Efficacy of a Text-Based Mental Health Coaching App in Improving the Symptoms of Stress, Anxiety, and Depression: Randomized Controlled Trial.

BACKGROUND: Stress, anxiety, and depression are major mental health concerns worldwide. A wide variety of digital mental health interventions have demonstrated efficacy in improving one's mental health status, and digital interventions that involve some form of human involvement have been shown to demonstrate greater efficacy than self-guided digital interventions. Studies demonstrating the efficacy of digital mental health interventions within the Asian region are scarce. OBJECTIVE: This study aimed to investigate the potential efficacy of the digital mental health intervention, ThoughtFullChat, which consists of one-on-one, asynchronous, text-based coaching with certified mental health professionals and self-guided tools, in improving self-reported symptoms of depression, anxiety, and stress. The study also aims to examine the potential differences in efficacy among occupational subgroups and between sexes. METHODS: A randomized controlled study was conducted among housemen (trainee physicians), students, faculty members, and corporate staff at International Medical University, Malaysia. A total of 392 participants were enrolled and randomized to the intervention (n=197, 50.3%) and control (n=195, 49.7%) groups. Depression, anxiety, and stress symptoms were measured using the Depression, Anxiety, and Stress Scale-21 items at baseline and after the 3-month intervention period. The Satisfaction with Life Scale and Brief Resilience Scale were also included, along with a questionnaire about demographics. RESULTS: Significant decrease was observed in depression (P=.02) and anxiety (P=.002) scores in the intervention group. A subgroup (corporate staff) also demonstrated significant decrease in stress (P=.005) alongside depression (P=.006) and anxiety (P=.002). Females showed significant improvements in depression (P=.02) and anxiety (P<.001) when compared with males. CONCLUSIONS: This study provides evidence that the ThoughtFullChat app is effective in improving the symptoms of depression, anxiety, and stress in individuals, particularly among corporate staff from the educational field. It also supports the notion that mobile mental health apps that connect users to mental health professionals in a discreet and cost-efficient manner can make important contributions to the improvement of mental health outcomes. The differential improvements among occupational subgroups and between sexes in this study indicate the need for future digital mental health app designs to consider an element of personalization focused on systemic components relating to occupation. TRIAL REGISTRATION: Clinicaltrials.gov NCT04944277; https://classic.clinicaltrials.gov/ct2/show/NCT04944277.

Is menopause managed well enough in general practice?

Menopause is an important phase in the life of older women. Women's life expectancy has increased worldwide. As women experience and perceive menopause differently depending on their personal, family and sociocultural backgrounds, perimenopausal symptoms can often go unnoticed and missed by general practitioners. General practitioners are uniquely placed in the healthcare delivery pyramid to close this gap and improve patients' quality of life by identifying perimenopausal signs and symptoms early. This article shares knowledge about continuing medical education for general practitioners to close the existing gap. As there is great variability within each menopausal woman's experience as well as among individual women, there is a need to individualise and render personalised care. By being able to discuss accepted and safe standards of care and by advocating for a holistic approach incorporating both non-pharmacological and pharmacological strategies, general practitioners would be able to improve the confidence of their patients for better health outcomes.

Communication skills in primary care settings: aligning student and patient voices.

INTRODUCTION: Effective communication is essential for patient-centred relationships. Although medical graduates acquire communication skills during undergraduate training, these have been shown to be inadequate in early practice. Both students' and patients' perspectives are required to improve readiness for the workplace, patient satisfaction, and health outcomes. Our research question was: to what extent are medical students prepared with patient-centred communication skills in primary care settings? METHODS: A qualitative descriptive research study using in-depth semi-structured interviews was conducted with Year 3 medical students and patients to study their experiences at a primary care clinic, over two weeks. Data were transcribed verbatim and analysed using Braun and Clark's thematic analysis. Both students' and patients' views on communication skills were obtained. RESULTS: Three themes were established based on student-patient communication in primary care settings: socio-cultural elements in student-patient communication; cognitive and emotional challenges for effective communication; and enablers for effective student-patient communication. The themes and sub-themes describe both students and patients valuing each other as individuals with socio-cultural beliefs and needs. CONCLUSION: The findings can be used to structure new approaches to communication skills education that is patient-centred, culturally sensitive, and informed by patients. Communication skills training should encourage students to prioritise and reflect more on patient perspectives while educators should engage patients to inform and assess the outcomes.

Reimagining medical education for primary care in the time of COVID-19: a world view.

This article sets out to highlight the challenges and opportunities for medical education in primary care realised during the COVID-19 pandemic and now being enacted globally. The themes were originally presented during a webinar involving educationalists from around the world and are subsequently discussed by members of the WONCA working party for education. The article recognises the importance of utilising diversity, addressing inequity and responding to the priority health needs of the community through socially accountable practice. The well-being of educators and learners is identified as priority in response to the ongoing global pandemic. Finally, we imagine a new era for medical education drawing on global connection and shared resources to create a strong community of practice.

The APEC Digital Hub-WONCA Collaborative Framework on Integration of Mental Health into Primary Care in the Asia Pacific.

Mental ill health affects individual well-being and national economic prosperity and makes up a substantial portion of the burden of disease globally, especially in the Asia-Pacific region. Integrating mental health into primary care is widely considered a key strategy to improve access to mental health care. Integration, however, is a complex process that needs to be addressed at multiple levels. A collaboration between the Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health and the World Organization of Family Doctors (WONCA) is described in this paper, which outlines a framework and next steps to improve the mental health of communities in APEC economies. This paper notes gaps related to the integration of mental health into primary care across the region and identifies enablers and current best practices from several APEC economies. The potential of digital technology to benefit primary mental health care for populations in the APEC region, including delivery of training programs for healthcare staff and access to resources for patients, is described. Finally, key next steps are proposed to promote enhanced integration into primary care and improve mental health care throughout the APEC region.

Stiff hands and feet, facial deformities.

The appearance of the skin on this woman's face, hands, and feet helped us to recognize an advanced case of an autoimmune disease.

The pre-employment medical--ethical dilemmas for GPs.

BACKGROUND: In many workplaces, employment is conditional on a successful pre-employment medical examination. This examination is usually conducted by a general practitioner on the employers' panel of approved clinics or by an in-house company doctor. OBJECTIVE: This article uses a case study to illustrate some of the ethical dilemmas that may be faced by GPs in the course of performing a pre-employment medical examination. DISCUSSION: Ethical issues discussed in this article include: Is it ethical for employers (based on physicians' reports) to select workers based on 'absence of illness' rather than 'fitness for work'? Should physicians divulge the illness of potential workers to third parties? What are the boundaries of a clinician's duty of care in the pre-employment medical examination setting?