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Anmella G, Sanabra M, Primé-Tous M, Segú X, Cavero M, Morilla I, Ruiz V, Grande I, Mas A, Martín-Villalba I, Caballo A, Esteva JP, Rodríguez-Rey A, Piazza F, Valdesoiro FJ, Rodriguez-Torrella C, Espinosa M, Sorroche C, Virgili G, Ruiz A, Solanes A, Radua J, Also MA, Sant E, Murgui S, Sans-Corrales M, H Young A, Vicens V, Blanch J, Caballeria E, López-Pelayo H, López C, Olivé V, Pujol L, Quesada S, Solé B, Martínez-Aran A, Torrent C, Guarch J, Navinés R, Murru A, Fico G, De Prisco M, Oliva V, Pio C, Amoretti S, Fernández-Canseco M, Villegas M, Vieta E, Hidalgo-Mazzei D. Vickybot, a chatbot for anxiety-depressive symptoms and work-related burnout in primary care and healthcare professionals: development, feasibility, and potential effectiveness studies. J Med Internet Res 2023; 25:e43293. [PMID: 36719325 PMCID: PMC10131622 DOI: 10.2196/43293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/19/2022] [Accepted: 01/31/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A significant proportion of people attending Primary Care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem and digital tools have been proposed as a solution. OBJECTIVE We present the development, feasibility, and potential effectiveness studies of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout in PC patients and healthcare workers. METHODS User-centered development strategies were adopted. Main functions included self-assessments, psychological modules, and emergency alerts. Healthy controls (HCs) tested Vickybot for reliability. (1) Simulation: HCs used Vickybot for 2 weeks to simulate different clinical situations. (2) Feasibility and effectiveness study: People consulting PC or healthcare workers with mental health problems were offered to use Vickybot for one month. Self-assessments for anxiety (GAD-7) and depression (PHQ-9) symptoms, and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every two weeks. Feasibility was determined from both subjective and objective user-engagement Indicators (UEIs). Potential effectiveness was measured using paired t-tests or the Wilcoxon signed-rank test for the change in self-assessment scores. RESULTS 40 HCs tested Vickybot simultaneously, and data was transmitted and registered reliably. (1) Simulation: 17 HCs (73% female; mean age=36.5±9.7) received 98.8% of the expected modules according to each simulation. Suicidal alerts were correctly received. (2) Feasibility and potential effectiveness study: 34 patients (15 from PC and 19 healthcare workers; 77% female; mean age=35.3±10.1) completed the first self-assessments, with 34 (100%) presenting anxiety symptoms, 32 (94%) depressive symptoms, and 22 (64.7%) work-related burnout. Nine (26.5%) patients completed the second self-assessments after two weeks of use. No significant differences were found between the scores of the first and second self-assessments for anxiety [t(8) = 1.000, P = .34] or depressive [t(8) = .40, P = .70] symptoms. However, work-related burnout scores were moderately reduced (Z = -2.07, P = 0.038, r = .32). There was a non-significant trend towards higher reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Three patients (8.8%) activated the suicide alert, and the research team intervened promptly with successful outcomes. Vickybot showed high subjective-UEIs, but low objective-UEIs (completion, adherence, compliance, and engagement). Feasibility was moderate. CONCLUSIONS The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and detecting suicidal risk. Potential effectiveness was shown in reducing work-related burnout, but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution in order to improve engagement. Consensus on how to report UEIs and validate digital solutions, especially for chatbots, are required. CLINICALTRIAL
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Affiliation(s)
- Gerard Anmella
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Miriam Sanabra
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Mireia Primé-Tous
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Xavier Segú
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Myriam Cavero
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Ivette Morilla
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Victoria Ruiz
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Iria Grande
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Ariadna Mas
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Inés Martín-Villalba
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Alejandro Caballo
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Julia-Parisad Esteva
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Arturo Rodríguez-Rey
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Flavia Piazza
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Francisco José Valdesoiro
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Claudia Rodriguez-Torrella
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Marta Espinosa
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Carlota Sorroche
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Giulia Virgili
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Alicia Ruiz
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Aleix Solanes
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, ES
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, ES
| | - María Antonieta Also
- CAP Casanova, Consorci Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Elisenda Sant
- CAP Casanova, Consorci Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Sandra Murgui
- CAP Borrell, Consorci d'Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Mireia Sans-Corrales
- CAP Borrell, Consorci d'Atenció primaria de Salut Barcelona Esquerra (CAPSBE), Barcelona, ES
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, GB
| | - Victor Vicens
- Chief Medical Officer and co-founder of Abi Global Health, Barcelona, ES
| | - Jordi Blanch
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Elsa Caballeria
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Hugo López-Pelayo
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Clara López
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Victoria Olivé
- Hospital Clínic de Barcelona, Occupational Health Department, barcelona, ES
| | - Laura Pujol
- Hospital Clínic de Barcelona, Occupational Health Department, barcelona, ES
| | - Sebastiana Quesada
- Hospital Clínic de Barcelona, Occupational Health Department, barcelona, ES
| | - Brisa Solé
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Anabel Martínez-Aran
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Carla Torrent
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Joana Guarch
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Ricard Navinés
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Andrea Murru
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Giovanna Fico
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Michele De Prisco
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Vicenzo Oliva
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Casimiro Pio
- Barcelona Supercomputing Center (BSC). Text Mining Technologies in the Health Domain, Barcelona, ES
| | - Silvia Amoretti
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - María Fernández-Canseco
- Barcelona Supercomputing Center (BSC). Text Mining Technologies in the Health Domain, Barcelona, ES
| | - Marta Villegas
- Barcelona Supercomputing Center (BSC). Text Mining Technologies in the Health Domain, Barcelona, ES
| | - Eduard Vieta
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
| | - Diego Hidalgo-Mazzei
- Hospital Clínic de Barcelona, Department of Psychiatry and Psychology, Institute of Neuroscience, C. de Villarroel, 170, 08036, Barcelona, ES
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Olivé V, Navinés R, Macías L, López JA, Ariz J, Quesada S, Barroso S, Filella X, Langohr K, Martin-Santos R. Psychosocial and biological predictors of resident physician burnout. Gen Hosp Psychiatry 2022; 78:68-71. [PMID: 35901627 DOI: 10.1016/j.genhosppsych.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A high proportion of health professionals in training suffer from work-related stress and may develop a burnout syndrome. OBJECTIVES To study the incidence of burnout after the first year of residency in a teaching hospital and to identify baseline psychological, psychosocial work conditions, and biological risk factors. METHODOLOGY We assessed the following in a prospective cohort of residents at baseline (first month residence) and after 1 year: background factors (socio-demographics, psychiatric history), perceived stress score (Perceived Stress Scale), Maslach Burnout Inventory score, and psychosocial factors (Job Content Questionnaire). Blood samples were obtained to study serum cortisol, IL-6, and TNF-α concentrations. The cumulative incidence was modelled by multivariate log-binomial regression analysis. RESULTS We included 71 participants with a female majority (64.8%), age 26.4 (2.65) years, psychiatric history in 20%, and burnout in 13%. Among those without burnout initially (N = 59), it had developed by 1 year in 22% of residents. Increased job demand (RR = 1.259, 95%CI = 1.019-1.556, p = 0.033) and decreased cortisol levels (RR = 0.877, 95%CI = 0.778-0.989, p = 0.032) predicted burnout after 1 year of residency among medical trainees. CONCLUSION Burnout syndrome develops in 22% of residents by 1 year of training and can be predicted by increased work demands and decreased cortisol levels.
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Affiliation(s)
- V Olivé
- Department of Medicine, Psychiatry Functional Unit, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain.; Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - R Navinés
- Department of Psychiatry and Psychology, Hospital Clinic, UB, Institut d' Investigació, Biomèdica August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain.
| | - L Macías
- Department of Biochemistry and Molecular Genetics, Center of Biomedic Diagnosis (CDB), Hospital Clinic, UB, IDIBAPS, Barcelona, Spain.
| | - J A López
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - J Ariz
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - S Quesada
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - S Barroso
- Department of Occupational Health and Prevention, Hospital Clinic, Barcelona, Spain.
| | - X Filella
- Department of Biochemistry and Molecular Genetics, Center of Biomedic Diagnosis (CDB), Hospital Clinic, UB, IDIBAPS, Barcelona, Spain.
| | - K Langohr
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya/Barcelonatech (UPC), Barcelona, Spain.
| | - R Martin-Santos
- Department of Medicine, Psychiatry Functional Unit, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain.; Department of Psychiatry and Psychology, Hospital Clinic, UB, Institut d' Investigació, Biomèdica August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain.
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Egri N, Olivé V, Hernández-Rodríguez J, Castro P, De Guzman C, Heredia L, Segura AC, Fernandez M, de Moner N, Torradeflot M, Ballús J, Martinez R, Vazquez M, Costa MV, Dobaño C, Mazza M, Mazzotti L, Pascal M, Juan M, González-Navarro EA, Calderón H. CoVITEST: A Fast and Reliable Method to Monitor Anti-SARS-CoV-2 Specific T Cells From Whole Blood. Front Immunol 2022; 13:848586. [PMID: 35865538 PMCID: PMC9295597 DOI: 10.3389/fimmu.2022.848586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023] Open
Abstract
Cellular and humoral immune responses are essential for COVID-19 recovery and protection against SARS-CoV-2 reinfection. To date, the evaluation of SARS-CoV-2 immune protection has mainly focused on antibody detection, generally disregarding the cellular response, or placing it in a secondary position. This phenomenon may be explained by the complex nature of the assays needed to analyze cellular immunity compared with the technically simple and automated detection of antibodies. Nevertheless, a large body of evidence supports the relevance of the T cell's role in protection against SARS-CoV-2, especially in vulnerable individuals with a weakened immune system (such as the population over 65 and patients with immunodeficiencies). Here we propose to use CoVITEST (Covid19 anti-Viral Immunity based on T cells for Evaluation in a Simple Test), a fast, affordable and accessible in-house assay that, together with a diagnostic matrix, allows us to determine those patients who might be protected with SARS-CoV-2-reactive T cells. The method was established using healthy SARS-CoV-2-naïve donors pre- and post-vaccination (n=30), and further validated with convalescent COVID-19 donors (n=51) in a side-by-side comparison with the gold standard IFN-γ ELISpot. We demonstrated that our CoVITEST presented reliable and comparable results to those obtained with the ELISpot technique in a considerably shorter time (less than 8 hours). In conclusion, we present a simple but reliable assay to determine cellular immunity against SARS-CoV-2 that can be used routinely during this pandemic to monitor the immune status in vulnerable patients and thereby adjust their therapeutic approaches. This method might indeed help to optimize and improve decision-making protocols for re-vaccination against SARS-CoV-2, at least for some population subsets.
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Affiliation(s)
- Natalia Egri
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Victoria Olivé
- Occupational Health Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - José Hernández-Rodríguez
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Vasculitis Research Unit and Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pedro Castro
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Medical Intensive Care Unit, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Catherine De Guzman
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Libertad Heredia
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ana Castellet Segura
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M. Dolores Fernandez
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Noemi de Moner
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
| | - María Torradeflot
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Judit Ballús
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Robert Martinez
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mario Vazquez
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Vidal Costa
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Carlota Dobaño
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- CIBER Infectious Diseases (CIBERINFEC), Barcelona, Spain
| | - Massimiliano Mazza
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, FC, Italy
| | - Lucia Mazzotti
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, FC, Italy
| | - Mariona Pascal
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Allergy Network ARADyAL, Instituto de Salud Carlos III, Madrid, Spain
| | - Manel Juan
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Europa Azucena González-Navarro
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Hugo Calderón
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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