negatively with function, cognition, quality of life, and survival. When these patients still have insight, the treatment of mild hallucinations may reduce the risk of progression to more severe symptoms, specifically hallucinations without insight or delusions. On October 22, 2020, a multidisciplinary consensus panel comprising United States-based experts in geriatric psychiatry, geriatric medicine, family medicine, movement disorders, and neuropsychology was convened remotely to discuss best practices for using telemedicine to evaluate, diagnose, and treat psychosis in patients with neurodegenerative diseases. This review reflects the opinions and recommendations discussed at this meeting. Despite drawbacks, telemedicine can offer several advantages over in-person care, particularly for older adults, and may be a unique opportunity for care of patients with neuropsychiatric symptoms. While telemedicine may not be suitable for all patients, it allows the involvement of specialists from multiple geographic locations and the extension of care to homebound individuals. Patients with neurodegenerative diseases who are likely to become homebound as the disease advances may benefit greatly from telemedicine as a standard of care. Healthcare provided via telemedicine should be nothing less than what would be offered to the patient in person. Telemedicine may present some difficulties, including technological issues and inherent constraints of remote care, but with proper planning many problems could be diminished. Technical issues associated with telemedicine are inevitable but may be partially offset by providing clear directions ahead of any tele-visit to ensure connectivity and access to the videoconferencing platform. Alternative procedures to communicate should be established in the eventuality of technological issues. Using these strategies, telemedicine can serve as a valuable complement to traditional in-person practices for the diagnosis and management of hallucinations and delusions associated with Parkinson’s disease psychosis or dementia-related psychosis.
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Affiliation(s)
- Craig Chepke
- Excel Psychiatric Associates, Huntersville, NC, USA
- Atrium Health, Charlotte, NC, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Correspondence: Craig Chepke Email
| | - Lynn W Shaughnessy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Brunton
- Primary Care Education Consortium, Winnsboro, SC, USA
- Department of Family Medicine, Touro University, Vallejo, CA, USA
| | - Jill G Farmer
- Parkinson’s Disease and Movement Disorder Program, Center for Neurosciences, Robert Wood Johnson University Hospital Hamilton, Lawrenceville, NJ, USA
- Department of Emergency Medicine, Drexel College of Medicine, Philadelphia, PA, USA
| | | | - George T Grossberg
- Department of Psychiatry, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Wendy L Wright
- Wright & Associates Family Health Care, Concord and Amherst, NH, USA
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Mashhadi SF, Hisam A, Sikander S, Rathore MA, Rifaq F, Khan SA, Hafeez A. Post Discharge mHealth and Teach-Back Communication Effectiveness on Hospital Readmissions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910442. [PMID: 34639741 PMCID: PMC8508113 DOI: 10.3390/ijerph181910442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 12/12/2022]
Abstract
Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions.
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Affiliation(s)
- Syed Fawad Mashhadi
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
- Department of Public Health, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan
- Correspondence:
| | - Aliya Hisam
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
| | - Siham Sikander
- Global Health Department, Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan;
- Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Mommana Ali Rathore
- Department of Community Medicine, Army Medical College, National University of Medical Sciences, Rawalpindi 46000, Pakistan; (A.H.); (M.A.R.)
| | - Faisal Rifaq
- Sehat Sahulat Program, Ministry of National Health Services, Regulations and Coordination, Government of Pakistan, Hall 3A, 3rd Floor, Kohsar Block, Pak Secretariat, Islamabad 44000, Pakistan;
| | - Shahzad Ali Khan
- Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan; (S.A.K.); (A.H.)
| | - Assad Hafeez
- Health Services Academy, Opposite National Institute of Health, Islamabad 44000, Pakistan; (S.A.K.); (A.H.)
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Singh SP, Mohan M, Giacco D. Psychosocial interventions for people with a first episode psychosis: between tradition and innovation. Curr Opin Psychiatry 2021; 34:460-466. [PMID: 34282104 DOI: 10.1097/yco.0000000000000726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Assessing recent evidence on psychosocial interventions for people with first episode psychosis (FEP). RECENT FINDINGS Family interventions (FI) reduce relapse rates, whilst cognitive behavioural therapy (CBT) shows a moderate effect in improving positive psychotic symptoms. Vocational interventions (VI) appear to be worthy of implementation within early intervention for psychosis (EIP) teams, but it is still unclear what is the most cost-effective strategy for their delivery. Promising interventions, which need more careful evaluation, focus on substance misuse, physical health comorbidities, improvement of social participation, peer support and the potential of new technologies. SUMMARY The first five years after the onset of psychotic symptoms are a 'critical period' in which psychosocial interventions can be particularly influential in determining prognosis. Traditional EIP interventions have different effectiveness profiles, i.e., FI reduce relapse rates, CBT has a moderate effectiveness on overall and positive symptoms and VI can improve educational and employment-related functioning. Newer interventions show promise on important targets for FEP treatment but require higher-quality evaluations. Decisions on which interventions to implement within EIP teams should be informed by high-quality evidence, but difficult choices will have to be made based on costs, professionals and technologies available, and local priorities.
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Affiliation(s)
- Swaran P Singh
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick
- Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Mohapradeep Mohan
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick
| | - Domenico Giacco
- Division of Mental Health & Wellbeing, Warwick Medical School, University of Warwick
- Coventry and Warwickshire Partnership Trust, Coventry, UK
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Rajabzadeh V, Burn E, Sajun SZ, Suzuki M, Bird VJ, Priebe S. Understanding global mental health: a conceptual review. BMJ Glob Health 2021; 6:bmjgh-2020-004631. [PMID: 33758013 PMCID: PMC7993328 DOI: 10.1136/bmjgh-2020-004631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Abstract
Background Mental health disorders are viewed as a global concern requiring globally led approaches to address them. Since the publication of the 2007 Lancet series on global mental health (GMH), the term has become widespread. Over the last two decades, GMH has become increasingly affiliated with policy reform, academic courses, funding bodies and research. However, it is not always obvious how those working in the field of GMH are using the term, resulting in a lack of clarity. Therefore, work is needed to synthesise the current understanding(s) of GMH to help characterise its meaning. Aim To synthesise the literature and identify the different ways GMH is understood. Method A conceptual review, using a systematic search and a content analysis, was conducted to develop a conceptual framework of the different conceptual understandings of GMH. Results We developed a conceptual framework of four understandings of GMH. These understandings of GMH are as follows: an area of research generating findings to establish a GMH evidence-base; implementation of research into practice; improving the mental health environment; learning from and supporting low-and-middle-income countries (LMICs). Conclusion Our review proposes a simple framework, clarifying the key characteristics of the GMH landscape. The findings highlight the diversity of usage of the term in the literature, as well as present the wide scope that comprises the field of GMH. Referring to this framework may help those engaged with GMH to be more specific with which aspect of the field they are concerned with.
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Affiliation(s)
- Vian Rajabzadeh
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Erin Burn
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Sana Z Sajun
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Mimi Suzuki
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Victoria Jane Bird
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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Williams A, Fossey E, Farhall J, Foley F, Thomas N. Impact of Jointly Using an e-Mental Health Resource (Self-Management And Recovery Technology) on Interactions Between Service Users Experiencing Severe Mental Illness and Community Mental Health Workers: Grounded Theory Study. JMIR Ment Health 2021; 8:e25998. [PMID: 34132647 PMCID: PMC8277385 DOI: 10.2196/25998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/04/2021] [Accepted: 04/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND e-Mental health resources are increasingly available for people who experience severe mental illness, including those who are users of community mental health services. However, the potential for service users (SUs) living with severe mental illness to use e-mental health resources together with their community mental health workers (MHWs) has received little attention. OBJECTIVE This study aims to identify how jointly using an interactive website called Self-Management And Recovery Technology (SMART) in a community mental health context influenced therapeutic processes and interactions between SUs and MHWs from their perspective. METHODS We conducted a qualitative study using a constructivist grounded theory methodology. Data were collected through individual semistructured interviews with 37 SUs and 15 MHWs who used the SMART website together for 2 to 6 months. Data analysis involved iterative phases of coding, constant comparison, memo writing, theoretical sampling, and consultation with stakeholders to support the study's credibility. RESULTS A substantive grounded theory, discovering ways to keep life on track, was developed, which portrays a shared discovery process arising from the SU-worker-SMART website interactions. The discovery process included choosing to use the website, revealing SUs' experiences, exploring these experiences, and gaining new perspectives on how SUs did and could keep their lives on track. SUs and MHWs perceived that their three-way interactions were enjoyable, beneficial, and recovery focused when using the website together. They experienced the shared discovery process as relationship building-their interactions when using the website together were more engaging and equal. CONCLUSIONS Jointly using an e-mental health resource elicited recovery-oriented interactions and processes between SUs and MHWs that strengthened their therapeutic relationship in real-world community mental health services. Further work to develop and integrate this novel use of e-mental health in community mental health practice is warranted.
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Affiliation(s)
- Anne Williams
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia.,Living with a Disability Research Centre, La Trobe University, Melbourne, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Australia
| | - Fiona Foley
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
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13
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Di Carlo F, Sociali A, Picutti E, Pettorruso M, Vellante F, Verrastro V, Martinotti G, di Giannantonio M. Telepsychiatry and other cutting-edge technologies in COVID-19 pandemic: Bridging the distance in mental health assistance. Int J Clin Pract 2021; 75:10.1111/ijcp.13716. [PMID: 32946641 PMCID: PMC7536971 DOI: 10.1111/ijcp.13716] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND At the end of 2019, a novel coronavirus (COVID-19) was identified in China. The high potential of human-to-human transmission led to subsequent COVID-19 global pandemic. Public health strategies including reduced social contact and lockdown have been adopted in many countries. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, resulting in loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines a relevant obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare. AIMS In this paper, we discuss the potential role of telepsychiatry (TP) and other cutting-edge technologies in the management of mental health assistance. We narratively review the literature to examine the advantages and risks related to the extensive application of these new therapeutic settings, along with the possible limitations and ethical concerns. RESULTS Telemental health services may be particularly feasible and appropriate for the support of patients, family members and healthcare providers during this COVID-19 pandemic. The integration of TP with other technological innovations (eg, mobile apps, virtual reality, big data and artificial intelligence (AI)) opens up interesting future perspectives for the improvement of mental health assistance. CONCLUSION Telepsychiatry is a promising and growing way to deliver mental health services but is still underused. The COVID-19 pandemic may serve as an opportunity to introduce and promote, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.
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Affiliation(s)
- Francesco Di Carlo
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Antonella Sociali
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Elena Picutti
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Federica Vellante
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
| | - Valeria Verrastro
- Department of Medical and Surgical SciencesUniversity “Magna Graecia” of CatanzaroCatanzaroItaly
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
- Department of Clinical, Pharmaceutical and Biological SciencesUniversity of HertfordshireHertsUK
| | - Massimo di Giannantonio
- Department of Neuroscience, Imaging and Clinical SciencesUniversity “G. d’Annunzio” of Chieti – PescaraChietiItaly
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14
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Carter H, Araya R, Anjur K, Deng D, Naslund JA. The emergence of digital mental health in low-income and middle-income countries: A review of recent advances and implications for the treatment and prevention of mental disorders. J Psychiatr Res 2021; 133:223-246. [PMID: 33360867 PMCID: PMC8801979 DOI: 10.1016/j.jpsychires.2020.12.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022]
Abstract
In low-income and middle-income countries (LMICs), emerging digital mental health interventions should be accompanied by regular and comprehensive assessment of available scientific evidence. This review aims to support efforts to monitor progress in digital mental health research, ensuring new evidence can guide researchers, clinicians, policymakers and program managers positioned to adopt and implement these digitally-enabled treatments. In accordance with PRISMA guidelines, an electronic database search from 2016 to 2020 yielded 37 digital intervention studies for detection, diagnosis, prevention, treatment, and/or management of a broad range of mental disorders in 13 LMICs. This date range was selected to update previous reviews. Most studies involved online interventions and many reported feasibility and acceptability, reflected by participant satisfaction or program adherence. About half the studies (N = 23) reported clinical benefits based on changes in mental health. For depression and mood disorders, some digital interventions showed improvements in depressive symptoms, quality of life, treatment adherence, and recovery. However, sample sizes were small and studies focused primarily on adults. Further limiting generalizability was the lack of consistency in clinical assessment and measurement tools between studies. No studies reported worsening symptoms, negative acceptability or dissatisfaction with digital interventions, suggesting possible publication bias. While digital interventions show promise, it remains difficult to conclude that digital interventions are effective from these studies, as it is prudent to exercise caution before drawing conclusions about clinical effectiveness. This review reflects continued growth in digital mental health research in LMICs and further highlights the need for rigorous evaluation of effectiveness and cost-effectiveness.
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Affiliation(s)
- Helena Carter
- The Center for Global Mental Health, King's College London, London, UK
| | - Ricardo Araya
- The Center for Global Mental Health, King's College London, London, UK; Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kavya Anjur
- Johns Hopkins University, Baltimore, MD, USA
| | - Davy Deng
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Mental Health for All Lab, Harvard Medical School, Boston, MA, USA
| | - John A Naslund
- The Mental Health for All Lab, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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15
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to review the application of telehealth in the assessment and treatment of psychotic illnesses. We present the contextual factors which make this approach to clinical care compelling, and review existing evidence about feasibility, acceptability, and effectiveness. RECENT FINDINGS The use of telehealth with individuals that suffer from serious mental illness and psychosis has been demonstrated to be feasible and acceptable, with effectiveness that is comparable to in-person clinical care. Telehealth holds the additional promises of expanding access, connecting patients, families, and the general public to behavioral health resources, and reducing overall health care costs. We provide two case examples which demonstrate the successful use of technology for the delivery and coordination of effective patient care for individuals with psychotic illnesses.
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Affiliation(s)
- Amy L. Donahue
- Access Care Services, Colorado Access, 11100 E Bethany Drive, Aurora, CO 80014 USA
| | - Jennifer Rodriguez
- Access Care Services, Colorado Access, 11100 E Bethany Drive, Aurora, CO 80014 USA
| | - Jay H. Shore
- Access Care Services, Colorado Access, 11100 E Bethany Drive, Aurora, CO 80014 USA ,grid.430503.10000 0001 0703 675XDepartment of Psychiatry and Family Medicine, School of Medicine And Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO USA
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16
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Krzystanek M, Krysta K, Borkowski M, Skałacka K, Przybyło J, Pałasz A, Mucic D, Martyniak E, Waszkiewicz N. The Effect of Smartphone-Based Cognitive Training on the Functional/Cognitive Markers of Schizophrenia: A One-Year Randomized Study. J Clin Med 2020; 9:jcm9113681. [PMID: 33207811 PMCID: PMC7696401 DOI: 10.3390/jcm9113681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/23/2020] [Accepted: 11/11/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Cognitive impairment is associated with long-term disability that results in the deterioration of both the social and professional status of individuals with schizophrenia. The impact of antipsychotic therapy on cognitive function is insufficient. Cognitive training is therefore proposed as a tool for cognitive rehabilitation in schizophrenia. In this study we investigated the effect of self-administered cognitive training using a smartphone-based application on the cognitive function of paranoid schizophrenia patients focusing on response time, correct answer rate, incorrect answer rate, and fatigability to check, if these functions can be functional markers of successful cognitive-smartphone rehabilitation. Methods: 1-year multicenter, open-label randomized study was conducted on 290 patients in a state of symptomatic remission. 191 patients were equipped with the full version of the application and conducted cognitive training twice a week. Reference group (n = 99) was provided with a version of the application having only limited functionality, testing the cognitive performance of patients every 6 months. Results: Statistically significant improvement was observed in both the rate of correct answers (by 4.8%, p = 0.0001), and cognitive fatigability (by 2.9%, p = 0.0001) in the study group, along with a slight improvement in the rate of incorrect answers (by 0.9%, p = 0.15). In contrast, the reference group, who performed cognitive training every 6 months, demonstrated no significant changes in any cognitive activities. Conclusions: Cognitive trainings facilitated by a smartphone-based application, performed regularly for a longer period of time are feasible and may have the potential to improve the cognitive functioning of individuals with schizophrenia. Correct answers and cognitive fatigability have potential to be functional markers of successful smartphone-based psychiatric rehabilitations in schizophrenia patients.
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Affiliation(s)
- Marek Krzystanek
- Clinic of Psychiatric Rehabilitation, Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Ziołowa 45/47, 40-635 Katowice, Poland; (M.K.); (M.B.); (E.M.)
| | - Krzysztof Krysta
- Clinic of Psychiatric Rehabilitation, Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Ziołowa 45/47, 40-635 Katowice, Poland; (M.K.); (M.B.); (E.M.)
- Correspondence:
| | - Mariusz Borkowski
- Clinic of Psychiatric Rehabilitation, Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Ziołowa 45/47, 40-635 Katowice, Poland; (M.K.); (M.B.); (E.M.)
| | - Katarzyna Skałacka
- Institute of Psychology, University of Opole, Kopernika 11A Street, 45-040 Opole, Poland;
| | - Jacek Przybyło
- Multispecialistic Voivodship Medical Clinic in Katowice, Lompy 16, 40-038 Katowice, Poland;
| | - Artur Pałasz
- Department of Histology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Medyków 18, 40-752 Katowice, Poland;
| | - Davor Mucic
- The Little Prince Treatment Centre, Havneholmen 82, 5th, V 1561 Copenhagen, Denmark;
| | - Ewa Martyniak
- Clinic of Psychiatric Rehabilitation, Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Ziołowa 45/47, 40-635 Katowice, Poland; (M.K.); (M.B.); (E.M.)
| | - Napoleon Waszkiewicz
- Department of Psychiatry, Medical University of Białystok, Plac Brodowicza 1 Str., 16-070 Choroszcz, Poland;
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17
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Features, outcomes, and challenges in mobile health interventions for patients living with chronic diseases: A review of systematic reviews. Int J Med Inform 2019; 132:103984. [PMID: 31605884 DOI: 10.1016/j.ijmedinf.2019.103984] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/13/2019] [Accepted: 09/27/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mobile health (mHealth) technology has the potential to play a key role in improving the health of patients with chronic non-communicable diseases. OBJECTIVES We present a review of systematic reviews of mHealth in chronic disease management, by showing the features and outcomes of mHealth interventions, along with associated challenges in this rapidly growing field. METHODS We searched the bibliographic databases of PubMed, Scopus, and Cochrane to identify systematic reviews of mHealth interventions with advanced technical capabilities (e.g., Internet-linked apps, interoperation with sensors, communication with clinical platforms, etc.) utilized in randomized clinical trials. The original studies included the reviews were synthesized according to their intervention features, the targeted diseases, the primary outcome, the number of participants and their average age, as well as the total follow-up duration. RESULTS We identified 5 reviews respecting our inclusion and exclusion criteria, which examined 30 mHealth interventions. The highest percentage of the interventions targeted patients with diabetes (n = 19, 63%), followed by patients with psychotic disorders (n = 7, 23%), lung diseases (n = 3, 10%), and cardiovascular disease (n = 1, 3%). 14 studies showed effective results: 9 in diabetes management, 2 in lung function, and 3 in mental health. Significantly positive outcomes were reported in 8 interventions (n = 8, 47%) from 17 studies assessing glucose concentration, one intervention assessing physical activity, 2 interventions (n = 2, 67%) from 3 studies assessing lung function parameters, and 3 mental health interventions assessing N-back performance, medication adherence, and number of hospitalizations. Divergent features were adopted in 14 interventions with significantly positive outcomes, such as personalized goal setting (n = 10, 71%), motivational feedback (n = 5, 36%), and alerts for health professionals (n = 3, 21%). The most significant found challenges in the development and evaluation of mHealth interventions include the design of studies with high quality, the construction of robust interventions in combination with health professional inputs, and the identification of tools and methods to improve patient adherence. CONCLUSIONS This review found mixed evidence regarding the health benefits of mHealth interventions for patients living with chronic diseases. Further rigorous studies are needed to assess the outcomes of personalized mHealth interventions toward the optimal management of chronic diseases.
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18
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Clarke S, Hanna D, Mulholland C, Shannon C, Urquhart C. A systematic review and meta-analysis of digital health technologies effects on psychotic symptoms in adults with psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2019. [DOI: 10.1080/17522439.2019.1632376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Stephen Clarke
- School of Psychology, Queens University of Belfast, Northern Ireland
| | - Donncha Hanna
- School of Psychology, Queens University of Belfast, Northern Ireland
- Centre for Evidence and Social Innovation, Queens University of Belfast, Northern Ireland
| | - Ciaran Mulholland
- Northern Health and Social Care Trust, Antrim, Northern Ireland
- School of Medicine, Queens University of Belfast, Northern Ireland
| | - Ciaran Shannon
- Northern Health and Social Care Trust, Antrim, Northern Ireland
| | - Callum Urquhart
- School of Psychology, Queens University of Belfast, Northern Ireland
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19
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Williams A, Farhall J, Fossey E, Thomas N. Internet-based interventions to support recovery and self-management: A scoping review of their use by mental health service users and providers together. BMC Psychiatry 2019; 19:191. [PMID: 31221125 PMCID: PMC6585058 DOI: 10.1186/s12888-019-2153-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/20/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Internet-based interventions can make self-management and recovery-oriented information and tools more accessible for people experiencing severe mental illness, including psychosis. The aim of this scoping review was to identify and describe emerging joint uses of these Internet-based interventions by service users experiencing psychosis and mental health workers. It also investigated how using these Internet-based interventions influenced interactions between service users and workers and whether recovery-oriented working practices were elicited. METHODS A scoping review method was used. Iterative review stages included identifying the review question, a comprehensive search including searching six electronic databases to locate relevant studies, selecting studies, charting the data, and collating and reporting the results. Rigour of the scoping review was enhanced by using an appraisal tool to evaluate the quality of included studies, and by using a published template for systematic description of interventions. RESULTS Fifteen papers about eleven Internet-based interventions that focused on self-management and/or recovery were identified. Interventions were web-based, mobile-device based, or both. The eleven interventions were used by service users either with their usual mental health workers, or with mental health workers employed in a research project. Emerging evidence suggested that jointly using an Internet-based intervention could support a positive sense of working together. However, mismatched expectations and poor integration of Internet-based interventions into service systems could also negatively influence interactions, leading to mistrust. The interventions demonstrated potential to elicit recognised recovery-oriented practices, specifically understanding service users' values and supporting their goal striving. CONCLUSIONS The use of Internet-based interventions focused on self-management and recovery in mental health services by service users and workers jointly demonstrates potential to support working together and recovery-oriented practice. Given that the quality of relationships is critical in recovery-oriented practice, greater focus on human support in Internet-based interventions is needed in future research and practice.
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Affiliation(s)
- Anne Williams
- Department of Occupational Therapy, Social Work and Social Policy, La Trobe University, Melbourne, Victoria, Australia. .,Department of Health Professions, Swinburne University of Technology, Hawthorn, Victoria, Australia.
| | - John Farhall
- 0000 0001 2342 0938grid.1018.8Department of Psychology and Counselling, La Trobe University, Melbourne, Victoria Australia ,0000 0004 0452 651Xgrid.429299.dNorthWestern Mental Health, Melbourne Health, Melbourne, Melbourne, Victoria Australia
| | - Ellie Fossey
- 0000 0004 1936 7857grid.1002.3Department of Occupational Therapy, Monash University, Frankston, Victoria Australia ,0000 0001 2342 0938grid.1018.8Living with Disability Research Centre, La Trobe University, Melbourne, Victoria Australia
| | - Neil Thomas
- 0000 0004 0409 2862grid.1027.4Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria Australia ,0000 0004 0623 9709grid.476960.aMonash Alfred Psychiatry Research Centre, Melbourne, Victoria Australia
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20
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Brimblecombe N, Quist H, Nolan F. A mixed-methods survey to explore views of staff and patients from mental health wards prior to introduction of a digital early warning system for physical deterioration. J Psychiatr Ment Health Nurs 2019; 26:65-76. [PMID: 30742343 DOI: 10.1111/jpm.12511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/03/2019] [Accepted: 02/07/2019] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The potential benefits of introducing technological innovation into all types of health services are recognized internationally. There are few studies exploring the use of technology in inpatient mental health settings, or the views of staff and patients regarding such developments. "Early warning systems" are increasingly used in inpatient mental health services to detect physical deterioration in patients and prompt staff to take appropriate action. We have identified no peer-reviewed publications concerning this development. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Using a questionnaire survey, this project gathered views from staff and patients on a planned change from a paper-based "early warning system" to one using handheld electronic devices (tablets). This study adds to the existing evidence by reporting specific staff and patient concerns about a technological development in an inpatient mental health setting. Some patients were concerned about confidentiality of data entered onto tablets. Whilst were either positive or neutral in attitude to the planned change some staff raised concerns that electronic devices could be used as weapons, and also that patients or visitors might misinterpret their use. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Views of staff and patients must be considered when introducing new technology into clinical practice, in order to make the change successful and sustainable. Inadequate or unclear information about the use and purpose of electronic devices may lead to misunderstandings as to their purpose and the security of their data, particularly in mental health settings. Further exploration across a range of services and countries would be useful in determining whether attitudes towards implementing similar technological change in mental health practice are commonly shared. ABSTRACT: Introduction Technological innovation offers opportunities to improve mental health care; however, little evidence exists regarding attitudes of inpatient staff and patients to such changes. We present a survey of staff and patients prior to introduction of a digital version of the National Early Warning Score (eNEWS) system for identifying physical deterioration. Aim To collate views of staff and inpatients related to prospective use of eNEWS, to inform the plan for implementation. Method Paper questionnaires were distributed to both groups in six wards prior to eNEWS implementation. Two discussion groups were then held. Results Eighty-two staff and 26 inpatients completed questionnaires. Some inpatients expressed concerns about data confidentiality. Most staff were neutral or positive about the planned change, but raised possible safety risks and the risk of electronic recording being misinterpreted by patients. The implementation plan was modified in response to this information, principally by improving communication processes with patients. Discussion This study adds to the existing evidence by reporting specific staff and patient concerns towards a form of information technology. Further evaluations would help determine the transferability of these findings. Implications for practice Listening to patient and staff views about planned technological innovation is essential for effective implementation.
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Affiliation(s)
| | - Haddy Quist
- South London and Maudsley NHS Foundation Trust, London, UK
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21
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Fernández-Sotos P, Fernández-Caballero A, González P, Aparicio AI, Martínez-Gras I, Torio I, Dompablo M, García-Fernández L, Santos JL, Rodriguez-Jimenez R. Digital Technology for Internet Access by Patients With Early-Stage Schizophrenia in Spain: Multicenter Research Study. J Med Internet Res 2019; 21:e11824. [PMID: 30950798 PMCID: PMC6533031 DOI: 10.2196/11824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/03/2018] [Accepted: 12/12/2018] [Indexed: 12/18/2022] Open
Abstract
Background Digital technology and social networks are part of everyday life in the current internet age, especially among young people. To date, few studies have been published worldwide on the pattern of use of digital technology devices and applications in patients with early-stage schizophrenia and even fewer comparing them with healthy participants (not using data from general population surveys) from the same demographic areas. In Spain, no such study has been carried out. Objective The aim of this study was to analyze how patients with early-stage schizophrenia use internet and social networks compared with healthy participants matched by age and gender and also to examine which devices are utilized to access internet resources. Methods A cross-sectional, multicentric study was carried out through a semistructured interview asking about the use of digital technology devices and internet. The sample comprised 90 patients and 90 healthy participants. The semistructured interview was conducted on 30 outpatients and 30 healthy subjects in each of the 3 different cities (Madrid, Alicante, and Cuenca). Student t test was used for continuous variables and chi-square test for categorical variables. In the case of ordinal variables, nonparametric Mann-Whitney U and Kruskal-Wallis H tests for independent samples were performed to compare groups. Results The results indicated that a large proportion of patients with early-stage schizophrenia have access to different digital devices and use them frequently. In addition, both groups coincide in the order of preference and the purpose for which they use the devices. However, a lower frequency of use of most digital technology devices was detected in patients compared with healthy participants. In the case of some devices, this was due to the impossibility of access and not a lack of interest. Conclusions To our knowledge, this is the first study to analyze patterns of internet access and use of digital technology devices and applications in Spanish patients with early-stage schizophrenia compared with healthy participants from the same demographic areas. The results on significant access and use of digital technology and internet shown in this cross-sectional study will allow enhanced and more efficient treatment strategies to be planned, utilizing digital technology devices, for patients with early-stage schizophrenia.
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Affiliation(s)
- Patricia Fernández-Sotos
- Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
| | - Antonio Fernández-Caballero
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Instituto de Investigación en Informática, Albacete, Spain.,Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Pascual González
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Instituto de Investigación en Informática, Albacete, Spain.,Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Ana Isabel Aparicio
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Servicio de Psiquiatría del "Hospital Virgen de la Luz", Cuenca, Spain
| | - Isabel Martínez-Gras
- Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Iosune Torio
- Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Universidad Rey Juan Carlos, Madrid, Spain
| | - Mónica Dompablo
- Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
| | - Lorena García-Fernández
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Hospital Universitario San Juan, Alicante, Spain
| | - José Luis Santos
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,Servicio de Psiquiatría del "Hospital Virgen de la Luz", Cuenca, Spain
| | - Roberto Rodriguez-Jimenez
- Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain.,CogPsy-Group, Universidad Complutense de Madrid, Madrid, Spain
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22
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Yeager CM, Benight CC. If we build it, will they come? Issues of engagement with digital health interventions for trauma recovery. Mhealth 2018; 4:37. [PMID: 30363749 PMCID: PMC6182033 DOI: 10.21037/mhealth.2018.08.04] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/17/2018] [Indexed: 12/12/2022] Open
Abstract
Exposure to traumatic events is extremely common with nearly 75% reported to have experienced one or more traumatic events worldwide. A significant number of those exposed will develop posttraumatic stress disorder (PTSD) along with depression, anxiety, and substance use disorders. Globally, trauma-related mental health disorders are the leading cause of global disability burden, and many of these disorders are caused, or worsened, by exposure to wars, natural and human-caused disasters, and other traumatic events. Significant barriers to treatment exist including logistical, geographical, financial, stigma, and other attitudinal challenges. One opportune approach to overcoming these barriers is the provision of mental health interventions via technology that can be readily standardized for wide dissemination of evidence-based care. However, engagement with technology-based interventions is a concern and limited participation and high attrition rates are common. This may be especially true for trauma survivors who often experience symptoms of avoidance and hyperarousal. Engagement is regarded as an essential component of intervention efficacy and has been demonstrated to be associated with more positive clinical outcomes, yet theoretically based research in this area is sparse. This review focuses on the complex issue of engagement with digital health interventions (DHIs). Specifically, we review the conceptualization and measurement of engagement, predictors of engagement, and importantly, the relationship of engagement with intervention effectiveness. Finally, a theoretically based model of engagement is proposed that considers the unique challenges of trauma recovery. This review is not intended to provide a systematic or exhaustive set of recommendations, rather it is intended to highlight the challenges of engagement research including its definition, measurement, and modeling. Future engagement research that includes valid and reliable measures of engagement will enable consistent exploration of engagement predictors that can then inform methods for increasing engagement and, ultimately, intervention effectiveness.
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Affiliation(s)
- Carolyn M. Yeager
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
| | - Charles C. Benight
- Psychology Department, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
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