Digital Health Interventions for Depression and Anxiety Among People With Chronic Conditions: Scoping Review

Digital Technologies and Artificial Intelligence in Cardiac Rehabilitation: A Narrative Review

PURPOSE

This review explores the role and impact of digital technology in cardiac rehabilitation (CR), assessing its potential to enhance patient outcomes and address barriers to CR delivery.

REVIEW METHODS

A comprehensive literature search was conducted using curated search terms to target CR studies using digital technologies as an adjunct to in-person CR or as part of remote (ie, asynchronous) or virtual (ie, synchronous audiovisual communication) formats. The literature search focused on studies that evaluated the implementation and efficacy of using digital technologies within CR.

SUMMARY

Digital technology offers significant opportunities to improve CR by providing flexible and scalable solutions that can overcome traditional barriers to CR such as accessibility and capacity constraints. Remote or virtual CR delivery that incorporates digital technologies improves CR adherence and achieves similar improvements in exercise capacity when compared to in-person CR. While the majority of studies have focused on exercise, digital technologies are increasingly used to deliver comprehensive CR solutions as part of remote and virtual CR programs. However, challenges and gaps in the literature remain, such as the impact of digital literacy and promoting equitable CR access, particularly in high-risk and vulnerable populations. Further research needs to focus on longer term outcomes to evaluate the safety, efficacy, and cost-effectiveness of digital CR interventions. The potential of digital health to transform CR and reduce the burden of cardiovascular disease is substantial and warrants further investigation.

Basic activities of daily living symptoms as central and bridging symptoms in the networks of functional and psychological disorders among older adults with different chronic disease patterns

OBJECTIVE

To examine chronic disease patterns and analyze the interrelations among Basic Activities of Daily Living, Instrumental Activities of Daily Living, anxiety, and depression in older adults.

METHODS

A total of 3,454 participants diagnosed with at least one chronic disease were included. Latent class analysis and network analysis were employed to analyze the data.

RESULTS

Four chronic disease patterns were identified: "Cardiopulmonary Health with Few Comorbidities," "Cardiovascular with Few Comorbidities," "Cardiovascular with Multiple Comorbidities," and "Respiratory with Few Comorbidities". "Indoor transferring" was identified as a central symptom, while "bathing" as a bridging one across the four chronic disease pattern networks.

CONCLUSION

Basic Activities of Daily Living symptoms emerged as central and bridging symptoms within the networks of functional and psychological disorders across diverse chronic disease patterns. Future research should further investigate interventions targeting these symptoms to assess their potential for enhancing overall network health among older adults.

Randomized clinical trial of a digital integrative medicine intervention among patients undergoing active cancer treatment

Exercise and mindfulness-based interventions have growing evidence for managing fatigue and comorbid symptoms; however, packaging them in a cohesive digital way for patients undergoing cancer treatment has not been evaluated. We conducted a randomized controlled trial to assess the impact of a 12 week digital integrative medicine program, Integrative Medicine at Home (IM@Home), versus enhanced usual care on fatigue severity (primary outcome), comorbid symptoms and acute healthcare utilization (secondary outcomes), in 200 patients with solid tumors experiencing fatigue during treatment. Fatigue severity decreased more in IM@Home than in the control (1.99 vs. 1.51 points; p = 0.04). IM@Home participants also had reduced symptom distress (p = 0.003), anxiety (p = 0.03), and depression (p = 0.02). Acute healthcare utilization was lower with IM@Home, with fewer emergency department visits (rate ratio 0.49; p = 0.04), hospitalizations (4% vs. 12.9%; p = 0.03), and shorter hospital stays (4.25 vs. 10 days; p < 0.001). These promising findings should be confirmed in phase III clinical trials. "Study registered at clinicaltrials.gov (NCT05053230) on 09-20-2021".

Clinical Health Psychology Perspectives in Diabetes Care: A Retrospective Cohort Study Examining the Role of Depression in Adherence to Visits and Examinations in Type 2 Diabetes Management

BACKGROUND

Depression in type 2 diabetes mellitus (T2DM) impacts glycemic control and complications. This study examines the influence of depression on compliance with recommended annual diabetes assessments in patients within the Local Healthcare Authority of Romagna. From a clinical health psychology perspective, understanding how depression influences patients' engagement in managing their conditions is crucial. This insight can help improve healthcare services by ensuring they address mental health needs and thereby enhance treatment effectiveness and overall patient outcomes.

METHODS

This retrospective cohort study included residents of Romagna with incident T2DM from 2015 to 2017, followed from 1 January 2018 to 31 December 2022. Depression was identified via hospital discharge records or antidepressant prescriptions. Adherence to diabetes care guidelines was measured using the Guideline Composite Indicator (GCI).

RESULTS

The study included 13,285 patients, with a mean age of 61.1 years. Prevalence of post-diabetes depression increased from 3.0% in 2018 to 8.9% in 2022. Initial analyses showed higher GCI rates among patients with depression. However, propensity-score adjustment revealed that by 2021-2022, patients with pre-diabetes depression had 5% lower compliance rates (p-value ≤ 0.05). Older adults with depression had reduced adherence, while younger adults with post-diabetes depression had higher adherence rates.

CONCLUSIONS

Depression significantly affects adherence to diabetes care guidelines in T2DM patients, particularly among older adults. Integrated care models addressing both diabetes and depression are crucial for improving health outcomes.

A chatbot based question and answer system for the auxiliary diagnosis of chronic diseases based on large language model

In recent years, artificial intelligence has made remarkable strides, improving various aspects of our daily lives. One notable application is in intelligent chatbots that use deep learning models. These systems have shown tremendous promise in the medical sector, enhancing healthcare quality, treatment efficiency, and cost-effectiveness. However, their role in aiding disease diagnosis, particularly chronic conditions, remains underexplored. Addressing this issue, this study employs large language models from the GPT series, in conjunction with deep learning techniques, to design and develop a diagnostic system targeted at chronic diseases. Specifically, performed transfer learning and fine-tuning on the GPT-2 model, enabling it to assist in accurately diagnosing 24 common chronic diseases. To provide a user-friendly interface and seamless interactive experience, we further developed a dialog-based interface, naming it Chat Ella. This system can make precise predictions for chronic diseases based on the symptoms described by users. Experimental results indicate that our model achieved an accuracy rate of 97.50% on the validation set, and an area under the curve (AUC) value reaching 99.91%. Moreover, conducted user satisfaction tests, which revealed that 68.7% of participants approved of Chat Ella, while 45.3% of participants found the system made daily medical consultations more convenient. It can rapidly and accurately assess a patient's condition based on the symptoms described and provide timely feedback, making it of significant value in the design of medical auxiliary products for household use.

Effect of Implementing an Informatization Case Management Model on the Management of Chronic Respiratory Diseases in a General Hospital: Retrospective Controlled Study

Background

The use of chronic disease information systems in hospitals and communities plays a significant role in disease prevention, control, and monitoring. However, there are several limitations to these systems, including that the platforms are generally isolated, the patient health information and medical resources are not effectively integrated, and the "Internet Plus Healthcare" technology model is not implemented throughout the patient consultation process.

Objective

The aim of this study was to evaluate the efficiency of the application of a hospital case management information system in a general hospital in the context of chronic respiratory diseases as a model case.

Methods

A chronic disease management information system was developed for use in general hospitals based on internet technology, a chronic disease case management model, and an overall quality management model. Using this system, the case managers provided sophisticated inpatient, outpatient, and home medical services for patients with chronic respiratory diseases. Chronic respiratory disease case management quality indicators (number of managed cases, number of patients accepting routine follow-up services, follow-up visit rate, pulmonary function test rate, admission rate for acute exacerbations, chronic respiratory diseases knowledge awareness rate, and patient satisfaction) were evaluated before (2019-2020) and after (2021-2022) implementation of the chronic disease management information system.

Results

Before implementation of the chronic disease management information system, 1808 cases were managed in the general hospital, and an average of 603 (SD 137) people were provided with routine follow-up services. After use of the information system, 5868 cases were managed and 2056 (SD 211) patients were routinely followed-up, representing a significant increase of 3.2 and 3.4 times the respective values before use (U=342.779; P<.001). With respect to the quality of case management, compared to the indicators measured before use, the achievement rate of follow-up examination increased by 50.2%, the achievement rate of the pulmonary function test increased by 26.2%, the awareness rate of chronic respiratory disease knowledge increased by 20.1%, the retention rate increased by 16.3%, and the patient satisfaction rate increased by 9.6% (all P<.001), while the admission rate of acute exacerbation decreased by 42.4% (P<.001) after use of the chronic disease management information system.

Conclusions

Use of a chronic disease management information system improves the quality of chronic respiratory disease case management and reduces the admission rate of patients owing to acute exacerbations of their diseases.

Feasibility and utility of mobile health interventions for depression and anxiety in rural populations: A scoping review

Despite the potential of mobile health (mHealth) to address high rates of depression and anxiety in underserved rural communities, most mHealth interventions do not explicitly consider the realities of rural life. The aim of this scoping review is to identify and examine the available literature on mHealth interventions that consider the needs of rural populations in order to gauge their feasibility and utility for addressing depression and anxiety. Additionally, we provide an overview of rural users' perceptions about and preferences for mHealth-delivered mental health screening and intervention systems. Out of 169 articles identified, 16 met inclusion criteria. Studies were conducted across a wide range of countries, age groups, and rural subpopulations including individuals with bipolar disorder, anxiety, perinatal depression, PTSD, and chronic pain, as well as refugees, veterans, and transgender and LGBTQ+ individuals. All interventions were in the feasibility/acceptability testing stage for rural users. Identified strengths included their simplicity, accessibility, convenience, availability of support between sessions with providers, and remote access to a care team. Weaknesses included problems with charging phone batteries and exceeding data limits, privacy concerns, and general lack of comfort with app-based support. Based upon this review, we provide recommendations for future mHealth intervention development including the value of developer-user coproduction methods, the need to consider user variation in access to and comfort with smartphones, and potential data or connectivity limitations, mental health stigma, and confidentiality concerns in rural communities.

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.

Strategies for coping with stress in mothers of children with atopic dermatitis - a cross-sectional study

Introduction

Our previous study showed that the severity of atopic dermatitis (AD) in children significantly correlates with the quality of life and perceived stress in their mothers.

Aim

To compare strategies for coping with stress in mothers of children with and without AD, as well as to investigate the relationship between coping strategies of mothers of affected children and AD variables, stress intensity, and quality of life.

Material and methods

The study included 88 mothers of children with AD and 57 mothers of children without AD as controls. The severity of skin lesions in children with AD was assessed by the Scoring Atopic Dermatitis (SCORAD) index, and skin itch was evaluated by the Numerical Rating Scale (NRS). All mothers completed the sociodemographic questionnaire (SD), the Perceived Stress Scale (PSS), and the Coping Orientations to Problems Experienced (COPE) scale. Additionally, mothers of children with AD filled out the Family Dermatology Life Quality Index (FDLQI).

Results

There were no statistically significant differences in coping strategies between the groups. However, there were significant correlations between the selected coping strategies and AD severity, perceived stress of mothers, and quality of life of the entire family of affected children.

Conclusions

Although mothers of children with AD experience higher levels of stress compared with mothers of children without AD, the disease does not change coping strategies. Psychological support for mothers of children with AD should be oriented toward strengthening cognitive coping strategies.

Implementation of digital home monitoring and management of respiratory disease

PURPOSE OF REVIEW

Digital respiratory monitoring interventions (e.g. smart inhalers and digital spirometers) can improve clinical outcomes and/or organizational efficiency, and the focus is shifting to sustainable implementation as an approach to delivering respiratory care. This review considers key aspects of the technology infrastructure, discusses the regulatory, financial and policy context that influence implementation, and highlights the over-arching societal themes of equity, trust and communication.

RECENT FINDINGS

Technological requirements include developing interoperable and connected systems; establishing stable, wide internet coverage; addressing data accuracy and monitoring adherence; realising the potential of artificial intelligence; and avoiding clinician data overload. Policy challenges include concerns about quality assurance and increasingly complex regulatory systems. Financial barriers include lack of clarity over cost-effectiveness, budget impact and reimbursement. Societal concerns focus on the potential to increase inequities because of poor e-health literacy, deprivation or lack of available infrastructure, the need to understand the implications for patient/professional interactions of shifting care to remote delivery and ensuring confidentiality of personal data.

SUMMARY

Understanding and addressing the implementation challenges posed by gaps in policy, regulatory, financial, and technical infrastructure is essential to support delivery of equitable respiratory care that is acceptable to patients and professionals.

Examining Patient Engagement in Chatbot Development Approaches for Healthy Lifestyle and Mental Wellness Interventions: Scoping Review

BACKGROUND

Chatbots are growing in popularity as they offer a range of potential benefits to end users and service providers.

OBJECTIVE

Our scoping review aimed to explore studies that used 2-way chatbots to support healthy eating, physical activity, and mental wellness interventions. Our objectives were to report the nontechnical (eg, unrelated to software development) approaches for chatbot development and to examine the level of patient engagement in these reported approaches.

METHODS

Our team conducted a scoping review following the framework proposed by Arksey and O'Malley. Nine electronic databases were searched in July 2022. Studies were selected based on our inclusion and exclusion criteria. Data were then extracted and patient involvement was assessed.

RESULTS

16 studies were included in this review. We report several approaches to chatbot development, assess patient involvement where possible, and reveal the limited detail available on reporting of patient involvement in the chatbot implementation process. The reported approaches for development included: collaboration with knowledge experts, co-design workshops, patient interviews, prototype testing, the Wizard of Oz (WoZ) procedure, and literature review. Reporting of patient involvement in development was limited; only 3 of the 16 included studies contained sufficient information to evaluate patient engagement using the Guidance for Reporting Involvement of Patients and Public (GRIPP2).

CONCLUSIONS

The approaches reported in this review and the identified limitations can guide the inclusion of patient engagement and the improved documentation of engagement in the chatbot development process for future health care research. Given the importance of end user involvement in chatbot development, we hope that future research will more systematically report on chatbot development and more consistently and actively engage patients in the codevelopment process.