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Anmella G, Primé-Tous M, Segú X, Solanes A, Ruíz V, Martín-Villalba I, Morilla I, Also-Fontanet A, Sant E, Murgui S, Sans-Corrales M, Murru A, Zahn R, Young AH, Vicens V, Viñas-Bardolet C, Martínez-Cerdá JF, Blanch J, Radua J, Fullana MÀ, Cavero M, Vieta E, Hidalgo-Mazzei D. PRimary carE digital Support ToOl in mental health (PRESTO): Design, development and study protocols. Span J Psychiatry Ment Health 2024; 17:114-125. [PMID: 33933665 DOI: 10.1016/j.rpsm.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/22/2021] [Accepted: 04/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND About 30-50% of Primary Care (PC) users in Spain suffer mental health problems, mostly mild to moderate anxious and depressive symptoms, which account for 2% of Spain's total Gross domestic product and 50% of the costs associated to all mental disorders. Mobile health tools have demonstrated to cost-effectively reduce anxious and depressive symptoms while machine learning (ML) techniques have shown to accurately detect severe cases. The main aim of this project is to develop a comprehensive ML digital support platform (PRESTO) to cost-effectively screen, assess, triage, and provide personalized treatments for anxious and depressive symptoms in PC. METHODS The project will be carried out in 3 complementary phases: First, a ML predictive severity model will be built based on all the cases referred to the PC mental health support programme during the last 5 years in Catalonia. Simultaneously, a smartphone app to monitor and deliver psychological interventions for anxiety and depressive symptoms will be developed and tested in a clinical trial. Finally, the ML models and the app will be integrated in a comprehensive decision-support platform (PRESTO) which will triage and assign to each patient a specific intervention based on individual personal and clinical characteristics. The effectiveness of PRESTO to reduce waiting times in receiving mental healthcare will be tested in a stepped-wedge cluster randomized controlled trial in 5 PC centres. DISCUSSION PRESTO will offer timely and personalized cost-effective mental health treatment to people with mild to moderate anxious and depressive symptoms. This will result in a reduction of the burden of mental health problems in PC and on society as a whole. TRIAL REGISTRATION The project and their clinical trials were registered in Clinical Trials.gov: NCT04559360 (September 2020).
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Affiliation(s)
- Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Mireia Primé-Tous
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - Xavier Segú
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - Aleix Solanes
- Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Victoria Ruíz
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - Inés Martín-Villalba
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - Ivette Morilla
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain
| | - Antonieta Also-Fontanet
- CAP Casanova, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Catalonia, Spain
| | - Elisenda Sant
- CAP Casanova, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Catalonia, Spain
| | - Sandra Murgui
- CAP Borrell, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Catalonia, Spain
| | - Mireia Sans-Corrales
- CAP Borrell, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Catalonia, Spain
| | - Andrea Murru
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Roland Zahn
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Victor Vicens
- Chief Medical Officer and co-founder of Abi Global Health, Spain
| | - Clara Viñas-Bardolet
- Data Analytics Programme for Health Research and Innovation (PADRIS) from the Catalan Agency for Health Quality and Evaluation (AQuAS), Catalonia, Spain
| | - Juan Francisco Martínez-Cerdá
- Data Analytics Programme for Health Research and Innovation (PADRIS) from the Catalan Agency for Health Quality and Evaluation (AQuAS), Catalonia, Spain
| | - Jordi Blanch
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Chief Medical Officer and co-founder of Abi Global Health, Spain; Director of the Mental Health and Addiction Programme, Department of Health, Generalitat de Catalunya, Spain; President of the European Association of Psychosomatic Medicine, Spain
| | - Joaquim Radua
- Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Miquel-Àngel Fullana
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Myriam Cavero
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain; Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; University of Barcelona, Barcelona, Catalonia, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
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Anmella G, Sanabra M, Primé-Tous M, Segú X, Solanes A, Ruíz V, Morilla I, Also Fontanet A, Sant E, Murgui S, Sans-Corrales M, Martínez-Aran A, Fico G, De Prisco M, Oliva V, Murru A, Zahn R, Young AH, Vicens V, Viñas-Bardolet C, Aparicio-Nogué V, Martínez-Cerdá JF, Mas A, Carreras B, Blanch J, Radua J, Fullana MA, Cavero M, Vieta E, Hidalgo-Mazzei D. Antidepressants overuse in primary care: Prescription trends between 2010 and 2019 in Catalonia. Rev Psiquiatr Salud Ment 2022:S1888-9891(22)00137-9. [PMID: 37758595 DOI: 10.1016/j.rpsm.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/17/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION There has been an increase in the prescription of antidepressants (AD) in primary care (PC). However, it is unclear whether this was explained by a rise in diagnoses with an indication for AD. We investigated the changes in frequency and the variables associated with AD prescription in Catalonia, Spain. METHODS We retrieved AD prescription, sociodemographic, and health-related data using individual electronic health records from a population-representative sample (N=947.698) attending PC between 2010 and 2019. Prescription of AD was calculated using DHD (Defined Daily Doses per 1000 inhabitants/day). We compared cumulative changes in DHD with cumulative changes in diagnoses with an indication for AD during the study period. We used Poisson regression to examine sociodemographic and health-related variables associated with AD prescription. RESULTS Both AD prescription and mental health diagnoses with an indication for AD gradually increased. At the end of the study period, DHD of AD prescriptions and mental health diagnoses with an indication for AD reached cumulative increases of 404% and 49% respectively. Female sex (incidence rate ratio (IRR)=2.83), older age (IRR=25.43), and lower socio-economic status (IRR=1.35) were significantly associated with increased risk of being prescribed an AD. CONCLUSIONS Our results from a large and representative cohort of patients confirm a steady increase of AD prescriptions that is not explained by a parallel increase in mental health diagnoses with an indication for AD. A trend on AD off-label and over-prescriptions in the PC system in Catalonia can be inferred from this dissociation.
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Affiliation(s)
- Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Miriam Sanabra
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia Primé-Tous
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xavier Segú
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aleix Solanes
- Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Victoria Ruíz
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ivette Morilla
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonieta Also Fontanet
- CAP Casanova, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Elisenda Sant
- CAP Casanova, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Sandra Murgui
- CAP Comte Borrell, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Mireia Sans-Corrales
- CAP Comte Borrell, Consorci d'Atenció Primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Anabel Martínez-Aran
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Giovanna Fico
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Michele De Prisco
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Vincenzo Oliva
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Andrea Murru
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Roland Zahn
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Clara Viñas-Bardolet
- Data Analytics Programme for Health Research and Innovation (PADRIS), Catalan Agency for Health Quality and Evaluation (AQuAS), Barcelona, Spain
| | - Vicenç Aparicio-Nogué
- Data Analytics Programme for Health Research and Innovation (PADRIS), Catalan Agency for Health Quality and Evaluation (AQuAS), Barcelona, Spain
| | - Juan Francisco Martínez-Cerdá
- Data Analytics Programme for Health Research and Innovation (PADRIS), Catalan Agency for Health Quality and Evaluation (AQuAS), Barcelona, Spain
| | - Ariadna Mas
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Bernat Carreras
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Blanch
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Abi Global Health, Spain; Mental Health and Addiction Programme, Department of Health, Generalitat de Catalunya, Barcelona, Spain; President of the European Association of Psychosomatic Medicine, Spain
| | - Joaquim Radua
- Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Miquel A Fullana
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Myriam Cavero
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Eduard Vieta
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
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