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1.
JMIR Form Res ; 6(7): e38684, 2022 Jul 07.
Article in English | MEDLINE | ID: covidwho-1923879

ABSTRACT

BACKGROUND: In recent years, there has been increasing interest in implementing digital technologies to diagnose, monitor, and intervene in substance use disorders. Smartphones are now a vehicle for facilitating telepsychiatry visits, measuring health metrics, and communicating with health care professionals. In light of the COVID-19 pandemic and the movement toward web-based and hybrid clinic visits and meetings, it has become especially salient to assess phone ownership among individuals with substance use disorders and their comfort in navigating phone functionality and using phones for mental health purposes. OBJECTIVE: The aims of this study were to summarize the current literature around smartphone ownership, smartphone utilization, and the acceptability of using smartphones for mental health purposes and assess these variables across two disparate substance use treatment sites. METHODS: We performed a focused literature review via a search of two academic databases (PubMed and Google Scholar) for publications since 2007 on the topics of smartphone ownership, smartphone utilization, and the acceptability of using mobile apps for mental health purposes among the substance use population. Additionally, we conducted a cross-sectional survey study that included 51 participants across two sites in New England-an inpatient detoxification unit that predominantly treats patients with alcohol use disorder and an outpatient methadone maintenance treatment clinic. RESULTS: Prior studies indicated that mobile phone ownership among the substance use population between 2013 and 2019 ranged from 83% to 94%, while smartphone ownership ranged from 57% to 94%. The results from our study across the two sites indicated 96% (49/51) mobile phone ownership and 92% (47/51) smartphone ownership among the substance use population. Although most (43/49, 88%) patients across both sites reported currently using apps on their phone, a minority (19/48, 40%) reported previously using any apps for mental health purposes. More than half of the participants reported feeling at least neutrally comfortable with a mental health app gathering information regarding appointment reminders (32/48, 67%), medication reminders (33/48, 69%), and symptom surveys (26/45, 58%). Most patients were concerned about privacy (34/51, 67%) and felt uncomfortable with an app gathering location (29/47, 62%) and social (27/47, 57%) information for health care purposes. CONCLUSIONS: The majority of respondents reported owning a mobile phone (49/51, 96%) and smartphone (47/51, 92%), consistent with prior studies. Many respondents felt comfortable with mental health apps gathering most forms of personal information and with communicating with their clinician about their mental health. The differential results from the two sites, namely greater concerns about the cost of mental health apps among the methadone maintenance treatment cohort and less experience with downloading apps among the older inpatient detoxification cohort, may indicate that clinicians should tailor technological interventions based on local demographics and practice sites and that there is likely not a one-size-fits-all digital psychiatry solution.

2.
JMIR Mhealth Uhealth ; 8(11): e22997, 2020 11 06.
Article in English | MEDLINE | ID: covidwho-1862476

ABSTRACT

BACKGROUND: eHealth interventions are widely used in clinical trials and increasingly in care settings as well; however, their efficacy in real-world contexts remains unknown. ReMindCare is a smartphone app that has been systematically implemented in a first episode of psychosis program (FEPP) for patients with early psychosis since 2018. OBJECTIVE: The objective of this study was to assess the efficacy of ReMindCare after 19 months of use in the clinic and varying use by individual patients. METHODS: The integration of the ReMindCare app into the FEPP started in October 2018. Patients with early psychosis self-selected to the app (ReMindCare group) or treatment as usual (TAU group). The outcome variables considered were adherence to the intervention and number of relapses, hospital admissions, and visits to urgent care units. Data from 90 patients with early psychosis were analyzed: 59 in the ReMindCare group and 31 in the TAU group. The mean age of the sample was 32.8 (SD 9.4) years, 73% (66/90) were males, 91% (83/90) were White, and 81% (74/90) were single. RESULTS: Significant differences between the ReMindCare and TAU groups were found in the number of relapses, hospitalizations, and visits to urgent care units, with each showing benefits for the app. Only 20% (12/59) of patients from the ReMindCare group had a relapse, while 58% (18/31) of the TAU patients had one or more relapses (χ2=13.7, P=.001). Moreover, ReMindCare patients had fewer visits to urgent care units (χ2=7.4, P=.006) and fewer hospitalizations than TAU patients (χ2=4.6, P=.03). The mean of days using the app was 352.2 (SD 191.2; min/max: 18-594), and the mean of engagement was 84.5 (SD 16.04). CONCLUSIONS: To our knowledge, this is the first eHealth intervention that has preliminarily proven its benefits in the real-world treatment of patients with early psychosis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1111/eip.12960.


Subject(s)
Mobile Applications , Psychotic Disorders , Telemedicine , Adult , Ambulatory Care , Female , Humans , Male , Psychotic Disorders/diagnosis , Psychotic Disorders/therapy , Smartphone
3.
JMIR Hum Factors ; 9(1): e28301, 2022 Mar 08.
Article in English | MEDLINE | ID: covidwho-1775560

ABSTRACT

BACKGROUND: The therapeutic alliance is crucial for the success of face-to-face therapies. Little is known about how coaching functions and fosters the therapeutic alliance in asynchronous treatment modalities such as smartphone apps. OBJECTIVE: The aim of this paper was to assess how coaching functions and fosters the therapeutic alliance in asynchronous treatment modalities. METHODS: We conducted a selected review to gather preliminary data about the role of coaching in mobile technology use for mental health care. We identified 26 trials using a 2019 review by Tønning et al and a 2021 scoping review by Tokgöz et al to assess how coaching is currently being used across different studies. RESULTS: Our results showed a high level of heterogeneity as studies used varying types of coaching methods but provided little information about coaching protocols and training. Coaching was feasible by clinicians and nonclinicians, scheduled and on demand, and across all technologies ranging from phone calls to social media. CONCLUSIONS: Further research is required to better understand the effects of coaching in mobile mental health treatments, but examples offered from reviewed papers suggest several options to implement coaching today. Coaching based on replicable protocols that are verifiable for fidelity will enable the scaling of this model and a better exploration of the digital therapeutic alliance.

4.
JMIR Ment Health ; 9(10): e37939, 2022 Oct 14.
Article in English | MEDLINE | ID: covidwho-1770936

ABSTRACT

COVID-19 has accelerated the use of telehealth and technology in mental health care, creating new avenues to increase both access to and quality of care. As video visits and synchronous telehealth become more routine, the field is now on the verge of embracing asynchronous telehealth, with the potential to radically transform mental health. However, sustaining the use of basic synchronous telehealth, let alone embracing asynchronous telehealth, requires new and immediate effort. Programs to increase digital literacy and competencies among both clinicians and patients are now critical to ensure all parties have the knowledge, confidence, and ability to equitably benefit from emerging innovations. This editorial outlines the immediate potential as well as concrete steps toward realizing the potential of a new, more personalized, scalable mental health system.

5.
J Psychiatr Pract ; 28(2): 117-129, 2022 03 03.
Article in English | MEDLINE | ID: covidwho-1722737

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has highlighted links among economic stability, health outcomes, and migration. The facets of financial worry and their associated psychological burden have been understudied among the immigrant population. The goal of this study was to determine the specific facets of financial worry and associated psychological burden in immigrants. This cross-sectional study, which used data from the 2013 to 2018 National Health Interview Survey (NHIS), examined patient-reported measures of worry regarding financial strain. The NHIS is a household survey of noninstitutionalized, nonmilitary adults in the United States. Multivariable ordinal logistic regressions were used to define adjusted odds ratios (AORs) for financial worry and psychological distress, adjusting for various sociodemographic variables. Among 131,669 US-born and 26,155 non-US-born participants who responded to all 6 questions on the 6-item Kessler Psychological Distress Scale (K6), the overall prevalence of participants reporting any serious psychological distress (K6 score ≥13) was 3.0% and 2.25%, respectively. Despite these overall prevalence data, there were specific areas of financial worries that were higher in non-US-born participants than in US-born participants. Compared with US-born participants, non-US-born participants had higher rates of financial worries regarding retirement [75.78% vs. 69.08%, AOR=1.37, 95% confidence interval (CI) 1.29-1.45, P<0.001], medical costs due to illness (worry about not being able to pay medical costs of a serious illness or accident) (74.94% vs. 65.27%, AOR=1.37, 95% CI: 1.29-1.45, P<0.001), standard of living (74.25% vs. 65.29%, AOR=1.42, 95% CI: 1.34-1.51, P<0.001), and medical cost of health care (worry about not having enough to pay medical costs for normal health care) (66.52% vs. 52.67%, AOR=1.51, 95% CI: 1.43-1.60, P<0.001), among other costs. Notably, serious psychological distress in non-US-born individuals was associated with increased financial worry relative to US-born individuals with a similar level of psychological distress. Further research is needed to evaluate the role physicians can play in mitigating psychological distress in patients with increased financial worry.


Subject(s)
COVID-19 , Emigrants and Immigrants , Psychological Distress , Adult , Cross-Sectional Studies , Humans , SARS-CoV-2 , Stress, Psychological/epidemiology , United States/epidemiology
6.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-315865

ABSTRACT

Background: The COVID-19 pandemic is exerting a devastating impact on mental health, but it is not clear how people with different types of mental health problems were differentially impacted as the initial wave of cases hit. Objective: We leverage natural language processing (NLP) with the goal of characterizing changes in fifteen of the world's largest mental health support groups (e.g., r/schizophrenia, r/SuicideWatch, r/Depression) found on the website Reddit, along with eleven non-mental health groups (e.g., r/PersonalFinance, r/conspiracy) during the initial stage of the pandemic. Methods: We create and release the Reddit Mental Health Dataset including posts from 826,961 unique users from 2018 to 2020. Using regression, we analyze trends from 90 text-derived features such as sentiment analysis, personal pronouns, and a “guns” semantic category. Using supervised machine learning, we classify posts into their respective support group and interpret important features to understand how different problems manifest in language. We apply unsupervised methods such as topic modeling and unsupervised clustering to uncover concerns throughout Reddit before and during the pandemic. Results: We find that the r/HealthAnxiety forum showed spikes in posts about COVID-19 early on in January, approximately two months before other support groups started posting about the pandemic. There were many features that significantly increased during COVID-19 for specific groups including the categories “economic stress”, “isolation”, and “home” while others such as “motion” significantly decreased. We find that support groups related to attention deficit hyperactivity disorder (ADHD), eating disorders (ED), and anxiety showed the most negative semantic change during the pandemic out of all mental health groups. Health anxiety emerged as a general theme across Reddit through independent supervised and unsupervised machine learning analyses. For instance, we provide evidence that the concerns of a diverse set of individuals are converging in this unique moment of history;we discover that the more users posted about COVID-19, the more linguistically similar (less distant) the mental health support groups became to r/HealthAnxiety (ρ = -0.96, P<.001). Using unsupervised clustering, we find the Suicidality and Loneliness clusters more than doubled in amount of posts during the pandemic. Specifically, the support groups for borderline personality disorder and post-traumatic stress disorder became significantly associated with the Suicidality cluster. Furthermore, clusters surrounding Self-Harm and Entertainment emerged. Conclusions: By using a broad set of NLP techniques and analyzing a baseline of pre-pandemic posts, we uncover patterns of how specific mental health problems manifest in language, identify at-risk users, and reveal the distribution of concerns across Reddit which could help provide better resources to its millions of users. We then demonstrate that textual analysis is sensitive to uncover mental health complaints as they arise in real time, identifying vulnerable groups and alarming themes during COVID-19, and thus may have utility during the ongoing pandemic and other world-changing events such as elections and protests from the present or the past.

7.
JMIR Mhealth Uhealth ; 10(1): e30557, 2022 01 07.
Article in English | MEDLINE | ID: covidwho-1662508

ABSTRACT

BACKGROUND: There is a growing need for the integration of patient-generated health data (PGHD) into research and clinical care to enable personalized, preventive, and interactive care, but technical and organizational challenges, such as the lack of standards and easy-to-use tools, preclude the effective use of PGHD generated from consumer devices, such as smartphones and wearables. OBJECTIVE: This study outlines how we used mobile apps and semantic web standards such as HTTP 2.0, Representational State Transfer, JSON (JavaScript Object Notation), JSON Schema, Transport Layer Security (version 1.3), Advanced Encryption Standard-256, OpenAPI, HTML5, and Vega, in conjunction with patient and provider feedback to completely update a previous version of mindLAMP. METHODS: The Learn, Assess, Manage, and Prevent (LAMP) platform addresses the abovementioned challenges in enhancing clinical insight by supporting research, data analysis, and implementation efforts around PGHD as an open-source solution with freely accessible and shared code. RESULTS: With a simplified programming interface and novel data representation that captures additional metadata, the LAMP platform enables interoperability with existing Fast Healthcare Interoperability Resources-based health care systems as well as consumer wearables and services such as Apple HealthKit and Google Fit. The companion Cortex data analysis and machine learning toolkit offer robust support for artificial intelligence, behavioral feature extraction, interactive visualizations, and high-performance data processing through parallelization and vectorization techniques. CONCLUSIONS: The LAMP platform incorporates feedback from patients and clinicians alongside a standards-based approach to address these needs and functions across a wide range of use cases through its customizable and flexible components. These range from simple survey-based research to international consortiums capturing multimodal data to simple delivery of mindfulness exercises through personalized, just-in-time adaptive interventions.


Subject(s)
Artificial Intelligence , Mobile Applications , Data Collection , Humans , Machine Learning , Smartphone
8.
BMJ Open ; 12(1): e056232, 2022 Jan 31.
Article in English | MEDLINE | ID: covidwho-1662317

ABSTRACT

INTRODUCTION: There is a surplus of information and communication technology (ICT)-based interventions for suicide prevention. However, it is unclear which of these ICT-based interventions for suicide prevention have been implemented in clinical settings. Furthermore, evidence shows that implementation strategies have often been mismatched to existing barriers. In response, the authors recognise the critical need for prospectively assessing the barriers and facilitators and then strategically developing implementation strategies. This review is part of a multiphase project to develop and test tailored implementation strategies for mobile app-based suicide prevention in clinical settings. The overall objective of this scoping review is to identify and characterise ICT-based interventions for all levels of suicide prevention in clinical settings. Additionally, this review will identify and characterise the barriers and facilitators to implementing these ICT-based interventions as well as reported measures and outcomes. The findings will directly inform the subsequent phase to maximise implementation and inform future efforts for implementing other types of ICT-based interventions related to suicide prevention in clinical settings. METHODS AND ANALYSIS: This review will adhere to the methods described by the Joanna Briggs Institute for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist. The following databases will be searched: Medline, PsycInfo, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL), Web of Science and Library, Information Science & Technology Abstracts (LISTA). Two reviewers will independently screen the articles and extract data using a standardised data collection tool. Then, authors will characterise extracted data using frameworks, typology and taxonomies to address the proposed review questions. ETHICS AND DISSEMINATION: Ethics approval is not required for this scoping review. Authors will share the results in a peer-reviewed, open access publication and conference presentations. Furthermore, the findings will be shared with relevant health organisations through lay language summaries and informal presentations.


Subject(s)
Information Technology , Suicide , Communication , Delivery of Health Care , Humans , Research Design , Review Literature as Topic , Suicide/prevention & control , Systematic Reviews as Topic , Technology
9.
Postgrad Med J ; 2021 Nov 22.
Article in English | MEDLINE | ID: covidwho-1528561

ABSTRACT

INTRODUCTION: Physician burnout has severe consequences on clinician well-being. Residents face numerous work-stressors that can contribute to burnout; however, given specialty variation in work-stress, it is difficult to identify systemic stressors and implement effective burnout interventions on an institutional level. Assessing resident preferences by specialty for common wellness interventions could also contribute to improved efficacy. METHODS: This cross-sectional study used best-worst scaling (BWS), a type of discrete choice modelling, to explore how 267 residents across nine specialties (anaesthesiology, emergency medicine, internal medicine, neurology, obstetrics and gynaecology, pathology, psychiatry, radiology and surgery) prioritised 16 work-stressors and 4 wellness interventions at a large academic medical centre during the COVID-19 pandemic (December 2020). RESULTS: Top-ranked stressors were work-life integration and electronic health record documentation. Therapy (63%, selected as 'would realistically consider intervention') and coaching (58%) were the most preferred wellness supports in comparison to group-based peer support (20%) and individual peer support (22%). Pathology, psychiatry and OBGYN specialties were most willing to consider all intervention options, with emergency medicine and internal medicine specialties least willing to consider intervention options. CONCLUSION: BWS can identify relative differences in surveyed stressors, allowing for the generation of specialty-specific stressor rankings and preferences for specific wellness interventions that can be used to drive institution-wide changes to improve clinician wellness. BWS surveys are a potential methodology for clinician wellness programmes to gather specific information on preferences to determine best practices for resident wellness.

10.
BJPsych Open ; 7(5): e174, 2021 Sep 21.
Article in English | MEDLINE | ID: covidwho-1430502

ABSTRACT

BACKGROUND: Electronic health records (EHRs) are a significant contributor to physicians' low satisfaction, reduced engagement and increased burnout. Yet the majority of evidence around EHR and physician harms is based on self-reported screen time, which may both over- and underreport actual exposure. AIMS: The purpose of this study was to examine how objective EHR use correlates with physician well-being and to develop preliminary recommendations for well-being-based EHR interventions. METHOD: Prior to the onset of COVID-19, psychiatry residents and attending physicians working in an out-patient clinic at an academic medical centre provided consent for access to EHR-usage logs and completed a well-being assessment made up of three scales: the Maslach Burnout Inventory, the Urecht Work Engagement Scale and the Professional Quality of Life Measure. Survey responses and objective EHR data were analysed with descriptive statistics. RESULTS: Responses were obtained from 20 psychiatry residents (total eligible residents n = 27; 74% participation) and 16 clinical faculty members (total eligible faculty n = 24; 67% participation) with an overall response rate of 71% (total eligible residents and faculty n = 51 and total residents and faculty who completed survey n = 36). Moderate correlations for multiple well-being domains emerged in analysis for all participants, especially around the time spent per note and patient visits closed the same day. CONCLUSIONS: EHR-usage logs represent an objective tool in the evaluation and enhancement of physician well-being. Results from our pilot study suggest that metrics for note writing efficiency and closing patient visits the same day are associated with physician well-being. These metrics will be important to study in ongoing efforts involving well-being-based EHR interventions.

11.
World Psychiatry ; 20(3): 318-335, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1400988

ABSTRACT

As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.

12.
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.

13.
Adm Policy Ment Health ; 49(1): 1-4, 2022 01.
Article in English | MEDLINE | ID: covidwho-1291418

ABSTRACT

Under the direction of the leadership at our medical center, beginning March 16, 2020, all non-urgent in-person ambulatory visits were to be limited, either rescheduled or performed virtually, as the hospital braced for the surge of COVID-19 patients. The outpatient psychiatry department quickly transitioned to a telehealth model. This paper details our actions taken to implement this plan, reflections on our experience one year later, and areas for future study. On the one-year anniversary of our department implementing remote care practices around COVID-19, we reflect on lessons learned in the transition and maintenance phases of the last 12 months. Reflecting on next steps as a face-to-face care becomes more possible, we share three core factors in our decision making and research opportunities to better quantify the impact of telehealth in 2021 and beyond.


Subject(s)
COVID-19 , Psychiatry , Telemedicine , Ambulatory Care , Humans , SARS-CoV-2
14.
Curr Psychiatry Rep ; 23(7): 38, 2021 05 07.
Article in English | MEDLINE | ID: covidwho-1219115

ABSTRACT

PURPOSE OF REVIEW: Interest in digital mental health, especially smartphone apps, has expanded in light of limited access to mental health services and the need for remote care during COVID-19. Digital clinics, in which apps are blended into routine care, offer a potential solution to common implementation challenges including low user engagement and lack of clinical integration of apps. RECENT FINDINGS: While the number of mental health apps available in commercial marketplaces continues to rise, there are few examples of successful implementation of these apps into care settings. We review one example of a digital clinic created within an academic medical center and another within the Department of Veterans Affairs. We then discuss how implementation science can inform new efforts to effectively integrate mental health technologies across diverse use cases. Integrating mental health apps into care settings is feasible but requires careful attention to multiple domains that will influence implementation success, including characteristics of the innovation (e.g., utility and complexity of the app), the recipients of the technology (e.g., patients and clinicians), and context (e.g., healthcare system buy-in, reimbursement, and regulatory policies). Examples of effective facilitation strategies that can be utilized to improve implementation efforts include co-production of technology involving all end users, specialized trainings for staff and patients, creation of new team members to aid in app usage (e.g., digital navigators), and re-design of clinical workflows.


Subject(s)
COVID-19 , Mobile Applications , Telemedicine , Humans , Mental Health , SARS-CoV-2 , Smartphone
15.
JMIR Mental Health ; 8(4), 2021.
Article in English | ProQuest Central | ID: covidwho-1209799

ABSTRACT

Background: In a growing number of countries worldwide, clinicians are sharing mental health notes, including psychiatry and psychotherapy notes, with patients. Objective: The aim of this study is to solicit the views of experts on provider policies and patient and clinician training or guidance in relation to open notes in mental health care. Methods: In August 2020, we conducted a web-based survey of international experts on the practice of sharing mental health notes. Experts were identified as informaticians, clinicians, chief medical information officers, patients, and patient advocates who have extensive research knowledge about or experience of providing access to or having access to mental health notes. This study undertook a qualitative descriptive analysis of experts’ written responses and opinions (comments) to open-ended questions on training clinicians, patient guidance, and suggested policy regulations. Results: A total of 70 of 92 (76%) experts from 6 countries responded. We identified four major themes related to opening mental health notes to patients: the need for clarity about provider policies on exemptions, providing patients with basic information about open notes, clinician training in writing mental health notes, and managing patient-clinician disagreement about mental health notes. Conclusions: This study provides timely information on policy and training recommendations derived from a wide range of international experts on how to prepare clinicians and patients for open notes in mental health. The results of this study point to the need for further refinement of exemption policies in relation to sharing mental health notes, guidance for patients, and curricular changes for students and clinicians as well as improvements aimed at enhancing patient and clinician-friendly portal design.

16.
J Am Coll Health ; : 1-5, 2021 Apr 23.
Article in English | MEDLINE | ID: covidwho-1199391

ABSTRACT

Federal and institutional policy changes have accelerated the use of telemental health to care for college students distant from their mental health providers during the early part of the COVID-19 pandemic. Temporary measures have made telemental health more readily available, including relaxing of regulations related to interstate licensure, controlled substance prescribing, patient privacy, and reimbursement. Though early efforts are underway to sustain these changes during and in the wake of the pandemic, there are important areas in which federal and institutional policy are still lacking. Additional steps are needed to successfully implement and sustain telemental health for college students include ensuring student access to technology and Internet; proactive outreach to optimize the student's home environment, addressing concerns about safety and confidentiality; developing the means to track rapidly shifting telemental health policy changes; and developing centralized resources that enable remote providers to become familiar with involuntary commitment laws and emergency protocols.

17.
Psychiatr Serv ; 72(10): 1222-1224, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1197302

ABSTRACT

The COVID-19 pandemic has catalyzed structural changes in the public mental health sector, including a shift to telehealth and telesupervision, financial strain for community mental health organizations and clinicians, and risk of burnout among clinicians and staff. This Open Forum considers how technical assistance organizations have supported community mental health providers in adapting to these changes. Moving forward, knowledge gained through this work can help to build the body of practice-based evidence to inform future technical assistance activities in a postpandemic world.


Subject(s)
COVID-19 , Pandemics , Health Personnel , Health Workforce , Humans , SARS-CoV-2
18.
Int Rev Psychiatry ; 33(4): 394-403, 2021 06.
Article in English | MEDLINE | ID: covidwho-1165120

ABSTRACT

The following case series provides several examples from the Digital Clinic, an outpatient mental health program which uses smartphone technology to augment traditional mental health care. The themes highlighted in this piece, expanding emotional-awareness, symptom tracking, and medication management, provide real-clinical examples of how the Digital Clinic offered remote mental health care to a diverse group of people. Furthermore, the following piece demonstrates to practicing clinicians how digital technologies, like smartphone apps, can diversify methods of clinical engagement, assist with collecting health metrics in a safe and ethical manner, and promote person centred care. With the COVID-19 pandemic forcing re-evaluation of how mental health services are provided, it is critical to ensure that digitally infused systems of care, like the Digital Clinic, are effective, accessible, and scalable.


Subject(s)
Internet-Based Intervention , Mental Health Services/supply & distribution , Mobile Applications , Patient-Centered Care , Smartphone , Telemedicine , COVID-19 , Female , Health Services Accessibility , Humans , Male , Outpatients/psychology
19.
JMIR Ment Health ; 8(3): e26589, 2021 Mar 19.
Article in English | MEDLINE | ID: covidwho-1160624

ABSTRACT

BACKGROUND: Antidepressants are known to show heterogeneous effects across individuals and conditions, posing challenges to understanding their efficacy in mental health treatment. Social media platforms enable individuals to share their day-to-day concerns with others and thereby can function as unobtrusive, large-scale, and naturalistic data sources to study the longitudinal behavior of individuals taking antidepressants. OBJECTIVE: We aim to understand the side effects of antidepressants from naturalistic expressions of individuals on social media. METHODS: On a large-scale Twitter data set of individuals who self-reported using antidepressants, a quasi-experimental study using unsupervised language analysis was conducted to extract keywords that distinguish individuals who improved and who did not improve following the use of antidepressants. The net data set consists of over 8 million Twitter posts made by over 300,000 users in a 4-year period between January 1, 2014, and February 15, 2018. RESULTS: Five major side effects of antidepressants were studied: sleep, weight, eating, pain, and sexual issues. Social media language revealed keywords related to these side effects. In particular, antidepressants were found to show a spectrum of effects from decrease to increase in each of these side effects. CONCLUSIONS: This work enhances the understanding of the side effects of antidepressants by identifying distinct linguistic markers in the longitudinal social media data of individuals showing the most and least improvement following the self-reported intake of antidepressants. One implication of this work concerns the potential of social media data as an effective means to support digital pharmacovigilance and digital therapeutics. These results can inform clinicians in tailoring their discussion and assessment of side effects and inform patients about what to potentially expect and what may or may not be within the realm of normal aftereffects of antidepressants.

20.
J Am Coll Health ; : 1-13, 2021 Mar 26.
Article in English | MEDLINE | ID: covidwho-1152980

ABSTRACT

Objective: This study assessed the feasibility of capturing smartphone based digital phenotyping data in college students during the COVID-19 pandemic with the goal of understanding how digital biomarkers of behavior correlate with mental health. Participants: Participants were 100 students enrolled in 4-year universities. Methods: Each participant attended a virtual visit to complete a series of gold-standard mental health assessments, and then used a mobile app for 28 days to complete mood assessments and allow for passive collection of GPS, accelerometer, phone call, and screen time data. Students completed another virtual visit at the end of the study to collect a second round of mental health assessments. Results: In-app daily mood assessments were strongly correlated with their corresponding gold standard clinical assessment. Sleep variance among students was correlated to depression scores (ρ = .28) and stress scores (ρ = .27). Conclusions: Digital Phenotyping among college students is feasible on both an individual and a sample level. Studies with larger sample sizes are necessary to understand population trends, but there are practical applications of the data today.

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