Attitudes towards Risk Prediction in a Help Seeking Population of Early Detection Centers for Mental Disorders-A Qualitative Approach

Ethical and social issues in prediction of risk of severe mental illness: a scoping review and thematic analysis

BACKGROUND

Over the last decade, there has been considerable development in precision psychiatry, especially in the development of novel prediction tools that can be used for early prediction of the risk of developing a severe mental disorder such as schizophrenia, depression, bipolar disorder. Although the clinical efficiency of those tools is still unclear it is crucial to consider the future ethical and social consequences of their clinical use before they are used in clinical practice. The literature on this issue is rapidly growing and represents input from scholars from different fields-psychiatrists, bioethicists etc. However, to our knowledge, nobody has produced a review addressing these issues. Therefore, the present study aims to bridge the gap.

METHODS

We conducted a scoping review, allowing integration of both empirical and non-empirical studies. The research question addressed is: what are the ethical and social issues raised by the potential use of predictive tools for the risk of developing of severe mental disorder identified in the existing empirical and theoretical literature? After developing the search terms, we conducted a search in three electronic databases: Scopus, Web of Science and PubMed. For the included articles bibliometric analysis and inductive thematic coding was performed. To ensure the transparency and rigour of this scoping review we followed he Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A qualitative inductive thematic analysis of the included articles was performed using Atlas.ti.

RESULTS

After screening, evaluation for eligibility and citation tracing 129 publications were included in the scoping review. The articles represent a wide range of fields of research-clinical psychology, general medicine, neuroscience, genetics, clinical genetics, psychiatry and mental health, philosophy, ethics, etc. The majority of the articles (83) are theoretical studies, 35 papers report results of empirical research and 11 are review papers. Qualitative thematic analysis of the included articles revealed four main themes: 1) Potential benefits and harms; 2) Rights and responsibilities; 3) Counselling, education and communication; 4) Ethical issues in different applications.

CONCLUSIONS

The articles included in the review cover a wide variety of concerns that might be raised when implementing predictive tools for the risk of developing of severe mental disorder. However, some important gaps in the literature are indicated. First, there are issues that should deserve more attention than they have received thus far (clinical utility, extensive or mandatory use). In several cases there is no empirical knowledge that determines whether particular concerns are justified (stigmatisation, use of machine learning algorithms).

No prediction without prevention: A global qualitative study of attitudes toward using a prediction tool for risk of developing depression during adolescence

Given the rate of advancement in predictive psychiatry, there is a threat that it outpaces public and professional willingness for use in clinical care and public health. Prediction tools in psychiatry estimate the risk of future development of mental health conditions. Prediction tools used with young populations have the potential to reduce the worldwide burden of depression. However, little is known globally about adolescents' and other stakeholders' attitudes toward use of depression prediction tools. To address this, key informant interviews and focus group discussions were conducted in Brazil, Nepal, Nigeria and the United Kingdom with 23 adolescents, 45 parents, 47 teachers, 48 health-care practitioners and 78 other stakeholders (total sample = 241) to assess attitudes toward using a depression prediction risk calculator based on the Identifying Depression Early in Adolescence Risk Score. Three attributes were identified for an acceptable depression prediction tool: it should be understandable, confidential and actionable. Understandability includes depression literacy and differentiating between having a condition versus risk of a condition. Confidentiality concerns are disclosing risk and impeding educational and occupational opportunities. Prediction results must also be actionable through prevention services for high-risk adolescents. Six recommendations are provided to guide research on attitudes and preparedness for implementing prediction tools.

'The lights are on, and the doors are always open': a qualitative study to understand challenges underlying the need for emergency care in people experiencing homelessness in rural and coastal North East England

Introduction

People experiencing homelessness have high rates of emergency care attendance compared with the general population. This study explores the factors underlying the need for emergency care services among people experiencing homelessness in rural and coastal areas of North East England.

Methods

The study was conducted in Northumberland and North Tyneside (North East England). One-to-one semistructured interviews were conducted with people experiencing homelessness. Interviews and focus groups were undertaken with frontline staff from housing associations, police, ambulance services, emergency care, primary healthcare, mental health services and alcohol and drug recovery services. Discussions centred on emergency care experiences, reasons for access and underlying health and social needs.

Results

Participants included 20 people experiencing homelessness (aged 18-56, 70% male) and 18 service professionals (aged 20-56, 56% female). Emergency care was often viewed by participants as an accessible safe place. Four key themes were found in this rural and coastal context: accessibility challenges due to limited public transport and geographic isolation; fragmented support exacerbated by widely dispersed services; service restrictions and limited alternatives having particular impact where options are few and prioritisation of immediate needs influenced by limited local resources.

Conclusion

Challenges in accessing primary healthcare and social care, alongside varying levels of timely support and understanding of individual contexts, can contribute to the increased use of emergency care for people experiencing homelessness in rural and coastal areas. Integrating services with a focus on flexibility could be crucial for addressing the needs of these populations. This involves adapting to the unique circumstances of multiple deprived groups who lack access to community support.

Ethical considerations for precision psychiatry: A roadmap for research and clinical practice

Precision psychiatry is an emerging field with transformative opportunities for mental health. However, the use of clinical prediction models carries unprecedented ethical challenges, which must be addressed before accessing the potential benefits of precision psychiatry. This critical review covers multidisciplinary areas, including psychiatry, ethics, statistics and machine-learning, healthcare and academia, as well as input from people with lived experience of mental disorders, their family, and carers. We aimed to identify core ethical considerations for precision psychiatry and mitigate concerns by designing a roadmap for research and clinical practice. We identified priorities: learning from somatic medicine; identifying precision psychiatry use cases; enhancing transparency and generalizability; fostering implementation; promoting mental health literacy; communicating risk estimates; data protection and privacy; and fostering the equitable distribution of mental health care. We hope this blueprint will advance research and practice and enable people with mental health problems to benefit from precision psychiatry.

A Vision of Future Healthcare: Potential Opportunities and Risks of Systems Medicine from a Citizen and Patient Perspective-Results of a Qualitative Study

Advances in (bio)medicine and technological innovations make it possible to combine high-dimensional, heterogeneous health data to better understand causes of diseases and make them usable for predictive, preventive, and precision medicine. This study aimed to determine views on and expectations of “systems medicine” from the perspective of citizens and patients in six focus group interviews, all transcribed verbatim and content analyzed. A future vision of the use of systems medicine in healthcare served as a stimulus for the discussion. The results show that although certain aspects of systems medicine were seen positive (e.g., use of smart technology, digitalization, and networking in healthcare), the perceived risks dominated. The high degree of technification was perceived as emotionally burdensome (e.g., reduction of people to their data, loss of control, dehumanization). The risk-benefit balance for the use of risk-prediction models for disease events and trajectories was rated as rather negative. There were normative and ethical concerns about unwanted data use, discrimination, and restriction of fundamental rights. These concerns and needs of citizens and patients must be addressed in policy frameworks and health policy implementation strategies to reduce negative emotions and attitudes toward systems medicine and to take advantage of its opportunities.