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1.
BMJ Open ; 12(4), 2022.
Article in English | EMBASE | ID: covidwho-1822070

ABSTRACT

Introduction Treatment-resistant schizophrenia (TRS) is associated with significant impairment of functioning and high treatment costs. Identification of patients at high risk of TRS at the time of their initial diagnosis may significantly improve clinical outcomes and minimise social and functional disability. We aim to develop a prognostic model for predicting the risk of developing TRS in patients with first-episode schizophrenia and to examine its potential utility and acceptability as a clinical decision tool. Methods and analysis We will use two well-characterised longitudinal UK-based first-episode psychosis cohorts: Aetiology and Ethnicity in Schizophrenia and Other Psychoses and Genetics and Psychosis for which data have been collected on sociodemographic and clinical characteristics. We will identify candidate predictors for the model based on current literature and stakeholder consultation. Model development will use all data, with the number of candidate predictors restricted according to available sample size and event rate. A model for predicting risk of TRS will be developed based on penalised regression, with missing data handled using multiple imputation. Internal validation will be undertaken via bootstrapping, obtaining optimism-adjusted estimates of the model's performance. The clinical utility of the model in terms of clinically relevant risk thresholds will be evaluated using net benefit and decision curves (comparative to competing strategies). Consultation with patients and clinical stakeholders will determine potential thresholds of risk for treatment decision-making. The acceptability of embedding the model as a clinical tool will be explored using qualitative focus groups with up to 20 clinicians in total from early intervention services. Clinicians will be recruited from services in Stafford and London with the focus groups being held via an online platform. Ethics and dissemination The development of the prognostic model will be based on anonymised data from existing cohorts, for which ethical approval is in place. Ethical approval has been obtained from Keele University for the qualitative focus groups within early intervention in psychosis services (ref: MH-210174). Suitable processes are in place to obtain informed consent for National Health Service staff taking part in interviews or focus groups. A study information sheet with cover letter and consent form have been prepared and approved by the local Research Ethics Committee. Findings will be shared through peer-reviewed publications, conference presentations and social media. A lay summary will be published on collaborator websites.

3.
Psychol Res Behav Manag ; 15: 291-303, 2022.
Article in English | MEDLINE | ID: covidwho-1799022

ABSTRACT

Background: The COVID-19 pandemic has accelerated the digitalization of services, but at the same time, some user groups are excluded due to a lack of digital skills. One of the vulnerable groups is people with mental health problems. It has previously been found that self-efficacy beliefs explain the use of digital technology, but the role of social support is largely unexamined. Bandura's concept of proxy agency provides a useful concept to investigate the role of social support in using digital services. Objective: The study investigates sources of social support and the effect of proxy agency, Internet efficacy, and self-efficacy beliefs on the intention to use digital health and social care services. Methods: Participants (N = 121) were users in community-based mental health services who were recruited through four organizations in southern Finland for a cross-sectional study. The scales for proxy agency and intention to use services were developed for purpose of the study. The questionnaire also comprised self-efficacy and Internet efficacy scales. Quantitative data were analyzed using descriptive statistics and linear regression analysis. Results: Both Internet self-efficacy and proxy efficacy (p < 0.001) predicted the intention to use digital health and social care services. Self-efficacy had an indirect positive effect on intention through Internet self-efficacy. Family members and friends were the main source of social support in using digital services. Conclusion: Internet self-efficacy and proxy efficacy are important contributors to the intention to use digital health and social care services. Proxy agents may serve as facilitators to reduce the digital divide and promote the use of digital services by complementing individuals' self-efficacy and Internet self-efficacy beliefs. It is important to develop different forms of social support, such as peer support, to enhance the quality of proxy agency. The limitations of proxy agency are discussed.

4.
Psychiatria Polska ; 56(1):115-122, 2022.
Article in Polish | EMBASE | ID: covidwho-1798674

ABSTRACT

The novel coronavirus disease (COVID-19) epidemic - in addition to its many widely described negative consequences - has created a challenge for the mental health care system in every country, including Poland to safely manage psychiatric disorders in addition to preventing and treating COVID-19. In Poland, online mental health services are provided for the outpatients. Still there are patients with severe psychiatric disorders who have suspected or confirmed COVID-19 and need to be treated in a psychiatric hospital. The Department of Child and Adolescent Psychiatry of the Medical University of Warsaw was appointed by local authorities to hospitalize children with mental disorders and with confirmed or suspected COVID-19. This created an urgent need to adapt our department for treating COVID-19 infected patients. As far as we know no guidelines for psychiatric hospitals management during the COVID-19 pandemic are available in English. In this manuscript, we present our guidelines regarding safe management of patients with suspected or confirmed COVID-19 in the Department of Child and Adolescent Psychiatry of the Medical University of Warsaw.

5.
BMC Health Serv Res ; 22(1): 406, 2022 Mar 27.
Article in English | MEDLINE | ID: covidwho-1793949

ABSTRACT

BACKGROUND: Mental health disparities between Indigenous and non-Indigenous people in Canada are related to underlying economic, social, and political inequities that are legacies of colonization and the oppression of Indigenous cultures. It also widely acknowledged that mental health services currently available may not be culturally appropriate in supporting the health needs of Indigenous Canadians. A two-day Indigenous mental health forum examined mental health needs and gaps among Indigenous communities across the Regional Municipality of Wood Buffalo (RMWB) on Treaty 8 territory, in northern Alberta, Canada. This paper outlines the insights generated by stakeholder engagement at the forum to identify and prioritize directions for Indigenous mental health and build a vision and strategy for improving mental health services and programs for the region's diverse Indigenous population. METHODS: We applied a modified nominal group technique (NGT) consensus method embedded within Indigenous knowledge to determine key priorities and directions for Indigenous-focused mental health and synthesize information from discussions that occurred at the forum. Following the NGT, a participatory community visioning exercise was conducted with participants to develop a vision, guiding principles, and components of an action plan for an Indigenous mental health strategy for the RMWB. RESULTS: Four key themes for setting priorities and directions for Indigenous mental health emerged from roundtable group discussions: 1) understand the realities of mental health experiences for Indigenous peoples, 2) design a holistic and culturally rooted mental health system, 3) foster cross-sectoral engagement and collaboration on mental health service delivery, and 4) focus on children and youth. The community visioning exercise helped stakeholders to visualize a direction or path forward for addressing existing gaps in the mental health system and opportunities for strengthening Indigenous mental health in the region. CONCLUSIONS: Forum participants described mental health and well-being around holistic concepts of social and emotional well-being. Addressing Indigenous mental health and wellness involves multi-sectoral action in various settings including community and school through programs, policies, and other interventions that promote mental health for all Indigenous peoples, as well as for those at greater risk such as children and youth.


Subject(s)
Mental Disorders , Mental Health Services , Adolescent , Alberta , Consensus , Humans , Mental Disorders/therapy , Mental Health
6.
Front Public Health ; 10: 814366, 2022.
Article in English | MEDLINE | ID: covidwho-1753416

ABSTRACT

Online mental health service (OMHS) has been named as the best psychological assistance measure during the COVID-19 pandemic. An interpretable, accurate, and early prediction for the demand of OMHS is crucial to local governments and organizations which need to allocate and make the decision in mental health resources. The present study aimed to investigate the influence of the COVID-19 pandemic on the online psychological help-seeking (OPHS) behavior in the OMHS, then propose a machine learning model to predict and interpret the OPHS number in advance. The data was crawled from two Chinese OMHS platforms. Linguistic inquiry and word count (LIWC), neural embedding-based topic modeling, and time series analysis were utilized to build time series feature sets with lagging one, three, seven, and 14 days. Correlation analysis was used to examine the impact of COVID-19 on OPHS behaviors across different OMHS platforms. Machine learning algorithms and Shapley additive explanation (SHAP) were used to build the prediction. The result showed that the massive growth of OPHS behavior during the COVID-19 pandemic was a common phenomenon. The predictive model based on random forest (RF) and feature sets containing temporal features of the OPHS number, mental health topics, LIWC, and COVID-19 cases achieved the best performance. Temporal features of the OPHS number showed the biggest positive and negative predictive power. The topic features had incremental effects on performance of the prediction across different lag days and were more suitable for OPHS prediction compared to the LIWC features. The interpretable model showed that the increase in the OPHS behaviors was impacted by the cumulative confirmed cases and cumulative deaths, while it was not sensitive in the new confirmed cases or new deaths. The present study was the first to predict the demand for OMHS using machine learning during the COVID-19 pandemic. This study suggests an interpretable machine learning method that can facilitate quick, early, and interpretable prediction of the OPHS behavior and to support the operational decision-making; it also demonstrated the power of utilizing the OMHS platforms as an always-on data source to obtain a high-resolution timeline and real-time prediction of the psychological response of the online public.


Subject(s)
COVID-19 , Help-Seeking Behavior , Algorithms , COVID-19/epidemiology , Humans , Machine Learning , Pandemics
7.
Front Psychiatry ; 12: 780236, 2021.
Article in English | MEDLINE | ID: covidwho-1674391

ABSTRACT

Background: The COVID-19 pandemic has had a substantial impact on forensic mental health service provision and implementation. This study aimed to provide an analysis of the impact of COVID-19 related restrictions on routine outcomes within a large forensic mental health service in London, UK. Method: We conducted a longitudinal cohort study using data collected routinely prior to the COVID-19 pandemic (April 2018-March 2020) and then stages thereafter (March 2020-March 2021; analyzed as March-May 2020, June-September 2020, October-December 2020, January-March 2021). We used causal impact models (Bayesian structural time-series) to examine the effect of COVID-19 related changes on routine outcomes related to service provision and implementation. Results: There was an overall increase in long-term segregation (LTS) hours during the pandemic; 140%, (95% Cl 107, 171%) during Lockdown 1; 113%, (159% Cl 127, 192%) during post-Lockdown 1; 45% (95% Cl 23, 68%) during Lockdown 2 and, finally, 90% (95% Cl 63, 113%) during Lockdown 3. The most negative outcomes were evident during Lockdown 3. Incidents of violence were significantly more frequent during Lockdown 3 than would have been predicted based on pre-pandemic data, including physical assaults to service users (206%, 95% CI 57%, 346%), non-physical assaults to service users (206%, 95% CI 53%, 339%), and self-harm (71%, 95% CI 0.4%, 135%). Use of enforced medication also increased during Lockdown 3 (317%, 95% CI 175%, 456%). Conclusion: The pandemic and its related restrictions negatively affected some service outcomes. This resulted in increased incidents of violence and increased use of restrictive interventions, beyond what would have been expected had the pandemic not occurred.

8.
Br J Psychiatry ; : 1-2, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1643206

ABSTRACT

Trieste mental health service is considered as one of the best mental healthcare systems in the world. This service is now under threat from right-wing politicians in the local region. We argue that this is a threat to progressive community psychiatry beyond Trieste and Italy. It is important for us to join forces with international colleagues and organisations in the campaign to defend and preserve the current service model in Trieste.

9.
Int J Ment Health Syst ; 15(1): 85, 2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-1632918

ABSTRACT

BACKGROUND: Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. METHODS: This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. RESULTS: Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. CONCLUSIONS: Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.

10.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617066

ABSTRACT

Background and Objectives: In March 2020, approximately 57 million children were affected by massive school closures in the wake of the SARS-CoV-2 pandemic. Many child advocates expressed concerns about the impact of physical school closures and transition to virtual learning on school-aged children's mental health and well-being, particularly those who utilized resources, such as counselling or special education, within the school system. This systematic review was done to identify a) the effect and impact of school closures on the mental health of children in grades K-12, if any, and b) to guide future research on the topic. Methods: A systematic review focused on published articles addressing the effect that COVID-19 related school closures and transition to virtual learning had on school-aged children's and adolescents' mental health. Inclusion criteria included: human studies, scholarly papers, school-aged children, SARS-CoV-2 research, mental health impacts, an article written in English, and research-based in the United States. Exclusion criteria included: not human studies, studies not available in English, individuals over 18 years old, and SARS-CoV or MERS-CoV research. The search was conducted between March 20, 2021, and April 18, 2021. Articles were further screened utilizing the PRISMA flow diagram. Once screened, included articles were reviewed by one member of the research team and a PICO-style analysis was used for each article. After the initial review, a total of 11 articles were included in this systematic review. Learning Points Discussion: We identified several areas of a child's life that school closures limited access to, such as reduced-cost meals, mental health services, and special education. Since the school closures and subsequent transition to online schooling, these resources became unavailable or limited by virtual technology. Children from lower socioeconomic backgrounds and marginalized communities were particularly vulnerable to negative mental health changes due to school closures and decreased access to school-based resources. These individuals belonging to a lower socioeconomic class are more likely to have inadequate computers to utilize in-home learning, have more unstable internet connections, and are less likely to have a caregiver that can stay home to help with their distanced learning. This research will be vital in understanding any adverse effects on children and shaping the future development of school-based programs and their funding.

11.
European Neuropsychopharmacology ; 53:S594, 2021.
Article in English | EMBASE | ID: covidwho-1598893

ABSTRACT

Background and objectives. The coronavirus (COVID-19) pandemic has profoundly changed the mode in which mental health services provide care. The rapid development of technological tools led to the implementation of digital psychiatry in everyday clinical practice both in the public and the private sector. This advanced innovation resulted in the ever-increasing need for a skilled workforce. Our purpose was to investigate the level of expertise of young mental health professionals and students in this field. In particular, we aimed 1) to assess the level of knowledge, education, and experience in the use of digital psychiatry in the different stages of the medical and psychiatric training;2) to investigate the opinions and experiences regarding digital psychiatry. Methods. An ad hoc cross-sectional online survey was designed containing questions about digital psychiatry, telepsychiatry and e-mental health. The study population included Italian early career psychiatrists (within five years of specialization), psychiatry residents, M.D. waiting to start the psychiatry training program, and medical students. From September 28, 2020, to April 07, 2021, 239 subjects completed the survey. Results. The study participants’ mean age and proportion of women were 26.6 ± 3.9 years and 61.5% (n = 147), respectively. Most of the sample declared that the topic of digital psychiatry was never discussed within the training in medical school (n = 213;89.1%) and psychiatry residency (n = 260;96.2%). Meanwhile, more than half of the sample stated the importance of addressing these issues during the training in medical school (n = 130;54.4%) and psychiatry residency (n = 182;76.2%). Despite the lack of training experience, over half of the sample provided a correct definition of telepsychiatry (n = 176;73.6%) and correctly identified videoconferencing as the most used communication method in this area (n = 195;81.6%). The majority of the sample (n = 175;73.2%) declared that telepsychiatry is less effective than in-person interventions or equally/more effective only in young patients. Generally, most participants (n = 173;72.4%) declared that digital interventions represent a valuable therapeutic tool in mental health. Conclusions. For many specialists, the current COVID-19 pandemic was the first opportunity to reshape patient care through technological tools. Digital psychiatry represented an ideal response to the social distancing need, but, at the same time, it brought out the advantages of technological tools in increasing access to mental health services. Although digital psychiatry offers numerous opportunities and benefits, digital interventions within this field are still uncommon, and there remains a certain skepticism regarding this field. The lack of formal training on digital psychiatry within medical school and psychiatry residency could be a limiting factor. These training gaps seem to reflect the use and perception that clinicians display about digital psychiatry. Therefore, we believe that addressing these issues in academic settings would be crucial to spreading this innovative practice long after the pandemic has ended. No conflict of interest

12.
European Neuropsychopharmacology ; 53:S191-S192, 2021.
Article in English | EMBASE | ID: covidwho-1597614

ABSTRACT

Background -Healthcare systems have changed dramatically in the last fifty years. The COVID-19 pandemic specifically has disrupted the traditional healthcare delivery model. New methods of care are needed that can be delivered safely and that complement and improve the way treatment is provided in and out of the doctor's office. Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in the field of mental health. Although there are many technologies currently being implemented, the research supporting their usability, efficacy and risk requires further examination, especially those interventions that can be used independently and without support. Objective - This review aims to identify evidence-based, self-directed virtual methods of care that could be used in adult patients after discharge from mental health services and have been evaluated with objective (in terms of improving health outcomes) and subjective measures (acceptability and usability). Methods - A systematic review was conducted broadly following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)/Prospero guidelines in 3 databases: PubMed, Web of Science and Ovid. We enforced strict criteria, all interventions reviewed had to be automated with no human input required (either at the patient's or the technology's end), so patients could implement them independently without any support from a healthcare professional or technical staff. Inclusion criteria were self-directed, automated, technology-based interventions related to mental health, for adults and with a solid evaluation process. Results – Thirty-four papers were identified that fit the inclusion criteria: 24 Randomized Controlled Trials (RCTs), 9 non-RCT quantitative studies and 1 qualitative study. Technologies employed included websites, automated text messaging, phone applications, videos, computer software and integrated voice response. Twenty studies focused on Internet-based Cognitive Behavioral Therapies (iCBTs) as a therapeutic paradigm compared to waitlist, on- line human delivered therapy and other interventions. Fourteen studies used paradigms other than iCBT. Out of eight studies directly comparing directly guided to unguided digital care, three studies showed no differences, three favored guided interventions and two favored unguided interventions. Research showed dropout rates as high as 80% in unguided interventions citing potential problems with acceptability of the suggested technologies. Conclusions - The use of virtual interventions in healthcare is increasing, but there seems to be a lack of research on efficacy and limited information over what types of interventions are most suitable for mental health care. Current research suggests an effectiveness of virtual care interventions that is superior to waitlist controls. However, to show effectiveness over traditional psychiatric care studies should use comparison groups that are comparable to the intervention studied avoiding waiting list or other non-intervention arms. One of the main advantages of digital therapeutics is that these interventions will also become accessible to people who do not have access to healthcare, such as patients who live far from healthcare centres, cannot travel because of disability or family commitments or cannot afford traditional care. In this way, self-directed digital therapeutics can contribute to healthcare equity. No conflict of interest

13.
British Journal of Surgery ; 108(SUPPL 6):vi254, 2021.
Article in English | EMBASE | ID: covidwho-1569645

ABSTRACT

Aim: Non-injury related factors have been extensively studied in major trauma and shown to have a significant impact on patient outcomes, with mental illness and associated medication use proven to have a negative effect on bone health and fracture healing. We report the epidemiological effect of COVID-19 pandemic on mental health associated Orthopaedic trauma, fractures, and admissions to our centre. Method: We collated data retrospectively from the electronic records of Orthopaedic inpatients in an 8-week non-COVID and COVID period analysing demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient co-morbidities including psychiatric history. Results: here were 824 Orthopaedic referrals and 358 admissions (6/ day) in the non-COVID period with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared to 473 referrals and 195 admissions (3/day) in the COVID period with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) a fracture. 22/38 (57.9%) and 52/73 (71.2%) patients were known to mental health services, respectively. Conclusions: Whilst total numbers utilising the Orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affected those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. It is imperative that adequate support is in place for vulnerable mental health patients, particularly as we are currently experiencing the 'second wave' of COVID-19.

14.
Psychiatria Danubina ; 33:697-701, 2021.
Article in English | EMBASE | ID: covidwho-1567580

ABSTRACT

Optimal psychic response during the COVID-19 pandemic is the result of many different factors. One of the main factors is the psychodynamic understanding of essential emotions such as shame. Despite the immense effort by health workers to address stress- and trauma-related disorders in the course of the COVID-19 pandemic, a large proportion of the people affected by the disorder do not have information regarding the emotion of shame. Lack of mentalizing capacity implies disturbed shame dynamics. The therapeutic relationship and optimal alliance offer the frame for acceptance of shame as useful for psychological growth. Empathy should be a cure for dysfunctional shame, at the individual or social level. We believe that including a psychodynamic approach in the national public and mental health emergency system will empower national prevention strategies.

15.
Early Interv Psychiatry ; 2021 Nov 22.
Article in English | MEDLINE | ID: covidwho-1528370

ABSTRACT

AIM: The COVID-19 pandemic has presented significant challenges for young people and youth mental health services. To address a gap in knowledge about the impact of the pandemic and associated restrictions on youth mental health services, this paper examined the nature of young people's engagement with Jigsaw's brief intervention service during the pandemic. METHOD: Data gathered from young people engaging with Jigsaw's brief intervention service in the 12 months after the official declaration of the COVID-19 pandemic (n = 6161), and 12 months prior (n = 8665) were examined. RESULTS: There were less referrals to Jigsaw during the pandemic, especially during lockdown periods, but this rebounded when public health restrictions were eased. A higher proportion of females (p < .001) and 12-17 year olds (p < .001) were referred during the pandemic period. There was an increase in the proportion of young people who presented with anxiety (p < .001) and sleep changes (p < .001). Although 12-16 year olds reported significantly higher levels of distress during the pandemic (p < .05), the effect size was small. Young people reported high levels of satisfaction with the new phone/video modes of support offered by Jigsaw, and the overall attendance rate improved during the pandemic period. CONCLUSIONS: The impact of COVID-19 on young people's mental health needs to be considered as a priority. This paper is helpful for services considering the long-term mental health needs of young people, and the best way of meeting those needs.

16.
BJPsych Open ; 7(6): e213, 2021 Nov 17.
Article in English | MEDLINE | ID: covidwho-1523369

ABSTRACT

BACKGROUND: Previous studies into mental health service utilisation during the COVID-19 pandemic are limited to a few countries or specific type of service. In addition, data on changes in telepsychiatry are currently lacking. AIMS: We aimed to investigate whether the COVID-19 pandemic is associated with changes in mental health service utilisation, including telepsychiatry, and how these changes were distributed among patients with mental illness during the first COVID-19 outbreak. METHOD: This retrospective study obtained routinely assessed healthcare data from a large Dutch mental healthcare institute. Data from the second quarter of 2020 (the first COVID-19 outbreak period) were compared with the pre-pandemic period between January 2018 and March 2020. Time-series analyses were performed with the quasi-Poisson generalised linear model, to examine the effect of the COVID-19 lockdown and the overall trend of mental health service utilisation per communication modality and diagnostic category. RESULTS: We analysed 204 808 care contacts of 28 038 patients. The overall number of care contacts in the second quarter of 2020 remained the same as in the previous 2 years, because the number of video consultations significantly increased (B = 2.17, P = 0.488 × 10-3) as the number of face-to-face out-patient contacts significantly decreased (B = -0.98, P = 0.011). This was true for all different diagnostic categories, although this change was less pronounced in patients with psychotic disorders. CONCLUSIONS: Diminished face-to-face out-patient contacts were well-compensated by the substantial increase of video consultations during the first COVID-19 outbreak in The Netherlands. This increase was less pronounced for psychotic disorders. Further research should elucidate the need for disorder-specific digital mental healthcare delivery.

17.
Int J Environ Res Public Health ; 18(21)2021 11 02.
Article in English | MEDLINE | ID: covidwho-1502422

ABSTRACT

Online mental health service (OMHS) platforms have contributed significantly to the public's mental health during the COVID-19 pandemic in China. However, it remains unclear why the public used OMHS platforms for psychological help-seeking (PHS) behavior and how PHS behavior varied across different stages of the COVID-19 pandemic. Based on the ecological PHS behavior data from two OMHS platforms, we extracted population, psychological problems, and influential factors of PHS behavior by text mining and time series analysis methods. Seven top-ranked psychological problems (i.e., depression and anxiety, lack of interest, suicidal tendencies, social phobia, feelings of being worried and afraid, suffering, anger) and seven influential factors (i.e., interpersonal relationships, love, family, work, psychotherapy, personal characteristics, marriage) were found. The online PHS behaviors related to different psychological problems and influential factors remained a growing trend before 2020 and have been increasing significantly due to the COVID-19 outbreak. Four main stages were found during the pandemic according to the changes in the online PHS population: sharp growth, significant decline, slight rebound, and slow decline. This study identified large-scale, spontaneous PHS behaviors among the online public during the COVID-19 pandemic and the various psychological problems and influential factors that varied across different stages of the pandemic, suggesting that the government and health practitioners should adopt effective policies and strategies to prevent and intervene in mental health problems for the online public.


Subject(s)
COVID-19 , Pandemics , Anxiety , Data Mining , Depression , Humans , SARS-CoV-2
18.
Internet Interv ; 25: 100439, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1330901

ABSTRACT

BACKGROUND: Digital mental health services (DMHS) provide highly accessible psychological supports and interventions that can supplement existing mental health services. Concerns about the mental health impact of the COVID-19 pandemic have been widespread and provide a unique impetus to examine the utility and responsivity of DMHS. This study examined the service utilisation and user characteristics of two DMHS (THIS WAY UP and Just a Thought) in Australia and New Zealand before and during the early pandemic period in these countries (March to June 2020). METHODS: Service use indices (website visits, course registrations and prescriptions, clinician registrations) were compared across different time periods before (12, 6 and 3 months) and during the pandemic in Australia and New Zealand. The demographic and clinical characteristics of course registrants (anxiety and depression symptom severity and psychological distress) were also compared across the pre- and during-COVID periods. RESULTS: Comparing pre-COVID to during-COVID time periods, we observed substantial increases across all service use indices in both DMHS (increases of >100% on the majority of service use indices). For example, in the 3 months prior to the pandemic, 2806 people registered for a THIS WAY UP course and 1907 people registered for a Just a Thought course, whereas 21,872 and 5442 registered for a THIS WAY UP and Just a Thought course, respectively, during the first 3 months of the COVID pandemic. Slight differences in the demographic and clinical profiles of course registrants were found between pre- and during-COVID time periods, with limited evidence of elevated anxiety and depression symptom severity in the COVID period. CONCLUSIONS: Following the outbreak of COVID-19 in Australia and New Zealand, the volume of users accessing DMHS increased yet the demographic and clinical characteristics of course registrants remained stable. Results underscore how nimble and scalable DMHS can be during periods of high demand.

19.
Int J Circumpolar Health ; 80(1): 1935133, 2021 12.
Article in English | MEDLINE | ID: covidwho-1294652

ABSTRACT

Mental health providers have rapidly pivoted their in-person practices to teletherapy and telehealth interventions to address the increased demand for mental health services during the COVID-19 crisis. The change to service delivery has emphasised challenges for mental health service providers, particularly in regions that rely on fly-in and fly-out (FIFO) mental health service providers who are no longer able to travel to their places of work. In this qualitative study, we examined the impact of COVID-19 on the delivery of mental health services in Inuit Nunangat. Using a participatory action research methodology, we conducted semi-structured interviews with eight FIFO mental health service providers to understand their experiences and implement strategies to effectively deliver mental health services in a pandemic. We identified three themes through thematic analysis: 1) Service providers identify the challenges in adapting their practices to meet individual and community needs; 2) Service providers recognise the opportunities for enhancements to service delivery; 3) Service providers identify telemental health services as a potentially effective adjunct to in-person sessions. The findings support reconceptualising post-pandemic mental health service delivery to include both face-to-face and telemental health services.


Subject(s)
COVID-19/epidemiology , Mental Disorders/therapy , Mental Health Services/organization & administration , Mental Health/statistics & numerical data , Telemedicine/organization & administration , COVID-19/therapy , Counseling/organization & administration , Humans , Qualitative Research , Social Support
20.
JMIR Res Protoc ; 10(6): e24697, 2021 Jun 14.
Article in English | MEDLINE | ID: covidwho-1290333

ABSTRACT

BACKGROUND: Australia's mental health care system has long been fragmented and under-resourced, with services falling well short of demand. In response, the World Economic Forum has recently called for the rapid deployment of smarter, digitally enhanced health services to facilitate effective care coordination and address issues of demand. The University of Sydney's Brain and Mind Centre (BMC) has developed an innovative digital health solution that incorporates 2 components: a highly personalized and measurement-based (data-driven) model of youth mental health care and a health information technology (HIT) registered on the Australian Register of Therapeutic Goods. Importantly, research into implementation of such solutions considers education and training of clinicians to be essential to adoption and optimization of use in standard clinical practice. The BMC's Youth Mental Health and Technology Program has subsequently developed a comprehensive education and training program to accompany implementation of the digital health solution. OBJECTIVE: This paper describes the protocol for an evaluation study to assess the effectiveness of the education and training program on the adoption and optimization of use of the digital health solution in service delivery. It also describes the proposed tools to assess the impact of training on knowledge and skills of mental health clinicians. METHODS: The evaluation study will use the Kirkpatrick Evaluation Model as a framework with 4 levels of analysis: Reaction (to education and training), Learning (knowledge acquired), Behavior (practice change), and Results (client outcomes). Quantitative and qualitative data will be collected using a variety of tools, including evaluation forms, pre- and postknowledge questionnaires, skill development and behavior change scales, as well as a real-time clinical practice audit. RESULTS: This project is funded by philanthropic funding from Future Generation Global. Ethics approval has been granted via Sydney Local Health District's Human Research Ethics Committee. At the time of this publication, clinicians and their services were being recruited to this study. The first results are expected to be submitted for publication in 2021. CONCLUSIONS: The education and training program teaches clinicians the necessary knowledge and skills to assess, monitor, and manage complex needs; mood and psychotic syndromes; and trajectories of youth mental ill-health using a HIT that facilitates a highly personalized and measurement-based model of care. The digital health solution may therefore guide clinicians to help young people recover low functioning associated with subthreshold diagnostic presentations and prevent progression to more serious mental ill-health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/24697.

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