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1.
JMIR Form Res ; 5(1): e24662, 2021 Jan 26.
Article in English | MEDLINE | ID: covidwho-1834122

ABSTRACT

BACKGROUND: Anxiety is an extremely prevalent condition, and yet, it has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. The COVID-19 pandemic has only exacerbated growing concerns about the burden of anxiety due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities. OBJECTIVE: This study examines differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and combined care) within an on-demand mental health system. We also explore the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety. METHODS: We conducted a retrospective observational study of individuals who accessed Ginger, an on-demand mental health system. Data were collected from 1611 Ginger members between January 1, 2018, and December 31, 2019. We used logistic regression to assess the association between care modality and improvement in anxiety symptoms. Within each modality, we assessed the association between level of engagement and improvement. RESULTS: Of 1611 Ginger members, 761 (47.0%) experienced a decrease in anxiety symptoms, as measured by a change from a positive to a negative 2-item Generalized Anxiety Disorder (GAD-2) screen. Among members who still screened positive at follow-up (865/1611, 53%), a total of 192 members (11.9%) experienced a clinically significant score reduction in the full GAD-7 (ie, a score reduction of >5 points), even though their GAD-2 scores were still positive. All modalities showed increased odds of improvement compared to those who were not engaged with coaching or clinical services ("app-only"). Higher GAD-7 intake scores were also associated with decreased odds of improvement. CONCLUSIONS: This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care, with larger effect sizes for higher utilization within all care modalities. Additionally, there is a promising observation that those engaged in combined care (teletherapy and text-based coaching) had the greatest odds of anxiety improvement. Future directions include more detailed classifications of utilization patterns and an exploration of explanations and solutions for lower-utilization members.

2.
Prim Health Care Res Dev ; 23: e18, 2022 03 22.
Article in English | MEDLINE | ID: covidwho-1751650

ABSTRACT

Mobile Health (mHealth) interventions have received a mix of praise and excitement, as well as caution and even opposition over recent decades. While the rapid adoption of mHealth solutions due to the COVID-19 pandemic has weakened resistance to integrating these digital approaches into practice and generated renewed interest, the increased reliance on mHealth signals a need for optimizing development and implementation. Despite an historically innovation-resistant medical ethos, mHealth is becoming a normalized supplement to clinical practice, highlighting increased demand. Reaching the full potential of mHealth requires new thinking and investment. The current challenge to broaden mHealth adoption and to ensure equity in access may be overcoming a "design purgatory," where innovation fails to connect to practice. We recommend leveraging the opportunity presented by the COVID-19 pandemic to disrupt routine practice and with a new focus on theory-driven replicability of mHealth tools and strategies aimed at medical education and professional organizations.


Subject(s)
COVID-19 , Telemedicine , Delivery of Health Care , Humans , Pandemics
3.
Psychiatr Q ; 2022 Feb 28.
Article in English | MEDLINE | ID: covidwho-1712304

ABSTRACT

This study investigated whether with disruptions in care due to the COVID-19 pandemic, persons who self-identified as living with a mental health condition increased their usage of an online peer support community. We also explored whether study participants who self-reported usage of online peer support communities were interested in using these communities to connect with evidence-based interventions and mental health services. This study employed a cross-sectional online survey design. The survey was disseminated by the Inspire online peer support community and Mental Health America through various social media channels. Descriptive and inferential analyses were conducted to summarize participant demographics, investigate patterns of use of online peer support communities, and interest in accessing additional programs through these platforms. There were 369 survey respondents, with a mean age of 49 (SD = 15.6), of which 77% were female. Most respondents self-reported having depression (34%), post-traumatic stress disorder (25%), and anxiety-related conditions (20%). The number of respondents who reported accessing online peer support platforms multiple times a day appeared to double after March 2020. We also found an overall positive association between frequency of community use and self-reported benefit to mental health. Approximately 81% of respondents expressed interest in accessing mental health services via an online peer support community. Persons who self-report living with mental health conditions and who engage in online peer support communities expressed interest in accessing evidence-based interventions via these online platforms. Participants were most interested in services related to enhancing coping mechanisms and skills, enabling overall wellbeing, and accessing therapy.

4.
Lancet Psychiatry ; 9(1): 8-9, 2022 01.
Article in English | MEDLINE | ID: covidwho-1569159
5.
Psychiatry Res ; 307: 114299, 2022 01.
Article in English | MEDLINE | ID: covidwho-1531725

ABSTRACT

Digital technology has emerged as a promising approach for training and building capacity of community health workers in low-income and middle-income countries (LMICs). Little is known about the cost of developing digital training programs in LMICs, which hinders the adoption, implementation, and scaling up of the programs in routine primary care settings. This study assessed the costs of developing a digital program for training community health workers to deliver a psychological treatment for depression in a rural district of Madhya Pradesh, India. We developed survey instruments to document required resources in development, including involved personnel (their roles, responsibilities, time spent, and salaries or payments), information technologies (e.g., smartphones, software programs), and infrastructure-related costs (e.g., vehicle, office space, utilities). Costs were estimated from an accounting perspective. Over a 10-month developmental period, the total costs were 208,814 USD, with the largest portion on human resources (61%, with 14% on management and supervision), followed by information technologies (33%), and infrastructure-related costs (6%). These findings could inform policymakers in LMICs on costs of developing online-training programs, which will be especially useful during the COVID-19 pandemic.


Subject(s)
COVID-19 , Community Health Workers , Depression , Humans , India , Pandemics , SARS-CoV-2
6.
Mental Health in a Digital World ; : 459-479, 2022.
Article in English | ScienceDirect | ID: covidwho-1520573

ABSTRACT

This chapter describes the rapid spread of digital mental health technologies across the world and further explores specific case studies in low-income and middle-income countries (LMICs). We are increasingly seeing rapid rates of technological innovation and adaptation in low-resource settings including the widespread use of smartphone mobile devices, apps and web-based platforms. Health-care settings have taken advantage of this growth and are maximizing its potential by introducing these technologies in their service delivery. These technologies have been applied to various settings such as training of health workers, screening patients, and care delivery. This chapter explores five major areas benefitting from these emerging technologies: (1) community outreach, challenging stigma, and spreading awareness, (2) youth mental health, (3) mental health in humanitarian settings, (4) clinical care and frontline health workers, and (5) technology for severe mental disorders. We close the chapter with a discussion of broad ethical considerations in LMICs, highlighting risks pertaining to misinformation, victimization, and widening health inequities. Finally, we emphasize the role of digital technologies during the COVID-19 pandemic in addressing the potential rise and exacerbation of mental health problems, and how these technologies can potentially be leveraged to alleviate this burden through the remote provision of essential mental health services.

7.
Ethics Med Public Health ; 192021 Dec.
Article in English | MEDLINE | ID: covidwho-1433499

ABSTRACT

Background: Mental health stigma is a major barrier to seeking help, and leads to poor quality of life and social withdrawal for individuals living with mental illness. These concerns are especially severe in low-income and middle-income countries (LMICs) that face a disproportionate share of the global burden of mental illnesses. With growing access to digital technologies in LMICs, there may be new opportunities to address mental health stigma. This review considers the potential for emerging digital technologies to advance efforts to challenge mental health stigma in LMICs. Methods: Promising digital strategies to reduce mental health stigma were identified through searching the peer-reviewed literature. Drawing from the Mental Illness Stigma Framework, these studies of digital strategies were grouped into three categories: 1) protest; 2) education, and 3) contact. Results: These three categories align with established stigma reduction programs. Digital strategies could expand the reach of or complement existing efforts. There are challenges with digital stigma reduction strategies, including the need for cultural adaptation of these programs to diverse contexts and settings, consideration of reliable measurement of mental health related stigma, and risks that digital media could perpetuate the spread of misinformation and exacerbate concerns pertaining to mental health stigma. Conclusion: This review highlights the promise of technology for addressing mental health stigma in LMICs. This is imperative in the face of growing demand for mental health services owing to the economic and social impacts of the COVID-19 pandemic, and the increasing reliance on digital platforms among individuals in most countries.

8.
Glob Ment Health (Camb) ; 8: e30, 2021.
Article in English | MEDLINE | ID: covidwho-1370709

ABSTRACT

BACKGROUND: Despite significant advancements in healthcare technology, digital health solutions - especially those for serious mental illnesses - continue to fall short of their potential across both clinical practice and efficacy. The utility and impact of medicine, including digital medicine, hinges on relationships, trust, and engagement, particularly in the field of mental health. This paper details results from Phase 1 of a two-part study that seeks to engage people with schizophrenia, their family members, and clinicians in co-designing a digital mental health platform for use across different cultures and contexts in the United States and India. METHODS: Each site interviewed a mix of clinicians, patients, and their family members in focus groups (n = 20) of two to six participants. Open-ended questions and discussions inquired about their own smartphone use and, after a demonstration of the mindLAMP platform, specific feedback on the app's utility, design, and functionality. RESULTS: Our results based on thematic analysis indicate three common themes: increased use and interest in technology during coronavirus disease 2019 (COVID-19), concerns over how data are used and shared, and a desire for concurrent human interaction to support app engagement. CONCLUSION: People with schizophrenia, their family members, and clinicians are open to integrating technology into treatment to better understand their condition and help inform treatment. However, app engagement is dependent on technology that is complementary - not substitutive - of therapeutic care from a clinician.

9.
The Lancet Psychiatry ; 8(5):e13, 2021.
Article in English | APA PsycInfo | ID: covidwho-1340928

ABSTRACT

Reports an error in "COVID-19 mental health impact and responses in low-income and middle-income countries: Reimagining global mental health" by Lola Kola, Brandon A. Kohrt, Charlotte Hanlon, John A. Naslund, Siham Sikander, Madhumitha Balaji, Corina Benjet, Eliza Yee Lai Cheung, Julian Eaton, Pattie Gonsalves, Maji Hailemariam, Nagendra P. Luitel, Daiane B. Machado, Eleni Misganaw, Olayinka Omigbodun, Tessa Roberts, Tatiana Taylor Salisbury, Rahul Shidhaye, Charlene Sunkel, Victor Ugo, Andre Janse van Rensburg, Oye Gureje, Soumitra Pathare, Shekhar Saxena, Graham Thornicroft and Vikram Patel (The Lancet Psychiatry, 2021[Jun], Vol 8[6], 535-550). In this Review, Lola Kola's degree should have been PhD and Brandon A Kohrt's degree should have been PhD. Madhumitha Balaji's affiliation should have been "Sangath, India". These corrections have been made to the online version as of Mar 8, 2021, and will be made to the printed version. (The following abstract of the original article appeared in record 2021-51602-023.) Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies;notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

10.
PLoS Med ; 18(6): e1003625, 2021 06.
Article in English | MEDLINE | ID: covidwho-1315879

ABSTRACT

John Naslund and Eirini Karyotaki discuss Mark Jordans and colleagues' accompanying research study on therapy for people with psychological distress in Nepal.


Subject(s)
Depression , Psychological Distress , Depression/diagnosis , Depression/epidemiology , Depression/therapy , Emergencies , Humans , Nepal , Stress, Psychological/therapy
11.
Asian J Psychiatr ; 63: 102750, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1309133

ABSTRACT

The COVID-19 pandemic impacted ongoing clinical trials globally resulting in the suspension, cancellation or transition to entirely remote implementation of studies. In India, the first countrywide lockdown was imposed in phases starting from March 2020 to June 2020, followed by a continued restriction on in-person activities including study procedures, which halted the ESSENCE (Enabling translation of Science to Service to ENhance Depression CarE) trial activities such as recruitment, consenting, baseline assessment, digital training orientation, face to face training and end-line assessment evaluation. This situation made it imperative to amend procedures in order to mitigate the risk and address safety requirements for participants and the research team. This paper summarizes the need, development and implementation of the protocols focused on risk reduction and safety enhancement with an objective to resume and continue the research activities while ensuring the safety of study participants and research staff. These protocols are comprised of guidelines and recommendations based on existing literature tailored according to different components in each arm of the trial such as guidelines for supervisors, travellers, training/recruitment venue safety procedures, individual safety procedures; and procedures to implement the study activities. These protocols can be adapted by researchers in other settings to conduct research trials during pandemics such as COVID-19.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Humans , India , Mental Health , Randomized Controlled Trials as Topic , Research Report , SARS-CoV-2
12.
Transl Behav Med ; 11(7): 1359-1364, 2021 07 29.
Article in English | MEDLINE | ID: covidwho-1280133

ABSTRACT

Behavioral health has the opportunity to lead the way in using lifestyle interventions to address obesity and health disparities in people with serious mental illness (SMI) in the COVID-19 era. Evidence-based interventions for weight loss in individuals with SMI exist, and the field has developed strategies for implementing these interventions in real-world mental health care settings. In addition to promoting weight loss, lifestyle interventions have the potential to address social isolation and loneliness and other patient-centered outcomes among individuals with SMI, which will be especially valuable for mitigating the growing concerns about loneliness attributed to the COVID-19 pandemic restrictions on in-person encounters. In this commentary, we discuss practice, policy, and research implications related to using evidence-based lifestyle interventions for individuals with SMI during the COVID-19 pandemic and sustaining these programs in the long-term.


Subject(s)
COVID-19 , Mental Disorders , Humans , Life Style , Mental Disorders/complications , Mental Disorders/epidemiology , Mental Disorders/therapy , Obesity/epidemiology , Obesity/prevention & control , Pandemics , SARS-CoV-2
13.
Front Public Health ; 9: 679397, 2021.
Article in English | MEDLINE | ID: covidwho-1241218

ABSTRACT

The COVID-19 pandemic has had an unprecedented impact on health systems in most countries, and in particular, on the mental health and well-being of health workers on the frontlines of pandemic response efforts. The purpose of this article is to provide an evidence-based overview of the adverse mental health impacts on healthcare workers during times of crisis and other challenging working conditions and to highlight the importance of prioritizing and protecting the mental health and well-being of the healthcare workforce, particularly in the context of the COVID-19 pandemic. First, we provide a broad overview of the elevated risk of stress, burnout, moral injury, depression, trauma, and other mental health challenges among healthcare workers. Second, we consider how public health emergencies exacerbate these concerns, as reflected in emerging research on the negative mental health impacts of the COVID-19 pandemic on healthcare workers. Further, we consider potential approaches for overcoming these threats to mental health by exploring the value of practicing self-care strategies, and implementing evidence based interventions and organizational measures to help protect and support the mental health and well-being of the healthcare workforce. Lastly, we highlight systemic changes to empower healthcare workers and protect their mental health and well-being in the long run, and propose policy recommendations to guide healthcare leaders and health systems in this endeavor. This paper acknowledges the stressors, burdens, and psychological needs of the healthcare workforce across health systems and disciplines, and calls for renewed efforts to mitigate these challenges among those working on the frontlines during public health emergencies such as the COVID-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Health Personnel , Health Priorities , Humans , Mental Health , Pandemics/prevention & control , Public Health , SARS-CoV-2
15.
JMIR Form Res ; 5(1): e24662, 2021 Jan 26.
Article in English | MEDLINE | ID: covidwho-1048872

ABSTRACT

BACKGROUND: Anxiety is an extremely prevalent condition, and yet, it has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. The COVID-19 pandemic has only exacerbated growing concerns about the burden of anxiety due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities. OBJECTIVE: This study examines differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and combined care) within an on-demand mental health system. We also explore the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety. METHODS: We conducted a retrospective observational study of individuals who accessed Ginger, an on-demand mental health system. Data were collected from 1611 Ginger members between January 1, 2018, and December 31, 2019. We used logistic regression to assess the association between care modality and improvement in anxiety symptoms. Within each modality, we assessed the association between level of engagement and improvement. RESULTS: Of 1611 Ginger members, 761 (47.0%) experienced a decrease in anxiety symptoms, as measured by a change from a positive to a negative 2-item Generalized Anxiety Disorder (GAD-2) screen. Among members who still screened positive at follow-up (865/1611, 53%), a total of 192 members (11.9%) experienced a clinically significant score reduction in the full GAD-7 (ie, a score reduction of >5 points), even though their GAD-2 scores were still positive. All modalities showed increased odds of improvement compared to those who were not engaged with coaching or clinical services ("app-only"). Higher GAD-7 intake scores were also associated with decreased odds of improvement. CONCLUSIONS: This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care, with larger effect sizes for higher utilization within all care modalities. Additionally, there is a promising observation that those engaged in combined care (teletherapy and text-based coaching) had the greatest odds of anxiety improvement. Future directions include more detailed classifications of utilization patterns and an exploration of explanations and solutions for lower-utilization members.

16.
Harv Public Health Rev (Camb) ; 282020.
Article in English | MEDLINE | ID: covidwho-1011994

ABSTRACT

Healthcare systems in many countries have been overwhelmed by the coronavirus disease (COVID-19) pandemic, with increasing demands to contain and respond to the virus. The result has been increased pressure on frontline health workers. As the pandemic unfolds, the impact on health systems in low-income and middle-income countries (LMICs) is becoming apparent. In lower resource settings, the detrimental effects on frontline health workers will likely be significant due to fragmented infrastructure, low compensation, and significant shortages of necessary resources such as personal protective equipment. These high stress conditions, coupled with risk of infection and fears and anxieties among patients, can result in grave psychosocial consequences for frontline health workers, who play a vital role in delivering the bulk of primary care services in LMICs. In this narrative review, we consider the psychological impact of the COVID-19 pandemic on frontline health workers in LMICs. We describe the important role of frontline health workers, summarize existing literature on burnout and risks to mental health in this essential workforce, and consider how public health emergencies exacerbate these concerns to showcase their vulnerability to mental health impacts of COVID-19. We explore emerging research on the detrimental effects of the COVID-19 pandemic on health workers and consider possible approaches to mitigate these consequences. This review draws from existing studies and emerging evidence to highlight the critical need to consider the wellbeing of frontline health workers, and to address these challenges as health systems respond to the pandemic.

18.
Curr Opin Psychiatry ; 33(5): 501-507, 2020 09.
Article in English | MEDLINE | ID: covidwho-594281

ABSTRACT

PURPOSE OF REVIEW: Increasingly, digital technologies, especially mobile telecommunications and smartphone apps, are seen as a novel tool for managing severe mental disorders (SMDs) in low-income and middle-income countries (LMICs). However, there is a need to identify best practices in the use of digital technologies to effectively reach, support, and manage care for patients living with SMDs. In this review, we summarize recent studies using digital technology to manage symptoms and support clinical care for this patient population and discuss new opportunities to advance digital psychiatry research and practice in LMICs. RECENT FINDINGS: Studies evaluating digital interventions for clinical populations living with SMDs in LMICs are limited. Yet, across recent articles surveyed, digital technology appears to yield diverse benefits for this at-risk patient population. These benefits include improved medication adherence, appointment adherence, reduced instances of relapse, and fewer re-hospitalizations. SUMMARY: Continued rigorous research evaluating effectiveness and cost-effectiveness of digital technologies in reaching, treating, and managing symptoms and supporting clinical care for patients with SMDs in LMICs is vital. The urgency for remote approaches for delivering specialized psychiatric care is particularly pronounced because of the immediate and long-term impact of the coronavirus (COVID-19) pandemic on access to in-person services. Future research should emphasize participatory approaches rooted in a process of codesign with target users, in order to achieve clinically effective remotely delivered digital mental health interventions.


Subject(s)
Coronavirus Infections , Mental Disorders , Pandemics , Pneumonia, Viral , Telemedicine , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Developing Countries , Humans , Internet-Based Intervention , Mental Disorders/epidemiology , Mental Disorders/therapy , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Socioeconomic Factors , Telemedicine/economics , Telemedicine/methods
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