1
|
Macrynikola N, Mir Z, Gopal T, Rodriguez E, Li S, Cox M, Yeh G, Torous J. The impact of mindfulness apps on psychological processes of change: a systematic review. NPJ MENTAL HEALTH RESEARCH 2024; 3:14. [PMID: 38609511 PMCID: PMC10955957 DOI: 10.1038/s44184-023-00048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/08/2023] [Indexed: 04/14/2024]
Abstract
Mindfulness-based interventions (MBIs) have demonstrated therapeutic efficacy for various psychological conditions, and smartphone apps that facilitate mindfulness practice can enhance the reach and impact of MBIs. The goal of this review was to summarize the published evidence on the impact of mindfulness apps on the psychological processes known to mediate transdiagnostic symptom reduction after mindfulness practice. A literature search from January 1, 1993, to August 7, 2023 was conducted on three databases, and 28 randomized controlled trials involving 5963 adults were included. Across these 28 studies, 67 outcome comparisons were made between a mindfulness app group and a control group. Between-group effects tended to favor the mindfulness app group over the control group in three psychological process domains: repetitive negative thinking, attention regulation, and decentering/defusion. Findings were mixed in other domains (i.e., awareness, nonreactivity, non-judgment, positive affect, and acceptance). The range of populations examined, methodological concerns across studies, and problems with sustained app engagement likely contributed to mixed findings. However, effect sizes tended to be moderate to large when effects were found, and gains tended to persist at follow-up assessments two to six months later. More research is needed to better understand the impact of these apps on psychological processes of change. Clinicians interested in integrating apps into care should consider app-related factors beyond evidence of a clinical foundation and use app databases to identify suitable apps for their patients, as highlighted at the end of this review.
Collapse
Affiliation(s)
- Natalia Macrynikola
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA.
| | - Zareen Mir
- Teacher's College, Columbia University, New York, NY, USA
| | | | | | - Sunnie Li
- Northeastern University, Boston, MA, USA
| | - Milann Cox
- Penn State College of Medicine, Hershey, PA, USA
| | - Gloria Yeh
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| | - John Torous
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Eisner E, Berry N, Bucci S. Digital tools to support mental health: a survey study in psychosis. BMC Psychiatry 2023; 23:726. [PMID: 37803367 PMCID: PMC10559432 DOI: 10.1186/s12888-023-05114-y] [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: 03/07/2023] [Accepted: 08/16/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND There is a notable a gap between promising research findings and implementation of digital health tools. Understanding and addressing barriers to use is key to widespread implementation. METHODS A survey was administered to a self-selecting sample in-person (n = 157) or online (n = 58), with questions examining: i) ownership and usage rates of digital devices among people with psychosis; ii) interest in using technology to engage with mental health services; and iii) facilitators of and barriers to using digital tools in a mental healthcare context. RESULTS Device ownership: Virtually all participants owned a mobile phone (95%) or smartphone (90%), with Android phones slightly more prevalent than iPhones. Only a minority owned a fitness tracker (15%) or smartwatch (13%). Device ownership was significantly lower in unemployed people and those without secondary education. Device cost and paranoid ideation were barriers to ownership. Technology and mental health services: Most participants (88%) said they would willingly try a mental health app. Symptom monitoring apps were most popular, then appointment reminders and medication reminders. Half the sample would prefer an app alongside face-to-face support; the other half preferred remote support or no other mental health support. Facilitators: Participants thought using a mental health app could increase their understanding of psychosis generally, and of their own symptoms. They valued the flexibility of digital tools in enabling access to support anywhere, anytime. Barriers: Prominent barriers to using mental health apps were forgetting, lack of motivation, security concerns, and concerns it would replace face-to-face care. Overall participants reported no substantial effects of technology on their mental health, although a quarter said using a phone worsened paranoid ideation. A third used technology more when psychotic symptoms were higher, whereas a third used it less. Around half used technology more when experiencing low mood. CONCLUSIONS Our findings suggest rapidly increasing device ownership among people with psychosis, mirroring patterns in the general population. Smartphones appear appropriate for delivering internet-enabled support for psychosis. However, for a sub-group of people with psychosis, the sometimes complex interaction between technology and mental health may act as a barrier to engagement, alongside more prosaic factors such as forgetting.
Collapse
Affiliation(s)
- Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Natalie Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
| |
Collapse
|
3
|
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.
Collapse
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
| | | |
Collapse
|
4
|
Ben-Zeev D, Chander A, Tauscher J, Buck B, Nepal S, Campbell A, Doron G. A Smartphone Intervention for People With Serious Mental Illness: Fully Remote Randomized Controlled Trial of CORE. J Med Internet Res 2021; 23:e29201. [PMID: 34766913 PMCID: PMC8663659 DOI: 10.2196/29201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/19/2021] [Accepted: 10/03/2021] [Indexed: 01/23/2023] Open
Abstract
Background People with serious mental illness (SMI) have significant unmet mental health needs. Development and testing of digital interventions that can alleviate the suffering of people with SMI is a public health priority. Objective The aim of this study is to conduct a fully remote randomized waitlist-controlled trial of CORE, a smartphone intervention that comprises daily exercises designed to promote reassessment of dysfunctional beliefs in multiple domains. Methods Individuals were recruited via the web using Google and Facebook advertisements. Enrolled participants were randomized into either active intervention or waitlist control groups. Participants completed the Beck Depression Inventory-Second Edition (BDI-II), Generalized Anxiety Disorder-7 (GAD-7), Hamilton Program for Schizophrenia Voices, Green Paranoid Thought Scale, Recovery Assessment Scale (RAS), Rosenberg Self-Esteem Scale (RSES), Friendship Scale, and Sheehan Disability Scale (SDS) at baseline (T1), 30-day (T2), and 60-day (T3) assessment points. Participants in the active group used CORE from T1 to T2, and participants in the waitlist group used CORE from T2 to T3. Both groups completed usability and accessibility measures after they concluded their intervention periods. Results Overall, 315 individuals from 45 states participated in this study. The sample comprised individuals with self-reported bipolar disorder (111/315, 35.2%), major depressive disorder (136/315, 43.2%), and schizophrenia or schizoaffective disorder (68/315, 21.6%) who displayed moderate to severe symptoms and disability levels at baseline. Participants rated CORE as highly usable and acceptable. Intent-to-treat analyses showed significant treatment×time interactions for the BDI-II (F1,313=13.38; P<.001), GAD-7 (F1,313=5.87; P=.01), RAS (F1,313=23.42; P<.001), RSES (F1,313=19.28; P<.001), and SDS (F1,313=10.73; P=.001). Large effects were observed for the BDI-II (d=0.58), RAS (d=0.61), and RSES (d=0.64); a moderate effect size was observed for the SDS (d=0.44), and a small effect size was observed for the GAD-7 (d=0.20). Similar changes in outcome measures were later observed in the waitlist control group participants following crossover after they received CORE (T2 to T3). Approximately 41.5% (64/154) of participants in the active group and 60.2% (97/161) of participants in the waitlist group were retained at T2, and 33.1% (51/154) of participants in the active group and 40.3% (65/161) of participants in the waitlist group were retained at T3. Conclusions We successfully recruited, screened, randomized, treated, and assessed a geographically dispersed sample of participants with SMI entirely via the web, demonstrating that fully remote clinical trials are feasible in this population; however, study retention remains challenging. CORE showed promise as a usable, acceptable, and effective tool for reducing the severity of psychiatric symptoms and disability while improving recovery and self-esteem. Rapid adoption and real-world dissemination of evidence-based mobile health interventions such as CORE are needed if we are to shorten the science-to-service gap and address the significant unmet mental health needs of people with SMI during the COVID-19 pandemic and beyond. Trial Registration ClinicalTrials.gov NCT04068467; https://clinicaltrials.gov/ct2/show/NCT04068467
Collapse
Affiliation(s)
- Dror Ben-Zeev
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Ayesha Chander
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Justin Tauscher
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Benjamin Buck
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Subigya Nepal
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Guy Doron
- School of Psychology, Interdisciplinary Center, Herzliya, Israel
| |
Collapse
|
5
|
MacLeod L, Suruliraj B, Gall D, Bessenyei K, Hamm S, Romkey I, Bagnell A, Mattheisen M, Muthukumaraswamy V, Orji R, Meier S. A Mobile Sensing App to Monitor Youth Mental Health: Observational Pilot Study. JMIR Mhealth Uhealth 2021; 9:e20638. [PMID: 34698650 PMCID: PMC8579216 DOI: 10.2196/20638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/02/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
Background Internalizing disorders are the most common psychiatric problems observed among youth in Canada. Sadly, youth with internalizing disorders often avoid seeking clinical help and rarely receive adequate treatment. Current methods of assessing internalizing disorders usually rely on subjective symptom ratings, but internalizing symptoms are frequently underreported, which creates a barrier to the accurate assessment of these symptoms in youth. Therefore, novel assessment tools that use objective data need to be developed to meet the highest standards of reliability, feasibility, scalability, and affordability. Mobile sensing technologies, which unobtrusively record aspects of youth behaviors in their daily lives with the potential to make inferences about their mental health states, offer a possible method of addressing this assessment barrier. Objective This study aims to explore whether passively collected smartphone sensor data can be used to predict internalizing symptoms among youth in Canada. Methods In this study, the youth participants (N=122) completed self-report assessments of symptoms of anxiety, depression, and attention-deficit hyperactivity disorder. Next, the participants installed an app, which passively collected data about their mobility, screen time, sleep, and social interactions over 2 weeks. Then, we tested whether these passive sensor data could be used to predict internalizing symptoms among these youth participants. Results More severe depressive symptoms correlated with more time spent stationary (r=0.293; P=.003), less mobility (r=0.271; P=.006), higher light intensity during the night (r=0.227; P=.02), and fewer outgoing calls (r=−0.244; P=.03). In contrast, more severe anxiety symptoms correlated with less time spent stationary (r=−0.249; P=.01) and greater mobility (r=0.234; P=.02). In addition, youths with higher anxiety scores spent more time on the screen (r=0.203; P=.049). Finally, adding passively collected smartphone sensor data to the prediction models of internalizing symptoms significantly improved their fit. Conclusions Passively collected smartphone sensor data provide a useful way to monitor internalizing symptoms among youth. Although the results replicated findings from adult populations, to ensure clinical utility, they still need to be replicated in larger samples of youth. The work also highlights intervention opportunities via mobile technology to reduce the burden of internalizing symptoms early on.
Collapse
Affiliation(s)
- Lucy MacLeod
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Dominik Gall
- Department of Psychology, University of Würzburg, Würzburg, Germany
| | - Kitti Bessenyei
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Sara Hamm
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Isaac Romkey
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Alexa Bagnell
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | | | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
6
|
Shpigelman CN, Tal A, Zisman-Ilani Y. Digital Community Inclusion of Individuals With Serious Mental Illness: A National Survey to Map Digital Technology Use and Community Participation Patterns in the Digital Era. JMIR Ment Health 2021; 8:e28123. [PMID: 34546177 PMCID: PMC8493452 DOI: 10.2196/28123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite the growing interest in developing and using mobile health (mHealth) and digital technologies in mental health, little is known about the scope and nature of virtual community inclusion. OBJECTIVE The overarching goal of this study was to understand and conceptualize virtual community inclusion of individuals with serious mental illness (SMI). Specific objectives of this study were as follows: (1) mapping the prevalence, trends, and experiences related to mHealth and digital technology use among individuals with SMI; (2) comparing patterns of technology use by individuals with and those without SMI; and (3) examining whether use of mHealth and digital technologies predicts recovery among individuals with SMI. METHODS A web-based survey of technology use and virtual participation was developed and distributed among adults with and those without SMI via social media, national email discussion lists, nonprofit organizations, and advocacy groups. RESULTS A total of 381 adults aged 18 years or older participated in the survey, of whom 199 (52%) identified as having a SMI. Participants with SMI reported significantly greater access to technology and significantly fewer days of face-to-face participation in community activities than those without SMI. Among participants with SMI, greater technology use was positively associated with positive emotions and significantly predicted recovery. CONCLUSIONS This study is the first to explore, map, and conceptualize virtual community inclusion among adults with SMI. Our findings indicate a gap in the literature and research on community inclusion and participation, and emphasize the need for virtual community inclusion, particularly during the COVID-19 pandemic and its future implications.
Collapse
Affiliation(s)
- Carmit Noa Shpigelman
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Amir Tal
- Beit Ekstein, Danel Group, Haifa, Israel
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| |
Collapse
|
7
|
Kopelovich SL, Monroe-DeVita M, Buck BE, Brenner C, Moser L, Jarskog LF, Harker S, Chwastiak LA. Community Mental Health Care Delivery During the COVID-19 Pandemic: Practical Strategies for Improving Care for People with Serious Mental Illness. Community Ment Health J 2021; 57:405-415. [PMID: 32562033 PMCID: PMC7304659 DOI: 10.1007/s10597-020-00662-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic has presented a formidable challenge to care continuity for community mental health clients with serious mental illness and for providers who have had to quickly pivot the modes of delivering critical services. Despite these challenges, many of the changes implemented during the pandemic can and should be maintained. These include offering a spectrum of options for remote and in-person care, greater integration of behavioral and physical healthcare, prevention of viral exposure, increased collaborative decision-making related to long-acting injectable and clozapine use, modifying safety plans and psychiatric advance directives to include new technologies and broader support systems, leveraging natural supports, and integration of digital health interventions. This paper represents the authors' collaborative attempt to both reflect the changes to clinical practice we have observed in CMHCs across the US during this pandemic and to suggest how these changes can align with best practices identified in the empirical literature.
Collapse
Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA, 98104, USA.
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Benjamin E Buck
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Carolyn Brenner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Lorna Moser
- Department of Psychiatry, Center of Excellence in Community Mental Health, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - L Fredrik Jarskog
- Department of Psychiatry, North Carolina Psychiatric Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Steve Harker
- Ramsey County ACT and Radias Forensic ACT Team, St. Paul, MN, USA
| | - Lydia A Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
8
|
Ben-Zeev D, Buck B, Meller S, Hudenko WJ, Hallgren KA. Augmenting Evidence-Based Care With a Texting Mobile Interventionist: A Pilot Randomized Controlled Trial. Psychiatr Serv 2020; 71:1218-1224. [PMID: 32631130 PMCID: PMC7708508 DOI: 10.1176/appi.ps.202000239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to evaluate the feasibility and clinical utility of training intensive psychiatric community care team members to serve as "mobile interventionists" who engage patients in recovery-oriented texting exchanges. METHODS A 3-month pilot randomized controlled trial was conducted to compare the mobile interventionist approach as an add-on to assertive community treatment (ACT) versus ACT alone. Participants were 49 individuals with serious mental illness (62% with schizophrenia/schizoaffective disorder, 24% with bipolar disorder, and 14% with depression). Clinical outcomes were evaluated at baseline, posttreatment, and 6-month follow-up, and satisfaction was evaluated posttreatment. RESULTS The intervention appeared feasible (95% of participants assigned to the mobile interventionist arm initiated the intervention, texting on 69% of possible days and averaging four messages per day), acceptable (91% reported satisfaction), and safe (no adverse events reported). Exploratory posttreatment clinical effect estimations suggested greater reductions in the severity of paranoid thoughts (Cohen's d=-0.61) and depression (d=-0.59) and improved illness management (d=0.31) and recovery (d=0.23) in the mobile interventionist group. CONCLUSIONS Augmentation of care with a texting mobile interventionist proved to be feasible, acceptable, safe, and clinically promising. The findings are encouraging given the relative ease of training practitioners to serve as mobile interventionists, the low burden placed on patients and practitioners, and the simplicity of the technology. The technical resources are widely accessible to patients and practitioners, boding well for potential intervention scalability. When pandemics such as COVID-19 block the possibility of in-person patient-provider contact, evidence-based texting interventions can serve a crucial role in supporting continuity of care.
Collapse
Affiliation(s)
- Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Benjamin Buck
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Suzanne Meller
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - William J Hudenko
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| |
Collapse
|
9
|
Yu Y, Li Y, Li T, Xi S, Xiao X, Xiao S, Tebes JK. New Path to Recovery and Well-Being: Cross-Sectional Study on WeChat Use and Endorsement of WeChat-Based mHealth Among People Living With Schizophrenia in China. J Med Internet Res 2020; 22:e18663. [PMID: 32945774 PMCID: PMC7532456 DOI: 10.2196/18663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/02/2020] [Accepted: 08/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background The past few decades have seen an exponential increase in using mobile phones to support medical care (mobile health [mHealth]) among people living with psychosis worldwide, yet little is known about WeChat use and WeChat-based mHealth among people living with schizophrenia (PLS) in China. Objective This study aims to assess WeChat use, endorsement of WeChat-based mHealth programs, and health related to WeChat use among PLS. Methods We recruited a random sample of 400 PLS from 12 communities in Changsha City of Hunan Province, China. WeChat use was assessed using the adapted WeChat Use Intensity Questionnaire (WUIQ). We also compared psychiatric symptoms, functioning, disability, recovery, quality of life, and general well-being between WeChat users and nonusers using one-to-one propensity-score matching. Results The WeChat use rate was 40.8% in this sample (163/400); 30.7% (50/163) had more than 50 WeChat friends and nearly half (81/163, 49.7%) spent more than half an hour on WeChat, a pattern similar to college students and the elderly. PLS also showed higher emotional connectedness to WeChat use than college students. About 80.4% (131/163) of PLS were willing to participate in a WeChat-based mHealth program, including psychoeducation (91/163, 55.8%), professional support (82/163, 50.3%), and peer support (67/163, 41.1%). Compared with nonusers, WeChat users were younger, better educated, and more likely to be employed. WeChat use was associated with improved health outcomes, including lower psychiatric symptoms, lower depression, higher functioning, better recovery, and higher quality of life. Conclusions WeChat-based mHealth programs hold promise as an empowering tool to provide cost-effective interventions, to foster global recovery, and to improve both physical and mental well-being among PLS. WeChat and WeChat-based mHealth programs have the potential to offer a new path to recovery and well-being for PLS in China.
Collapse
Affiliation(s)
- Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tongxin Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shijun Xi
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xi Xiao
- Department of Psychiatry, Changsha Psychiatric Hospital, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jacob Kraemer Tebes
- Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
10
|
Choi WT, Yu DK, Wong T, Lantta T, Yang M, Välimäki M. Habits and Attitudes of Video Gaming and Information Technology Use in People with Schizophrenia: Cross-Sectional Survey. J Med Internet Res 2020; 22:e14865. [PMID: 32459646 PMCID: PMC7407262 DOI: 10.2196/14865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 03/25/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
Background Information technology and video gaming have potential advantages in the treatment of schizophrenia. However, information regarding the habits and attitudes related to internet use and video gaming in people with schizophrenia is limited. Objective The aim of this study was to explore the habits and attitudes regarding video gaming and information technology usage and their associated factors in people with schizophrenia in Hong Kong. Methods In this cross-sectional survey, service users with schizophrenia were recruited from 6 halfway hostels and 7 integrated centers for mental wellness in Hong Kong. A 79-item self-report questionnaire was utilized to explore the habits of internet use and video gaming in these people with schizophrenia. The attitude toward video gaming was assessed using the Gaming Attitudes, Motivations, and Experiences Scales. Of the 148 individuals in a convenience sample who were invited to participate in this study, 110 willingly participated (a response rate of 74.3%). The data were analyzed using descriptive statistics, a two-tailed independent t test, Pearson correlation, and principal analysis with 3 methods of rotation (varimax, equimax, and promax). Results Most participants (100/110, 90.9%) had access to the internet and half of them (54/110, 49.1%) used the internet daily mostly to watch videos (66/110, 60.0%) or read news or books, etc (42/110, 38.2%). One-third of the participants (36/110, 32.7%) used the internet to play web-based games, and most of them (88/110, 80.0%) had played a video game in the past year. The most favorable gaming platforms were cellular phones (43/88, 49%) followed by computers (19/88, 22%) and arcade cabinets (6/88, 7%). The most favorable game genre was action games (34/145, 23.4%). Those who had a bachelor’s degree or higher scored lower in social interaction than those with a lower education level (P=.03). Those who played video games daily scored higher in the category of story than those who did not play daily (t86=2.03, P=.05). The most popular gaming category was autonomy and the least popular categories were violent catharsis and violent reward. Two motives, “social playing” and “evasive playing,” were formed to describe the characteristics of playing video games. Conclusions Our data showed a high internet utilization rate among people with schizophrenia in Hong Kong. Only a few of them used the internet to search for health-related information. Our study also exemplified the unique habits of gaming among the participants. Health care professionals could utilize video games to engage people with schizophrenia and promote coping with stress and provide social skills training to such people with schizophrenia. Identification of the gaming attitudes can contribute to the development of serious games for the schizophrenic population. Further investigation is vital for the promotion of mental health through web-based platforms.
Collapse
Affiliation(s)
- William Th Choi
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Dan Ks Yu
- The Mental Health Association of Hong Kong, Hong Kong, Hong Kong
| | - Terry Wong
- New Life Psychiatric Rehabilitation Association, Hong Kong, Hong Kong
| | - Tella Lantta
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Min Yang
- West China School of Public Health, Sichuan University Huaxi Medical Center, Sichuan, China.,Faculty of Health, Design and Art, Swinburne University of Technology, Melbourne, Australia
| | - Maritta Välimäki
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.,Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| |
Collapse
|
11
|
Wisiewski H, Torous J. Digital navigators to implement smartphone and digital tools in care. Acta Psychiatr Scand 2020; 141:350-355. [PMID: 31930477 PMCID: PMC7928068 DOI: 10.1111/acps.13149] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
While smartphone apps and other digital health tools have the clear potential to increase both quality of and access to care, actual successful implementation remains limited. Challenges often encountered in seeking to use apps in care include selecting safe/effective tools, spending clinical time troubleshooting technology instead of discussing health matters, and lack of time to check and review constant streams of data these digital tools can produce. In this 'From Research to Clinical Practice' piece, we focus on how a new care team member, the digital navigator, can help overcome these barriers through conducting evidence-based app evaluation to help in selecting the right apps, troubleshooting technology outside of visits to improve the therapeutic alliance during, and finally summarizing digital data to facilitate clinical care that focus on actionable data.
Collapse
Affiliation(s)
- Hannah Wisiewski
- Division of Digital Psychiatry. Department of Psychiatry. Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA, 02446
| | - John Torous
- Division of Digital Psychiatry. Department of Psychiatry. Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA, 02446
| |
Collapse
|
12
|
Abstract
There is growing interest in digital mental health as well as accumulating evidence of the potential for technology-based tools to augment traditional mental health services and to potentially overcome barriers to access and use of mental health services. Our research group has examined how people with mental illnesses think about and make use of technology in their everyday lives as a means to provide insight into the emerging paradigm of digital mental health. This research has been guided by anthropological approaches that emphasise lived experience and underscore the complexity of psychiatric recovery. In this commentary I describe how an anthropological approach has motivated us to ask how digital technology can be leveraged to promote meaningful recovery for people with mental illnesses and to develop a new approach to the integration of technology-based tools for people with mental illnesses.
Collapse
|
13
|
Noel VA, Carpenter-Song E, Acquilano SC, Torous J, Drake RE. The technology specialist: a 21st century support role in clinical care. NPJ Digit Med 2019; 2:61. [PMID: 31388565 PMCID: PMC6594932 DOI: 10.1038/s41746-019-0137-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/05/2019] [Indexed: 11/17/2022] Open
Abstract
Mental health clinicians, clients, and researchers have shown keen interest in using technology to support mental health recovery. However, technology has not been routinely integrated into clinical care. Clients use a wide range of digital tools and apps to help manage their mental health, but clinicians rarely discuss this form of self-management in clinical interactions. This absence of communication is concerning because the safety and quality of the digital tools and apps people use may negatively affect their mental health outcomes. Mental health systems could benefit from someone to help identify technology-based supports that reflect current evidence and minimize privacy and security concerns. This technology specialist may also enhance the therapeutic bond between the client and the clinician. In working with a technology specialist, clients may begin to gain a sense of control over their mental health, and perhaps use fewer mental health services.
Collapse
Affiliation(s)
| | | | - Stephanie C Acquilano
- 3The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
| | - John Torous
- 4Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Robert E Drake
- 1Westat, Inc., Lebanon, NH USA.,3The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
| |
Collapse
|
14
|
Torous J, Wisniewski H, Bird B, Carpenter E, David G, Elejalde E, Fulford D, Guimond S, Hays R, Henson P, Hoffman L, Lim C, Menon M, Noel V, Pearson J, Peterson R, Susheela A, Troy H, Vaidyam A, Weizenbaum E, Naslund JA, Keshavan M. Creating a Digital Health Smartphone App and Digital Phenotyping Platform for Mental Health and Diverse Healthcare Needs: an Interdisciplinary and Collaborative Approach. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s41347-019-00095-w] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|