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Vonderlin R, Boritz T, Claus C, Senyüz B, Mahalingam S, Schmelz J, Knolle-Ventjeer S, Santangelo PS, Ebner-Priemer UW, Schmahl C, Margraf J, Teismann T, Lis S, Kleindienst N, McMain S, Bohus M. Trauma-focused dialectical behavior therapy: study protocol for a randomized controlled multi-center trial in online and face-to-face formats. Borderline Personal Disord Emot Dysregul 2025; 12:15. [PMID: 40346702 PMCID: PMC12065370 DOI: 10.1186/s40479-025-00294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 04/22/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is a severe mental health condition that requires intensive psychotherapeutic treatment. Dialectical Behavior Therapy (DBT) is a specialized treatment approach for BPD with broad empirical evidence. However, as with other disorder-specific treatments, the effect sizes of the standard DBT approach are only modest and access to treatment is limited. To enhance the efficacy of DBT, we developed an adaptation called Trauma-Focused DBT (TF-DBT), which is based on the principles, treatment modes, and functions of DBT. The goal was to (i) condense and accelerate the core therapeutic processes of DBT and (ii) expand therapeutic strategies for addressing BPD symptoms beyond Stage I of DBT (i.e., focusing on behavioral dyscontrol). TF-DBT adopts an accelerated experiential approach that is phase-based in its delivery. It emphasizes the processing of maladaptive emotions related to a wide range of developmental relational trauma (i.e., experiences of traumatic invalidation, emotional abuse, bullying, sexual abuse, or neglect in childhood or adolescence). AIM The primary aim of this study is to investigate the efficacy of this novel DBT adaptation (TF-DBT) compared to standard DBT (S-DBT) as developed by M. Linehan. We hypothesize that TF-DBT is superior to S-DBT on all BPD symptom measures. A second aim of the study is to investigate the efficacy of the delivery format of both treatments (i.e., online vs. face-to-face), with the hypothesis that online therapy is non-inferior to face-to-face treatment. METHODS This study will enroll N = 260 individuals diagnosed with BPD according to DSM-5. Participants will be randomly assigned to 12 months of outpatient TF-DBT or S-DBT in an online or face-to-face format. DISCUSSION The expected results might help to improve psychotherapy efficacy for BPD. Additionally, they will improve our understanding of the efficacy of online-delivered DBT treatments which might contribute to facilitating access to treatment. TRIAL REGISTRATION German Clinical Trials Register: registration number DRKS00031808, date of registration 04 July 2023. WHO Universal Trial Number: U1111-1273-3381.
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Affiliation(s)
- Ruben Vonderlin
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, J5, 68159, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
| | - Tali Boritz
- Department of Psychology, York University, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Borderline Personality Disorder Clinic, Toronto, ON, Canada
| | - Carola Claus
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Büsra Senyüz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, J5, 68159, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
| | - Saskia Mahalingam
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, J5, 68159, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
| | - Julia Schmelz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, J5, 68159, Germany
| | - Silja Knolle-Ventjeer
- Center for Integrative Psychiatry - ZIP, Department of Psychiatry and Psychotherapy, Kiel, Germany
| | - Philip S Santangelo
- Department of Behavioral and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Ulrich W Ebner-Priemer
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
- Mental mHealth Lab, Faculty for Humanities and Social Sciences, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, J5, 68159, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Stefanie Lis
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, J5, 68159, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
| | - Shelley McMain
- Centre for Addiction and Mental Health, Borderline Personality Disorder Clinic, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, J5, 68159, Germany.
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany.
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany.
- McLean Hospital, Harvard Medical School, Boston, MA, USA.
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Tawfik F, Ryland H, Yosef M, Morsy M, Kaligis F, Noël C, Abdulhakim M, Mazereel V, Palavra IR, Prošev A, Fiorillo A, Sampogna G, Durán XM, Jurado JDM, Ibrahim I. A cross-sectional survey of psychiatrists' experiences of using telepsychiatry during the COVID-19 pandemic and the relationship with burnout in selected high, middle, and low-income countries. Int J Soc Psychiatry 2025:207640241308197. [PMID: 39846472 DOI: 10.1177/00207640241308197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2025]
Abstract
BACKGROUND The COVID-19 pandemic necessitated substantial modifications in the delivery of patient care on a global scale. Telemedicine-based care services were implemented worldwide to maximize access to healthcare systems. AIMS This study aimed to investigate the use of and satisfaction with telepsychiatry services implemented during the COVID-19 pandemic by psychiatrists across low, middle, and high income countries, and to assess levels of burnout among psychiatrists providing telepsychiatry services in different settings and countries. We hypothesized that use of telepsychiatry will have increased during the pandemic and is associated with increased risk of burnout. METHODS A cross-sectional survey was conducted from October 2020 to June 2021 on psychiatrists practicing in Egypt, United Kingdom, Croatia, Belgium, Indonesia, Italy, and El Salvador. Participants were asked to provide sociodemographic data and to complete a questionnaire developed ad-hoc by the authors on telepsychiatry use, the Modified Arizona Telemedicine Program Satisfaction (MATPS) survey and the Oldenburg Burnout Inventory questionnaire. RESULTS A total of 347 participants completed the survey. Sixty three percent indicated that they had not utilized teleservices for clinical consultation or academic purposes prior to the COVID-19 pandemic. A substantial shift was observed during the pandemic, with this percentage increasing to 98%. Over two-thirds of psychiatrists expressed satisfaction with the visual (76%) and audio (77%) aspects of teleconsultation. No significant correlation was found between burnout and satisfaction. While older age was negatively correlated with burnout levels, years of experience showed a positive correlation with levels of burnout. CONCLUSION While there was an increased acceptance and satisfaction with teleconsultation, a persistent preference for in-person consultations remained. The study did not find a correlation between satisfaction in telepsychiatry and levels of burnout. Moreover, increasing age was correlated with lower burn out rate, whereas a correlation between years of experience and heightened levels of burnout was evident.
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Affiliation(s)
- Fairouz Tawfik
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Howard Ryland
- Oxford Health NHS Foundation Trust and Department of Psychiatry, University of Oxford, UK
| | - Mostafa Yosef
- Department of Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Morsy
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Fransiska Kaligis
- Department of Psychiatry, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Camille Noël
- Department of Psychiatry, Saint Pierre University Hospital Centre, Université Libre de Bruxelles, Belgium
| | | | - Victor Mazereel
- Department of Neurosciences, Center for Clinical Psychiatry, KU Leuven, Belgium
| | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania 'L. Vanvitelli', Naples, Italy
| | | | | | - Islam Ibrahim
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Vonderlin R, Boritz T, Claus C, Senyüz B, Mahalingam S, Tennenhouse R, Lis S, Schmahl C, Margraf J, Teismann T, Kleindienst N, McMain S, Bohus M. Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study. JMIR Form Res 2025; 9:e66181. [PMID: 39808784 PMCID: PMC11775487 DOI: 10.2196/66181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 10/28/2024] [Accepted: 11/01/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND The potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation. OBJECTIVE This study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD). METHODS A total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists' and patients' perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples. RESULTS Analyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format. CONCLUSIONS Telehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered. TRIAL REGISTRATION German Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824.
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Affiliation(s)
- Ruben Vonderlin
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
| | - Tali Boritz
- Department of Psychology, York University, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Borderline Personality Disorder Clinic, Toronto, ON, Canada
| | - Carola Claus
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Büsra Senyüz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
| | - Saskia Mahalingam
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
| | - Rachel Tennenhouse
- Centre for Addiction and Mental Health, Borderline Personality Disorder Clinic, Toronto, ON, Canada
| | - Stefanie Lis
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
| | - Shelley McMain
- Centre for Addiction and Mental Health, Borderline Personality Disorder Clinic, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Center for Mental Health (DZPG), Partner Site Mannheim - Heidelberg - Ulm, Mannheim, Germany
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
- McLean Hospital, Harvard Medical School, Boston, MA, United States
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Wadoo O, Khan F, Latoo J, Saeed Khan Y, Chandra P, Iqbal Y, Amro R, Reagu S, Alabdulla M. Telepsychiatry implementation in Qatar: A three-year analysis of no-show rates and its impact on mental health service delivery. Qatar Med J 2024; 2024:50. [PMID: 39911183 PMCID: PMC11795204 DOI: 10.5339/qmj.2024.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 10/13/2024] [Indexed: 02/07/2025] Open
Abstract
Background: The COVID-19 pandemic triggered a rapid shift to telehealth and reshaped healthcare delivery worldwide. In Qatar, telehealth has emerged as a critical tool for ensuring uninterrupted care while minimizing the spread of viruses. However, its long-term efficacy, particularly in mental health services, is still poorly understood. The aim of this study was to address this gap by evaluating the post-pandemic impact of telehealth on the accessibility of mental health services in Qatar. Methods: We conducted a comparative analysis of no-show rates over a four-month period before the initiation of telepsychiatry and telepsychology (March to June 2019) and corresponding periods in 2020, 2021, and 2022. The analysis considered visit types (new visit and follow-up visit) in various psychiatric (child and adolescent, adult, geriatric, forensic, and intellectual disability) and psychological outpatient clinics before and after the implementation of telehealth services. Results: Among both new and follow-up cases, there was a significant reduction (p < 0.0001) in the collective proportion of no-show rates following the introduction of telehealth compared to the rates recorded before the implementation. Exceptions to this trend were appointments in child and adolescent mental health service psychology and forensic psychiatric services. Conclusion: Telehealth has proven instrumental in improving access to mental health services in Qatar post-pandemic. Its integration shows the potential for reducing no-show rates and enhancing continuity of care. These findings are important for healthcare policy-making and practice in Qatar and provide valuable insights into the global discourse on the evolving role of telehealth.
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Affiliation(s)
| | - Faisal Khan
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Yousaf Iqbal
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Raed Amro
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
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Cho S, Kang J, Baek WH, Jeong YB, Lee S, Lee SM. Comparing counseling outcome for college students: Metaverse and in-person approaches. Psychother Res 2024; 34:1117-1130. [PMID: 37848177 DOI: 10.1080/10503307.2023.2270139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
ABSTRACTObjective This study compared metaverse counseling with in-person counseling, using in-person counseling as a comparison group. To achieve this, we assessed whether metaverse counseling, a novel treatment approach, is comparable to traditional in-person counseling. Method: A total of 60 participants voluntarily participated in the study. Among the participants, 28 preferred in-person counseling, whereas 32 selected metaverse counseling as their preferred treatment option. Results and Conclusion: The findings indicated no statistically significant differences in the psychological symptom change patterns between the two counseling modalities. Both metaverse and in-person counseling demonstrated a common pattern of reduced symptom levels from pre-to post-session (Metaverse counseling Cohen's d = 1.04, In-person counseling Cohen's d = .62), which remained stable from post-session to follow-up regardless of the chosen counseling modality. Furthermore, the study revealed that the metaverse counseling group exhibited a higher level of working alliances than the in-person counseling group. Additionally, there was a slight tendency toward higher levels of counseling satisfaction in the metaverse counseling group than in the in-person counseling group. The results of this study support the use of synchronous metaverse programs to treat college students. The implications and limitations of this study are discussed. (195 words).
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Affiliation(s)
- Soohyun Cho
- Department of Education, Keimyung University, Daegu, Korea
| | - Jieun Kang
- Department of Education, Korea University, Seoul, Korea
| | - Woo Hyun Baek
- Department of Education, Korea University, Seoul, Korea
| | | | | | - Sang Min Lee
- Department of Education, College of Education, Korea University, Seoul, Korea
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Madegowda RK, Nirisha PL, Sabhahit GG, Manjunatha N, Kumar CN, Math SB. The child and adolescent patient's profiles and usefulness of instant collaborative video consultations of tele-psychiatrists with primary care doctors. Ind Psychiatry J 2024; 33:354-359. [PMID: 39898102 PMCID: PMC11784670 DOI: 10.4103/ipj.ipj_36_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/30/2024] [Accepted: 04/18/2024] [Indexed: 02/04/2025] Open
Abstract
Background The Tele-Medicine Center at the National Institute of Mental Health and Neurosciences, Bengaluru, organized module-based capacity-building training courses for in-service primary care doctors (PCDs) with MBBS degree. The objective was to bolster the coverage of the National Mental Health Program services and diminish the treatment gap in the region. As part of this training, an instant collaborative video consultation (i-CVC) module allowed PCDs to engage in live, real-time video consultations with tele-psychiatrists at NIMHANS to discuss their patients' cases. Approximately 7% of the i-CVC cases focused on child and adolescent psychiatric disorders. Aim Aim of this study is understand the profiles of child and adolescent patients and usefulness of instant collaborative video consultations of tele-psychiatrists with primary care doctors. Materials and Methods This study delved into data from 41 children and adolescents' (aged 10-17 years) i-CVC module case proformas. It examined six predefined learning themes highlighted by PCDs and evaluated patientprofiles, along with diagnostic agreement between PCDs and tele-psychiatrists. Results Among the 41 patients, there were 19 males (46.3%) and 22 females (53.7%), aged between 10 and 17 years. The study identified six key learning themes: clinical assessment, identification and diagnosis, counseling for children and parents, pharmacotherapy, and legal aspects. Emotional disorders were noted in 12 patients (29.3%), developmental disorders in eight patients (19.5%), psychotic disorders in eight patients (19.5%), and behavioral disorders in three patients (7.3%). Pharmacotherapy was initiated for five patients (12.2%), while 23 patients (56.1%) received counseling, and 13 patients (31.7%) received both treatments. Conclusion Diagnostic agreement between PCDs and tele-psychiatrists was observed in 25 cases (61%). This study represents the first evaluation of the collaborative i-CVC module aimed at training PCDs in child and adolescent psychiatry in India. The 61% diagnostic agreement suggests the feasibility of PCD training. These findings underscore the pressing need for an Indianized, point-of-care manual in child and adolescent psychiatry to train PCDs throughout India.
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Affiliation(s)
- Rajendra K Madegowda
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - P Lakshmi Nirisha
- Department of Psychiatry, All India Institute of Medical Sciences, Raipur, India
| | | | - Narayana Manjunatha
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, NIMHANS, Bengaluru, India
| | | | - Suresh Bada Math
- Tele-Medicine Centre, NIMHANS Digital Academy, Department of Psychiatry, NIMHANS, Bengaluru, India
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McIntyre RS, Greenleaf W, Bulaj G, Taylor ST, Mitsi G, Saliu D, Czysz A, Silvesti G, Garcia M, Jain R. Digital health technologies and major depressive disorder. CNS Spectr 2023; 28:662-673. [PMID: 37042341 DOI: 10.1017/s1092852923002225] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
There is an urgent need to improve the clinical management of major depressive disorder (MDD), which has become increasingly prevalent over the past two decades. Several gaps and challenges in the awareness, detection, treatment, and monitoring of MDD remain to be addressed. Digital health technologies have demonstrated utility in relation to various health conditions, including MDD. Factors related to the COVID-19 pandemic have accelerated the development of telemedicine, mobile medical apps, and virtual reality apps and have continued to introduce new possibilities across mental health care. Growing access to and acceptance of digital health technologies present opportunities to expand the scope of care and to close gaps in the management of MDD. Digital health technology is rapidly evolving the options for nonclinical support and clinical care for patients with MDD. Iterative efforts to validate and optimize such digital health technologies, including digital therapeutics and digital biomarkers, continue to improve access to and quality of personalized detection, treatment, and monitoring of MDD. The aim of this review is to highlight the existing gaps and challenges in depression management and discuss the current and future landscape of digital health technology as it applies to the challenges faced by patients with MDD and their healthcare providers.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Walter Greenleaf
- Virtual Human Interaction Lab, Stanford University, San Francisco, CA, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Steven T Taylor
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, McLean Hospital, Boston, MA, USA
| | | | | | - Andy Czysz
- Sage Therapeutics, Inc., Cambridge, MA, USA
| | | | | | - Rakesh Jain
- Department of Psychiatry, Texas Tech University School of Medicine, Lubbock, TX, USA
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Sharma S, Rawal R, Shah D. Addressing the challenges of AI-based telemedicine: Best practices and lessons learned. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:338. [PMID: 38023098 PMCID: PMC10671014 DOI: 10.4103/jehp.jehp_402_23] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/02/2023] [Indexed: 12/01/2023]
Abstract
Telemedicine is the use of technology to provide healthcare services and information remotely, without requiring physical proximity between patients and healthcare providers. The coronavirus disease 2019 (COVID-19) pandemic has accelerated the rapid growth of telemedicine worldwide. Integrating artificial intelligence (AI) into telemedicine has the potential to enhance and expand its capabilities in addressing various healthcare needs, such as patient monitoring, healthcare information technology (IT), intelligent diagnosis, and assistance. Despite the potential benefits, implementing AI in telemedicine presents challenges that can be overcome with physician-guided implementation. AI can assist physicians in decision-making, improve healthcare delivery, and automate administrative tasks. To ensure optimal effectiveness, AI-powered telemedicine should comply with existing clinical practices and adhere to a framework adaptable to various technologies. It should also consider technical and scientific factors, including trustworthiness, reproducibility, usability, availability, and cost. Education and training are crucial for the appropriate use of new healthcare technologies such as AI-enabled telemedicine. This article examines the benefits and limitations of AI-based telemedicine in various medical domains and underscores the importance of physician-guided implementation, compliance with existing clinical practices, and appropriate education and training for healthcare providers.
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Affiliation(s)
- Sachin Sharma
- Department of Computer Science and Engineering, Indrashil University, Mehsana, Gujarat, India
| | - Raj Rawal
- Department of Critical Care, Gujarat Pulmonary and Critical Care Medicine, Ahmedabad, Gujarat, India
| | - Dharmesh Shah
- Department of ICT, Indrashil University, Mehsana, Gujarat, India
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Adem JB, Melaku MS, Zeleke T, Tesfaye M, Kitila FL, Walle AD. Attitude of mental healthcare providers toward tele-psychiatry services and associated factors at public referral hospitals in Addis Ababa city, Ethiopia. Int J Ment Health Syst 2023; 17:26. [PMID: 37700358 PMCID: PMC10496341 DOI: 10.1186/s13033-023-00596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 08/27/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Health systems around the world are struggling with the massive numbers of people with mental disorders who require professional care. The treatment gap for mental disorders is high all over the world, with between 76 and 85% of people in low- and middle-income countries with severe mental disorders receiving no treatment for their mental health conditions. Tele-psychiatry is used as an alternative solution to the problem of limited mental health services and effective Tele-psychiatry service use may be achievable if mental health providers have a good attitude towards it. OBJECTIVE To assess the attitude of mental healthcare providers toward Tele-psychiatry services and associated factors at public referral hospitals in Addis Ababa city, Ethiopia, 2022. METHOD A Multicenter institution-based cross-sectional study was conducted among 413 mental health professionals working in public referral hospitals in Addis Ababa city, from May 04 to June 10, 2022. Data were collected by using a structured and self-administered questionnaire prepared by reviewing previous related studies. Epi Data version 3.1 and Stata version 14 were used for data entry and analysis respectively. Bivariate and multivariable logistic regression analyses were used to identify factors associated with attitudes toward Tele-psychiatry services. A statistical significance was declared at p-value < 0.05. RESULT A total of 413 Participants were enrolled with a response rate of 91.8%. The majority of respondents 230 (55.69%) were male and the mean age of participants was 29 years (SD + 5.02). In this study the majority (49%) of mental health care professionals had a poor attitude toward Tele-psychiatry. Having electronic health technology experience [AOR 16.79; 95% CI (4.26, 29.3)], lack of training in telemedicine applications [(AOR 0.1; 95% CI (0.01, 0.41)], a good computer uses for daily work activities [AOR 3.65; 95% CI (1.14, 11.60)], availability of e-Health technology awareness program [AOR 0.16; 95% CI (0.03, 0.90)], having a positive perception about the importance of e-Health technologies[AOR 0.041; 95% CI (0.01, 0.29)] and having good knowledge of Tele-psychiatry services [AOR 6.89; 95% CI (1.8, 12.0)] were significantly associated with attitude towards Tele-psychiatry services. CONCLUSION This study found that mental healthcare providers at a public referral hospital in Addis Ababa city generally had poor attitudes regarding Tele-psychiatry services. Considering the significant factors will improve the attitude to use tele-psychiatry services in Ethiopia.
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Affiliation(s)
- Jibril Bashir Adem
- Department of Public Health, College of Health Science, Arsi University, Asela, Ethiopia.
| | - Mequannent Sharew Melaku
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tirualem Zeleke
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Muluken Tesfaye
- Department of Psychiatry, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Firaol Lemessa Kitila
- Department of Public Health, College of Health Science, Arsi University, Asela, Ethiopia
| | - Agmasie Damtew Walle
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
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10
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Adem JB, Zeleke T, Walle AD, Atinafu WT, Tilahun KN, Melaku MS, Kebede SD. Awareness and readiness of mental healthcare providers to implement telemental health services and associated factors at public referral hospitals in Addis Ababa City, Ethiopia. BMJ Open 2023; 13:e069671. [PMID: 37524552 PMCID: PMC10391830 DOI: 10.1136/bmjopen-2022-069671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To assess the awareness and readiness of mental healthcare providers to implement telemental health services and the associated factors at public referral hospitals in Addis Ababa City, Ethiopia. STUDY DESIGN A cross-sectional study was conducted among mental health professionals working at public referral hospitals in Addis Ababa City from 4 May to 10 June 2022. PARTICIPANTS A total of 413 (55.7% male and 44.3% female) health professionals participated in the study. The study participants were selected using a simple random sampling technique. All mental healthcare providers working at public referral hospitals in Addis Ababa City were considered as the source population. Mental healthcare providers who meet the inclusion criteria were considered the study population. Having a minimum diploma qualification and 6 months or more of work experience and giving written consent were considered the inclusion criteria. OUTCOME MEASURE The main outcome measure was awareness and readiness to implement telemental health services. RESULT A total of 413 participants were enrolled, with a response rate of 90.6%. The prevalence of good awareness towards telemental health services was 41% (95% CI 37%, 47%). Being female (adjusted OR (AOR)=0.34; 95% CI 0.15, 0.76), having poor information technology support (AOR=0.32; 95% CI 0.11, 0.99) and having electronic health technology experience (AOR=1.21; 95% CI 1.1, 2.44) were significantly associated with awareness of telemental health services, whereas computer access at the workplace (AOR=0.04; 95% CI 0.003, 0.55) and awareness (AOR=4.34; 95% CI 1.02, 18.48) and attitude (AOR=1.01; 95% CI 1.03, 2.19) towards telemental health services were the variables that showed statistically significant association with readiness of mental healthcare providers for telemental health services. CONCLUSION Although majority of healthcare providers in this survey were prepared to implement telemental health services, there was typically little awareness among mental healthcare providers.
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Affiliation(s)
| | - Tirualem Zeleke
- Department of Health Informatics, University of Gondar, Gondar, Ethiopia
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11
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Izadi R, Bahrami MA, Khosravi M, Delavari S. Factors affecting the acceptance of tele-psychiatry: a scoping study. Arch Public Health 2023; 81:131. [PMID: 37443137 PMCID: PMC10339628 DOI: 10.1186/s13690-023-01146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND In today's digital world, providing services through telemedicine has become an essential issue in health systems, and the Covid-19 pandemic has made this necessity even more apparent. On the other hand, mental health services are needed more than ever, and their nature makes their delivery via telemedicine more feasible than other specialized services. This study aimed to determine the factors affecting the acceptance of telemedicine among users of this technology in the field of mental health. METHODS This article is a scoping review based on the PRISMA guidelines and without any time limit until June 20, 2022. The search was performed in PubMed, Scopus, Web of Science, and PsycINFO databases using keywords related to the three fields of telemedicine, acceptance, and mental disorders. Two authors independently selected the studies based on inclusion and exclusion criteria. Then the data were collected using a data extraction form, and finally, the results were determined using the content analysis method. RESULTS Five main factors affect the acceptance of telemedicine among users of this technology in the field of mental health: perceived effectiveness, users' understanding of the effects of telemedicine on the quality and outcomes of care delivery, technological aspects, organizational change capacity, the nature of the disease and psychological and psychosocial factors. These main factors are associated with 21 related sub-factors. CONCLUSIONS Revealing the factors affecting the acceptance of telemedicine among recipients and providers of services, as key actors in health systems, can help managers and policymakers to successfully implement telemedicine in the less-regarded field of mental health, especially in the early stages.
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Affiliation(s)
- Reyhane Izadi
- Department of Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Bahrami
- Health Human Resources Research Center, School of health management and information sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Khosravi
- Department of Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of health management and information sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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12
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Ghosh A, Mahintamani T, Aswathy PV, Basu D, Mattoo SK, Subodh BN, Pillai RR, Kaur M. Service users' perception and attitude toward telemedicine-based treatment for substance use disorders: A qualitative study from India. Indian J Psychiatry 2023; 65:774-784. [PMID: 37645352 PMCID: PMC10461579 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_167_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 06/28/2023] [Indexed: 08/31/2023] Open
Abstract
Aim We aimed to assess the service user's acceptability, feasibility, and attitude toward telemedicine practice and compare it with in-person consultation in substance use disorder (SUD). Materials and Methods We recruited 15 adult patients with SUD who accessed both telemedicine and in-person care. We conducted in-depth interviews on awareness and access, facilitators and barriers, treatment satisfaction, and therapeutic relationship in the telemedicine context. We performed a conventional content analysis of the interview excerpts and used inductive and deductive coding. We assumed that social, personal, and logistic contexts influence patients' perceptions and experiences with telemedicine-based addiction care (TAC). Results Most participants were middle-aged men (40.5 years, 86.7%), dependent on two or more substances (86.7%), and had a history of chronic, heavy substance use (use ~16 years, dependence ~11.5 years). Patients' perspectives on TAC could broadly be divided into three phases: pre-consultation, consultation, and post-consultation. Patients felt that TAC improved treatment access with adequate autonomy and control; however, there were technical challenges. Patients expressed privacy concerns and feared experiencing stigma during teleconsultation. They reported missing the elaborate inquiry, physical examination, and ritual of visiting their doctors in person. Additionally, personal comfort and technical difficulties determine the satisfaction level with TAC. Overall perception and suitability of TAC and the decision to continue it developed in the post-consultation phase. Conclusion Our study provides an in-depth insight into the barriers and facilitators of telemedicine-based SUD treatment access, use, and retention; it also helps to understand better the choices and preferences for telehealth care vis-à-vis standard in-person care for SUDs.
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Affiliation(s)
- Abhishek Ghosh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tathagata Mahintamani
- Department of Addiction Medicine,Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India
| | - P. V. Aswathy
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debasish Basu
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - B. N. Subodh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renjith R. Pillai
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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13
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Zhang Y, Leuk JSP, Teo WP. Domains, Feasibility, Effectiveness, Cost, and Acceptability of Telehealth in Aging Care: Scoping Review of Systematic Reviews. JMIR Aging 2023; 6:e40460. [PMID: 37071459 PMCID: PMC10155091 DOI: 10.2196/40460] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/02/2022] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Aging is becoming a major global challenge. Compared with younger adults, the older population has greater health needs but faces inadequate access to appropriate, affordable, and high-quality health care. Telehealth can remove geographic and time boundaries, as well as enabling socially isolated and physically homebound people to access a wider range of care options. The impacts of different telehealth interventions in terms of their effectiveness, cost, and acceptability in aging care are still unclear. OBJECTIVE This scoping review of systematic reviews aimed to provide an overview of the domains of telehealth implemented in aging care; synthesize evidence of telehealth's feasibility, effectiveness, cost benefits, and acceptability in the context of aging care; identify gaps in the literature; and determine the priorities for future research. METHODS Guided by the methodological framework of the Joanna Briggs Institute, we reviewed systematic reviews concerning all types of telehealth interventions involving direct communication between older users and health care providers. In total, 5 major electronic databases, PubMed, Embase (Ovid), Cochrane Library, CINAHL, and PsycINFO (EBSCO), were searched on September 16, 2021, and an updated search was performed on April 28, 2022, across the same databases as well as the first 10 pages of the Google search. RESULTS A total of 29 systematic reviews, including 1 post hoc subanalysis of a previously published large Cochrane systematic review with meta-analysis, were included. Telehealth has been adopted in various domains in aging care, such as cardiovascular diseases, mental health, cognitive impairment, prefrailty and frailty, chronic diseases, and oral health, and it seems to be a promising, feasible, effective, cost-effective, and acceptable alternative to usual care in selected domains. However, it should be noted that the generalizability of the results might be limited, and further studies with larger sample sizes, more rigorous designs, adequate reporting, and more consistently defined outcomes and methodologies are needed. The factors affecting telehealth use among older adults have been categorized into individual, interpersonal, technological, system, and policy levels, which could help direct collaborative efforts toward improving the security, accessibility, and affordability of telehealth as well as better prepare the older population for digital inclusion. CONCLUSIONS Although telehealth remains in its infancy and there is a lack of high-quality studies to rigorously prove the feasibility, effectiveness, cost benefit, and acceptability of telehealth, mounting evidence has indicated that it could play a promising complementary role in the care of the aging population.
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Affiliation(s)
- Yichi Zhang
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
- Ageing Research Institute for Society and Education, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore, Singapore
| | - Jessie Siew-Pin Leuk
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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14
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Pourat N, Padilla-Frausto DI, Chen X, Lim D, Osterweil D, Batra RA. The Impact of a Primary Care Telepsychiatry Program on Outcomes of Managed Care Older Adults. J Am Med Dir Assoc 2023; 24:119-124.e4. [PMID: 36356654 DOI: 10.1016/j.jamda.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The goal of this study was to assess the outcomes of a primary-based telepsychiatry intervention program for older managed care enrollees with depression/anxiety and with limited access to in-person psychiatric care. DESIGN A pre-post design was used to examine service use (n = 218) and severity of depression (n = 204). Enrollment, claims, and depression and anxiety score data were obtained from the medical group. The implementation process and self-reported outcomes were examined. SETTING AND PARTICIPANTS The program was funded by the Senior Care Action Network (SCAN) group and implemented by a large medical group serving older adults who were identified as needing outpatient psychiatric care, including those with psychiatric hospitalizations, depression/anxiety disorders, comorbid substance use disorders, or other multiple comorbidities. METHODS Poisson regressions were used to examine changes in predicted rates of outpatient services, emergency department visits, and hospitalizations up to 24 months prior and 24 months following the first telepsychiatry visit. Changes in predicted severity of depression up to 2 quarters prior and 3 quarters following the first telepsychiatry visit were examined. RESULTS The number of outpatient services declined significantly by 0.24 per patient per 6-month time frame following the first telepsychiatry visit. The number of emergency department visits and hospitalizations also declined after the first visit (0.07 and 0.03 per patient per 6-month time frame, respectively). Depression severity scores also declined in the quarters following the first visit (1.52). The medical group reported improvements in both wait time for appointments and no-show rates with the integration of telepsychiatry in primary care. CONCLUSIONS AND IMPLICATIONS The telepsychiatry program lowered service use, depression severity, and increased better access to psychiatry care. The findings highlight the potential benefits of sustaining and expanding the telepsychiatry program by SCAN and other plans facing a limited supply of psychiatrists.
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Affiliation(s)
- Nadereh Pourat
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Xiao Chen
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA
| | - Dominic Lim
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
| | - Dan Osterweil
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA; Division of Geriatric Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Romilla A Batra
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
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15
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Galvin E, Desselle S, Gavin B, Quigley E, Flear M, Kilbride K, McNicholas F, Cullinan S, Hayden J. Implementation of telemedicine consultations for people with mental health conditions in the community: a protocol for a systematic review. HRB Open Res 2022; 4:125. [PMID: 36348659 PMCID: PMC9627101 DOI: 10.12688/hrbopenres.13435.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The COVID-19 pandemic response has led to an exponential increase in the use and spread of telemedicine internationally. In community mental health care settings, telemedicine services were implemented within a few weeks, with little time for rigorous planning. Despite the reported acceptability of telemedicine by patients and clinicians, barriers to its implementation have come to light. There is now a need to investigate these barriers, and facilitators, as telemedicine begins to show potential promise beyond the pandemic. We propose a review that aims to identify the factors affecting the implementation of telemedicine consultations for patients with mental health conditions in the community. Methods: A systematic review will be conducted and reported according to the PRISMA guidelines. Five electronic databases will be searched using a pre-defined search strategy from 2016 to 2021. Only studies of synchronous, interactive telemedicine consultations conducted via video, phone or live messaging between patients and providers will be included. Quantitative, qualitative and mixed methods studies will be eligible for inclusion. Only studies published in the English language will be included. Titles and abstracts will be screened by two reviewers. Full text articles will be screened by two reviewers. The methodological quality of studies will be assessed using the Mixed Method Appraisal Tool (MMAT) by two reviewers. Data will be extracted and tabulated to address the aims of the review. A narrative synthesis will be conducted and reported factors will be mapped to the domains of the Consolidated Framework for Implementation Research (CFIR). Conclusion: By identifying the factors that influence the implementation of telemedicine consultations for patients with mental conditions in the community, consideration can be given to both barriers and facilitators that could be addressed in future mental health services planning. PROSPERO registration: CRD42021273422 (04/10/2021).
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Affiliation(s)
- Emer Galvin
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Blánaid Gavin
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Etain Quigley
- National University of Ireland, Maynooth, Maynooth, Ireland
| | | | | | | | - Shane Cullinan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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16
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Abouzid MR, Elshafei SM, Elkhawas I, Elbana MK. Applications of Telemedicine in the Middle East and North Africa Region: Benefits Gained and Challenges Faced. Cureus 2022; 14:e26611. [PMID: 35936169 PMCID: PMC9355518 DOI: 10.7759/cureus.26611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/05/2022] Open
Abstract
Information and communication technology has left a print on all fields of life, including medicine and the health care system. Telemedicine is the perfect way to ensure adequate healthcare delivery to all people at any time, particularly during pandemics, regardless of any geographic or economic considerations. This article investigates the different types, categories, and benefits in addition to the barriers to telemedicine implementation, especially in the Middle East and North Africa (MENA) region. After a thorough review of medical literature related to telemedicine using PubMed, Google Scholar, and some other gray literature, it has been found that telemedicine has been involved in almost all medical specialties with a positive influence on healthcare delivery and medical education and research. It had a major role during the COVID-19 pandemic. However, many obstacles prevent its proper application and need to be addressed carefully by the government and relevant authorities. Due to the rapidly growing population, unequal distribution of healthcare services, and social distancing of the COVID-19 pandemic, the role of telemedicine has become increasingly essential. Regarding medical education and research, telemedicine facilitates the exchange of information and ideas between physicians and professionals from all over the world, bringing these various minds together on a single platform.
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Affiliation(s)
- Mohamed R Abouzid
- Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, USA
| | - Shorouk M Elshafei
- Internal Medicine, Mansoura University Faculty of Medicine, Mansoura, EGY
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17
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Galvin E, Desselle S, Gavin B, Quigley E, Flear M, Kilbride K, McNicholas F, Cullinan S, Hayden J. Implementation of telemedicine consultations for people with mental health conditions in the community: a protocol for a systematic review. HRB Open Res 2022; 4:125. [PMID: 36348659 PMCID: PMC9627101 DOI: 10.12688/hrbopenres.13435.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 09/07/2024] Open
Abstract
Background: The COVID-19 pandemic response has led to an exponential increase in the use and spread of telemedicine internationally. In community mental health care settings, telemedicine services were implemented within a few weeks, with little time for rigorous planning. Despite the reported acceptability of telemedicine by patients and clinicians, barriers to its implementation have come to light. There is now a need to investigate these barriers, and facilitators, as telemedicine begins to show potential promise beyond the pandemic. We propose a review that aims to identify the factors affecting the implementation of telemedicine consultations for patients with mental health conditions in the community. Methods: A systematic review will be conducted and reported according to the PRISMA guidelines. Five electronic databases will be searched using a pre-defined search strategy from 2016 to 2021. Only studies of synchronous, interactive telemedicine consultations conducted via video, phone or live messaging between patients and providers will be included. Quantitative, qualitative and mixed methods studies will be eligible for inclusion. Only studies published in the English language will be included. Titles and abstracts will be screened by two reviewers. Full text articles will be screened by two reviewers. The methodological quality of studies will be assessed using the Mixed Method Appraisal Tool (MMAT) by two reviewers. Data will be extracted and tabulated to address the aims of the review. A narrative synthesis will be conducted and reported factors will be mapped to the domains of the Consolidated Framework for Implementation Research (CFIR). Conclusion: By identifying the factors that influence the implementation of telemedicine consultations for patients with mental conditions in the community, consideration can be given to both barriers and facilitators that could be addressed in future mental health services planning. PROSPERO registration: CRD42021273422 (04/10/2021).
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Affiliation(s)
- Emer Galvin
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Blánaid Gavin
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Etain Quigley
- National University of Ireland, Maynooth, Maynooth, Ireland
| | | | | | | | - Shane Cullinan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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18
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Naslund JA, Mitchell LM, Joshi U, Nagda D, Lu C. Economic evaluation and costs of telepsychiatry programmes: A systematic review. J Telemed Telecare 2022; 28:311-330. [PMID: 32746762 PMCID: PMC11694481 DOI: 10.1177/1357633x20938919] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Telepsychiatry involves use of telecommunications technology to deliver psychiatric care and offers promise to reduce costs and increase access to mental health services. This systematic review examined cost reporting of telepsychiatry programmes for mental healthcare. METHODS We systematically searched electronic databases for studies reporting costs, including economic evaluations such as cost-effectiveness analyses, or costs of developing telepsychiatry programmes for clinical care of mental disorders. Included studies enrolled participants with mental disorders and involved telepsychiatry for depression, anxiety disorders, serious mental illnesses including schizophrenia spectrum disorders and bipolar disorder, post-traumatic stress disorder, dementia or epilepsy. RESULTS Twenty-six unique studies met inclusion criteria (17,967 participants), with most targeting depression (n = 7; 27%), general mental disorders and screening (n = 7; 27%), child mental health (n = 4; 15%) and geriatric mental health (n = 4; 15%). Nearly all studies (n = 25; 96%) compared telepsychiatry programme costs with either standard in-person consultation or usual care, with 15 (60%) reporting that telepsychiatry programmes were less expensive, and 8 (32%) showing telepsychiatry programmes were more expensive. Three studies reported cost-effectiveness analyses, favouring telepsychiatry programmes, but at highly elevated cost-effectiveness thresholds. Few studies reported costs of developing or delivering telepsychiatry programmes. CONCLUSION Costs of telepsychiatry programmes varied widely, with substantial heterogeneity in how costs were defined and reported. Some programmes cost less than in-person services while others cost more. Therefore, rigorous cost-effectiveness studies following established standards in economic evaluation are needed to inform implementation and sustainability of these programmes in health systems.
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Affiliation(s)
- John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | | | | | | | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Kaphzan H, Sarfati Noiman M, Negev M. The Attitudes and Perceptions of Israeli Psychiatrists Toward Telepsychiatry and Their Behavioral Intention to Use Telepsychiatry. Front Psychiatry 2022; 13:829965. [PMID: 35386519 PMCID: PMC8977602 DOI: 10.3389/fpsyt.2022.829965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although telemedicine care has grown in recent years, telepsychiatry is growing at a slower pace than expected, because service providers often hamper the assimilation and expansion of telepsychiatry due their attitudes and perceptions. The unified theory of acceptance and use of technology (UTAUT) is a model that was developed to assess the factors influencing the assimilation of a new technology. We used the UTAUT model to examine the associations between the attitudes and perceptions of psychiatrists in Israel toward telepsychiatry and their intention to use it. Methods An online, close-ended questionnaire based on a modified UTAUT model was distributed among psychiatrists in Israel. Seventy-six questionnaires were completed and statistically analyzed. Results The behavioral intention of Israeli psychiatrists to use telepsychiatry was relatively low, despite their perceptions of themselves as capable of high performance with low effort. Nonetheless, they were interested in using telepsychiatry voluntarily. Experience in telepsychiatry, and to a lesser extent, facilitating conditions, were found to be positively correlated with the intention to use telepsychiatry. Psychiatrists have a positive attitude toward treating patients by telepsychiatry and perceive its risk as moderate. Discussion Despite high performance expectancy, low effort expectancy, low perceived risk, largely positive attitudes, high voluntariness, and the expectancy for facilitating conditions, the intention to use telepsychiatry was rather low. This result is explained by the low level of experience, which plays a pivotal role. We recommend promoting the facilitating conditions that affect the continued use of telepsychiatry when initiating its implementation, and conclude that it is critical to create a sense of success during the initial stages of experience.
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Affiliation(s)
- Hanoch Kaphzan
- Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | | | - Maya Negev
- Division of Health Systems Policy and Administration, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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20
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Malhotra S, Chand P, Chatterjee K, Brahma A. Practice of Telepsychiatry and its Current Legal Status. Indian J Psychiatry 2022; 64:S176-S184. [PMID: 35599648 PMCID: PMC9122142 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_716_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/01/2021] [Accepted: 10/13/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
| | - Prabhat Chand
- Department of Psychiatry, NIMHANS Digital Academy and Centre for Addiction Medicine, IMHANS, Bengaluru, Karnataka, India
| | - Kaushik Chatterjee
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Arabinda Brahma
- Girindra Sekhar Bose Clinic, Kolkata, West Bengal, India. E-mail:
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21
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Garg A, Agrawal R, Velleman R, Rane A, Costa S, Gupta D, Dsouza E, Jambhale A, Sabnis A, Fernandes G, Bhatia U, Nadkarni A. Integrating assisted tele-psychiatry into primary healthcare in Goa, India: a feasibility study. Glob Ment Health (Camb) 2022; 9:26-36. [PMID: 36618733 PMCID: PMC9806979 DOI: 10.1017/gmh.2021.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/13/2021] [Accepted: 11/29/2021] [Indexed: 01/11/2023] Open
Abstract
Background Tele-psychiatry is an increasingly acceptable and feasible platform to deliver mental health care with the potential to increase access to care in low-resource settings. We aim to examine the acceptability and preliminary impact of the delivery of assisted tele-psychiatry services in primary healthcare settings in Goa, India. Methods Before-after uncontrolled treatment cohort study. In total, 161 adults with either a mental or alcohol use disorder were provided tele-consultation by psychiatrists through a customised video conferencing platform, along with medication or counselling (via trained lay counsellors) or both as needed. Data on socio-demographics, clinical outcomes and process indicators were collected at baseline and 3 months post-baseline. Paired t tests were used to assess clinical outcomes pre- and post-treatment using the General Health Questionnaire-12 (GHQ-12) and World Health Organisation Disability Adjustment Schedule (WHODAS) 2.0, and logistic regression was used to find associations between changes in these scores and various factors. Results The most common diagnosis was depression (35%). Post-treatment, there was a significant reduction in both GHQ-12 and WHODAS 2.0 scores. Participants showed high satisfaction with the tele-psychiatry services and technology platform. Improvement in GHQ-12 score was associated with being employed [OR 8.74 (1.92-39.75, p = 0.005)] and being a homemaker [OR 6.42 (CI 1.61-25.57, p = 0.008)]. Conclusion Treatment of mental disorders through a tele-psychiatry platform appears to be highly acceptable and is associated with improved clinical outcomes. Considering its potential for scalability, a model of assisted tele-psychiatry integrated into primary care can be an important strategy to increase access to mental healthcare in low-resource settings.
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Affiliation(s)
| | - Ravindra Agrawal
- Sangath, Porvorim, Goa, India
- Antarman Centre for Psychosocial Wellbeing, Panjim, Goa, India
- Manipal Hospital, Panaji, Goa, India
| | | | - Anil Rane
- Institute of Psychiatry & Human Behaviour, Bambolim, Goa, India
| | - Sheina Costa
- Sangath, Porvorim, Goa, India
- Manovikas English Medium School, Margao, Goa, India
| | - Devika Gupta
- Sangath, Porvorim, Goa, India
- Department of Population Health, London School of Hygiene & Tropical Medicine, Centre for Global Mental Health, London, UK
| | | | | | - Akshada Sabnis
- Institute of Psychiatry & Human Behaviour, Bambolim, Goa, India
| | | | - Urvita Bhatia
- Sangath, Porvorim, Goa, India
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Headington Rd, Headington, Oxford OX3 0BP, UK
| | - Abhijit Nadkarni
- Sangath, Porvorim, Goa, India
- Department of Population Health, London School of Hygiene & Tropical Medicine, Centre for Global Mental Health, London, UK
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22
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Yue H, Mail V, DiSalvo M, Borba C, Piechniczek-Buczek J, Yule AM. Patient Preferences for Patient Portal-Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study. JMIR Form Res 2022; 6:e33697. [PMID: 34932497 PMCID: PMC8793913 DOI: 10.2196/33697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the COVID-19 pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial and technological barriers, termed the "digital divide," prevent some patients from accessing the technology needed to use telepsychiatry services. OBJECTIVE As an extension to a clinic's outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital's patient portal among adult behavioral health patients at an urban safety net hospital, we aim to assess patient preference for patient portal-based video visits or telephone-only visits and to identify the demographic variables associated with their preference. METHODS Patients in an outpatient psychiatry clinic were contacted by phone, and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. RESULTS A total of 128 patients were reached by phone. A total of 79 (61.7%) patients chose video-based visits, and 69.6% (n=55) of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. CONCLUSIONS Among behavioral health patients at a safety net hospital, there was relatively low engagement with video-based visits through the hospital's patient portal, particularly among older adults.
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Affiliation(s)
- Han Yue
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
| | - Victoria Mail
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
| | - Maura DiSalvo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Christina Borba
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Joanna Piechniczek-Buczek
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
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Abstract
AIMS AND METHOD This review aims to clarify the evidence on the effectiveness of telepsychiatry following the COVID-19 pandemic. We conducted a literature review of three databases (Cochrane Library, PubMed and PsycINFO), using the terms virtual consultation/telepsychiatry/video consultation AND psychiatry/mental illness. RESULTS We identified 325 eligible papers and conducted a thematic analysis resulting in five themes: patient and clinical satisfaction, diagnostic reliability, outcomes, technology and professional guidance. The most significant factors linked to effectiveness of telepsychiatry were patient and clinician satisfaction and adequate technology to facilitate examination of the patient. CLINICAL IMPLICATIONS The consistent diagnostic reliability, satisfactory clinical outcomes and patient satisfaction linked to telepsychiatry favour its continued use once the pandemic ends. The main barrier is reluctance among clinicians and lack of professional guidance. We recommend education on the uses of telepsychiatry among clinicians, and the provision of professional guidance for its use from medical bodies and organisations.
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24
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Galvin E, Desselle S, Gavin B, Quigley E, Flear M, Kilbride K, McNicholas F, Cullinan S, Hayden J. Implementation of telemedicine consultations for people with mental health conditions in the community: a protocol for a systematic review. HRB Open Res 2021; 4:125. [PMID: 36348659 PMCID: PMC9627101 DOI: 10.12688/hrbopenres.13435.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 09/07/2024] Open
Abstract
Background: The COVID-19 pandemic response has led to an exponential increase in the use and spread of telemedicine internationally. In community mental health care settings, telemedicine services were implemented within a few weeks, with little time for rigorous planning. Despite the reported acceptability of telemedicine by patients and clinicians, barriers to its implementation have come to light. There is now a need to investigate these barriers, and facilitators, as telemedicine begins to show potential promise beyond the pandemic. We propose a review that aims to identify the factors affecting the implementation of telemedicine consultations for patients with mental health conditions in the community. Methods: A systematic review will be conducted and reported according to the PRISMA guidelines. Five electronic databases will be searched using a pre-defined search strategy from 2016 to 2021. Only studies of synchronous, interactive telemedicine consultations conducted via video, phone or live messaging between patients and providers will be included. Quantitative, qualitative and mixed methods studies will be eligible for inclusion. Only studies published in the English language will be included. Titles and abstracts will be screened by two reviewers. Full text articles will be screened by a single reviewer, with a random 20% sample screened by a second reviewer. The methodological quality of studies will be assessed using the Mixed Method Appraisal Tool (MMAT) by two reviewers. Data will be extracted and tabulated to address the aims of the review. A narrative synthesis will be conducted and reported factors will be mapped to the domains of the Consolidated Framework for Implementation Research (CFIR). Conclusion: By identifying the factors that influence the implementation of telemedicine consultations for patients with mental conditions in the community, consideration can be given to both barriers and facilitators that could be addressed in future mental health services planning. PROSPERO registration: CRD42021273422 (04/10/2021).
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Affiliation(s)
- Emer Galvin
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Blánaid Gavin
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Etain Quigley
- National University of Ireland, Maynooth, Maynooth, Ireland
| | | | | | | | - Shane Cullinan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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25
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Dave S, Abraham S, Ramkisson R, Matheiken S, Pillai AS, Reza H, Bamrah JS, Tracy DK. Digital psychiatry and COVID-19: the Big Bang effect for the NHS? BJPsych Bull 2021; 45:259-263. [PMID: 33081867 PMCID: PMC7844168 DOI: 10.1192/bjb.2020.114] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic has brought untold tragedies. However, one outcome has been the dramatically rapid replacement of face-to-face consultations and other meetings, including clinical multidisciplinary team meetings, with telephone calls or videoconferencing. By and large this form of remote consultation has received a warm welcome from both patients and clinicians. To date, human, technological and institutional barriers may have held back the integration of such approaches in routine clinical practice, particularly in the UK. As we move into the post-pandemic phase, it is vital that academic, educational and clinical leadership builds on this positive legacy of the COVID crisis. Telepsychiatry may be but one component of 'digital psychiatry' but its seismic evolution in the pandemic offers a possible opportunity to embrace and develop 'digital psychiatry' as a whole.
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Affiliation(s)
- Subodh Dave
- Derbyshire Healthcare Foundation Trust, Royal Derby Hospital, UK
| | | | | | | | | | | | - J. S. Bamrah
- Greater Manchester Mental Health Foundation Trust, UK
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26
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Almalky AM, Alhaidar FA. Patients' Satisfaction With Telepsychiatry Services at a University Hospital in Riyadh During the COVID-19 Pandemic. Cureus 2021; 13:e17307. [PMID: 34552838 PMCID: PMC8449544 DOI: 10.7759/cureus.17307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background and objective Telepsychiatry uses electronic communication and various technologies to provide psychiatric care by a psychiatrist in one location to a patient in another location. It was originally created to meet the mental health needs of patients in rural, remote, and inaccessible areas. This study aimed to assess the satisfaction level with telepsychiatry from patients' perspectives and to study whether the satisfaction levels influence the patients' decision to use the service in the future. Methodology This was a cross-sectional survey study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia. The study included psychiatric patients with complete medical records who were followed up through the telepsychiatry program over the phone due to the restriction and regulation implemented by the government in the wake of the coronavirus disease 2019 (COVID-19) pandemic. The data were collected via a questionnaire designed on a Google Form. Initially, the sample size was set at 337 psychiatric patients, but only 141 patients agreed to be included. The SPSS Statistics program (IBM, Armonk, NY) was used to analyze the data. Results Patients were generally satisfied with the telepsychiatry services; 80.1%, 95.7%, and 96.5% of the participants were satisfied with the structure, process, and outcome, respectively, and 94.3% of the patients reported a sense of overall satisfaction. The study did not find any relationship between satisfaction and demographic characteristics. Patients highly valued some aspects during the service use, such as comfort, privacy, easy access, carefulness, and skillfulness of the clinicians. Of the respondents, 24.1% agreed and 24.8% strongly agreed when asked if they would use the service in the future. Conclusion Patients had generally positive satisfaction levels toward telepsychiatry service, and many reported that they would like to continue using it in the future. However, further studies are needed to assess whether patient perception will change over time after the COVID-19 pandemic.
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Affiliation(s)
| | - Fatima A Alhaidar
- Faculty of Medicine, King Saud University, Riyadh, SAU.,Child and Adolescent Psychiatric Department, King Khalid University Hospital, Riyadh, SAU
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27
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Rashid Soron T, Ashiq MAR, Al-Hakeem M, Chowdhury ZF, Uddin Ahmed H, Afrooz Chowdhury C. Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh. JMIR Form Res 2021; 5:e24624. [PMID: 34346893 PMCID: PMC8439177 DOI: 10.2196/24624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence. OBJECTIVE In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care. METHODS We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation). RESULTS We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services. CONCLUSIONS Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner.
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Affiliation(s)
| | | | - Marzia Al-Hakeem
- Telepsychiatry Research and Innovation Network Ltd, Dhaka, Bangladesh
| | | | - Helal Uddin Ahmed
- Department of Child, Adolescent, and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
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Ackerman M, Greenwald E, Noulas P, Ahn C. Patient Satisfaction with and Use of Telemental Health Services in the Perinatal Period: a Survey Study. Psychiatr Q 2021; 92:925-933. [PMID: 33389477 PMCID: PMC7778562 DOI: 10.1007/s11126-020-09874-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
We aimed to assess patients' utilization of and satisfaction with telemental health (TMH) in the perinatal period. We hypothesized that satisfaction with TMH would be at least equal to, if not greater than, with in-person appointments. We conducted a cross-sectional survey between March 2018-June 2019 to evaluate patient satisfaction with and use of TMH services in the perinatal period. Participants used TMH services across the second and third trimester of pregnancy and the first year post-partum. Nearly half of the patients (8/19, 42%) used TMH to see their provider within the first two weeks post-partum. Participants were most commonly in treatment for anxiety (14/19, 74%) and/or depression (9/19, 47%). Most participants agreed or strongly agreed (13/19, 69%) that TMH improved their access to healthcare and that they could see the clinician as well as if they met in person (14/19, 74%). TMH was a highly accepted and appreciated method of mental health care delivery for perinatal women when offered as an alternative to in-person or telephone sessions.
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Affiliation(s)
- Marra Ackerman
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
| | - Elizabeth Greenwald
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Paraskevi Noulas
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Christina Ahn
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
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Okyere‐Twum E. Can digital innovation be helpful to counselling and psychotherapy in low‐ and middle‐income countries? The case of Ghana. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ernest Okyere‐Twum
- Social Psychology Department Université de Paris Boulogne‐Billancourt France
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30
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Nagendrappa S, Vinod P, Pai NM, Ganjekar S, Desai G, Kishore MT, Thippeswamy H, Vaiphei K, Chandra PS. Perinatal Mental Health Care for Women With Severe Mental Illness During the COVID-19 Pandemic in India-Challenges and Potential Solutions Based on Two Case Reports. Front Glob Womens Health 2021; 2:648429. [PMID: 34816204 PMCID: PMC8593993 DOI: 10.3389/fgwh.2021.648429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/22/2021] [Indexed: 01/09/2023] Open
Abstract
The ongoing COVID-19 pandemic in India has created several challenges in the care of women with perinatal mental illness. Access to healthcare has been disrupted by lockdowns, travel restrictions, and the unavailability of outpatient services. This report aims to discuss the challenges faced by women with severe mental illnesses during the perinatal period with the help of two case reports. Accordingly, we have highlighted the role of COVID-19 infection as a traumatic event during childbirth and its role in triggering a psychotic episode in women with vulnerabilities; difficulties faced by women with postpartum psychosis in accessing perinatal psychiatry services; and the challenges of admission into an inpatient Mother-Baby Unit (MBU). Further, we have discussed potential solutions from the perspectives of Lower and Middle-income (LAMI) countries that need to be extended beyond the pandemic. They include offering video consultations, reviewing hospital policies, and evolving strategies to mitigate traumatic experiences for pregnant and postpartum women with severe mental illnesses in both obstetric and psychiatric care.
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Affiliation(s)
- Sachin Nagendrappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pratibha Vinod
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naveen Manohar Pai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - M. Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kimneihat Vaiphei
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Prabha S. Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India,*Correspondence: Prabha S. Chandra
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31
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Banerjee D, Vajawat B, Varshney P. Digital gaming interventions: a novel paradigm in mental health? Perspectives from India. Int Rev Psychiatry 2021; 33:435-441. [PMID: 33210563 DOI: 10.1080/09540261.2020.1839392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The mental health gap has been a persistent concern globally, especially in low and middle-income countries (LMIC). In an attempt to mitigate resource limitations, the psychiatric practice has been undergoing a paradigm shift into digitalized mental health interventions. One such innovation involves digital gaming utilizing the principles of 'gamification' to incorporate both the playfulness component of online gaming as well as the domain-targeted design of gaming elements. Digital gaming-based interventions have been to deliver psychotherapy, biofeedback, cognitive training and rehabilitation, as well as behavioural modification and social skills training. Research shows their utility in autism spectrum disorders, attention deficit disorders, schizophrenia, depression, anxiety disorders, post-traumatic stress, eating disorders, neurocognitive disorders and also to promote healthy aging. Though promising in scope, these interventions face pragmatic challenges for implementation in developing countries. Even though increased use of technology, internet penetration and growing digital literacy have enhanced their accessibility and feasibility, various factors like socio-cultural diversity, lack of standardization, poor infrastructural support, bandwidth issues and lack of practice can impair their use and acceptability. Keeping this in the background, this commentary critically discusses the scope, applications and challenges of digital gaming in mental healthcare delivery in one of the rapidly globalizing LMIC nations, India.
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Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prateek Varshney
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Kulkarni KR, Shyam RPS, Bagewadi VI, Gowda GS, Manjunatha BR, Shashidhara HN, Basavaraju V, Manjunatha N, Moirangthem S, Kumar CN, Math SB. A study of collaborative telepsychiatric consultations for a rehabilitation centre managed by a primary healthcare centre. Indian J Med Res 2021; 152:417-422. [PMID: 33380707 PMCID: PMC8061593 DOI: 10.4103/ijmr.ijmr_676_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background & objectives: Telepsychiatric methods can be used for the purpose of providing clinical care comparable to in-person treatment in various settings including rehabilitation. Previous evidence has shown that clinical outcomes for both are comparable. In view of challenges posed in the implementation of traditional psychiatric care in India, telepsychiatry offers an avenue to provide feasible, affordable and clinically useful psychiatric services. This study was conducted to examine the utility, feasibility and clinical effectiveness of providing collaborative telepsychiatric services with a primary care doctor for inpatients in a rehabilitation centre through a telepsychiatrist of estabilished psychiatry department in a tertiary care centre in south India in a collaborative care model with a primary care doctor. Methods: Patients at the rehabilitation centre attached to an urban primary healthcare centre received collaborative care using telepsychiatry for a period from January 2013 to December 2016. A retrospective review of their charts was performed and sociodemographic, clinical and treatment details were collected and analyzed. Results: The sample population (n=132) consisted of 75 per cent males, with a mean age of 43.8 ± 12.1 yr. Each patient received an average of 7.8 ± 4.9 live video-consultations. Initially, an antipsychotic was prescribed for 84.1 per cent (n=111) of patients. Fifty four patients (40.9%) had a partial response and 26 (19.7%) patients showed a good response. Interpretation & conclusions: The study sample represented the population of homeless persons with mental illness who are often brought to the rehabilitation centre. This study results demonstrated the successful implementation of inpatients collaborative telepsychiatry care model for assessment, follow up, investigation and treatment of patients through teleconsultation.
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Affiliation(s)
- Karishma R Kulkarni
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - R P S Shyam
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - B R Manjunatha
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Harihara N Shashidhara
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Suresh Bada Math
- Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Pahuja E, Kumar TS, Uzzafar F, Manjunatha N, Kumar CN, Gupta R, Math SB. An impact of a digitally driven primary care psychiatry program on the integration of psychiatric care in the general practice of primary care doctors. Indian J Psychiatry 2020; 62:690-696. [PMID: 33896975 PMCID: PMC8052894 DOI: 10.4103/psychiatry.indianjpsychiatry_324_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/29/2020] [Accepted: 07/07/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The prevalence of psychiatric disorders among the general population is 10.6%. Primary care doctors (PCDs) are often the first contact for patients with common psychiatric disorders, but the majority of them are ill equipped to handle the same leading to symptomatic treatment. Hence, an innovative digitally driven and modular-based 1-year primary care psychiatry program (PCPP) was designed and implemented exclusively for practicing PCDs of Uttarakhand. AIM The aim of the study was to assess the impact of this digitally driven 1-year PCPP on the general practice of PCDs. MATERIALS AND METHODS Ten PCDs were trained in the curriculum module "Clinical Schedule for Primary Care Psychiatry" which is a validated concise guideline for screening, classification, diagnosis, treatment, follow-ups, and referrals. Furthermore, they underwent training in on-site basic module (10 days); three online modules (with nil or minimal disruption in their regular clinical work) - Telepsychiatric On-Consultation Training (Tele-OCT), Collaborative Video Consultations, and weekly virtual classroom; and one public health module. In addition, PCDs underwent 10 criteria-based formative assessment including self-reports of weekly patients' audit (Primary Care Psychiatry Quotient [PCPQ]) and quarterly Tele-OCT evaluation sessions (Translational Quotient [TQ]). RESULTS PCPQ was 11.09% (2182 psychiatric patients of total 19,670 general outpatients) which means 11.09% of PCDs' total general consultations had psychiatric disorders, which would have been otherwise missed. Average scores obtained in first and second Tele-OCT evaluations (similar to clinical examination but in their real-time consultation) were 70.33% and 76.33%, respectively, suggestive of adequate TQ at 6 and 9 months of the course. CONCLUSIONS One-year PCPP is shown to be effective in acquiring psychiatry knowledge, skills, and retention of skills (TQ) and also translated in providing psychiatric care in general practice with a positive impact on the delivery of primary care psychiatry.
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Affiliation(s)
- Erika Pahuja
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Thamaraiselvan Santhosh Kumar
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Fareed Uzzafar
- Department of Medical Health and Family Welfare, National Health Mission, Government of Uttarakhand, Dehradun, Uttarakhand, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Suresh Bada Math
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Abstract
The utilization of telemedicine and telepsychiatry (TP) services in the outpatient department (OPD) has been increasing in recent years. The information about the technological, administrative, and clinical challenges is being addressed by the telemedicine and TP guidelines published by several individual nations. TP aims to address the treatment gaps, barriers for utilization, accessibility, diagnostic validity, financial implications, and individual client preferences. Utilization of TP in the OPD varies from country to country depending upon their healthcare delivery systems. It also varies in populations utilizing the TP services-urban, rural, child and adolescent, geriatric, and differently abled. TP services in the OPDs are being incorporated differentially by government organizations, insurance recognized psychiatric healthcare organizations, private psychiatric group practice deliverers, and individual, standalone psychiatric healthcare deliverers. TP may not replace the traditional in-person consultations completely. Covid-19 pandemic has hastened its utilization across several healthcare delivery systems. Healthcare organizations, clinicians, other healthcare deliverers, and end users are in the process of adapting to the new scenario. Incorporation of the big data, machine learning, artificial intelligence, virtual reality, and other technological advances in the psychiatric healthcare delivery systems into TP services in the OPDs would significantly contribute to the overall quality and efficacy of the psychiatric healthcare delivery systems in the future.
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Affiliation(s)
| | | | - Amala Emani
- Columbus Hospital, Hyderabad, Telangana, India
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Sousa AD, Shrivastava A, Shah B. Telepsychiatry and Telepsychotherapy: Critical Issues Faced by Indian Patients and Psychiatrists. Indian J Psychol Med 2020; 42:74S-80S. [PMID: 33354069 PMCID: PMC7736729 DOI: 10.1177/0253717620960407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Telepsychiatry and telepsychotherapy are new treatment modalities that have been used more than ever during the COVID-19 pandemic. There are many challenges that are faced with the use of this modality for both patients and psychiatrists alike. There are critical issues faced with regard to the development of rapport, managing the entire teleconsultation set up, privacy and issues related to fees, issues related to prescribing and monitoring, and issues while handling emergencies. The challenges faced are discussed and some solutions if possible are laid out.
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Affiliation(s)
- Avinash De Sousa
- De Sousa Foundation, Mumbai, Maharashtra, India
- Dept. of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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Abstract
This review chronicles the origin of telepsychiatry services started by the Schizophrenia Research Foundation (SCARF) in the community and traces the birth of the Scarf Telepsychiatry in Pudukkottai (STEP) program at Pudukkottai in Tamil Nadu. This paper also examines the trajectory of STEP and highlights other relevant models existing in the country in the last decade.
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Affiliation(s)
- Hema Tharoor
- Dept. of Mental Health and Social Sciences, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - Rangaswamy Thara
- Research and DEMCARES, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
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Sunjaya AP, Chris A, Novianti D. Efficacy, patient-doctor relationship, costs and benefits of utilizing telepsychiatry for the management of post-traumatic stress disorder (PTSD): a systematic review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2020; 42:102-110. [DOI: 10.1590/2237-6089-2019-0024] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/17/2019] [Indexed: 01/18/2023]
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Stoll J, Müller JA, Trachsel M. Ethical Issues in Online Psychotherapy: A Narrative Review. Front Psychiatry 2020; 10:993. [PMID: 32116819 PMCID: PMC7026245 DOI: 10.3389/fpsyt.2019.00993] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The provision of psychotherapy over distance using technology is a growing market reaching many patients and therefore the risks and benefits need to be known by all psychotherapists whether they themselves practice online or not. This comprehensive review of the main ethical arguments for and against different forms of online psychotherapy aims to enhance discussion of ethical issues in this growing area. METHODS A search of three databases (PubMed, PsycINFO, Web of Science) was conducted in August 2019 using a specific search protocol yielding 249 publications. RESULTS Of 24 ethical arguments in favor of online psychotherapy and 32 against, the top five ethical arguments in favor of online psychotherapy were (1) increased access to psychotherapy and service availability and flexibility; (2) therapy benefits and enhanced communication; (3) advantages related to specific client characteristics (e.g. remote location); (4) convenience, satisfaction, acceptance, and increased demand; and (5) economic advantages. The top five ethical arguments against engagement in online psychotherapy were (1) privacy, confidentiality, and security issues; (2) therapist competence and need for special training; (3) communication issues specific to technology; (4) research gaps; and (5) emergency issues. CONCLUSIONS The findings may be of help to practitioners in deciding whether to engage in online psychotherapy, and in informing patients about risks and benefits, improving ethical guidelines, and stimulating further ethical discussion. The findings are argumentative and qualitative in nature, and further quantitative research is needed.
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Affiliation(s)
| | | | - Manuel Trachsel
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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Kommu JVS, Jacob P. Specialty training in child and adolescent psychiatry in India. Eur Child Adolesc Psychiatry 2020; 29:89-93. [PMID: 31529268 DOI: 10.1007/s00787-019-01407-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/11/2019] [Indexed: 10/26/2022]
Abstract
India has a considerable skilled manpower deficit in the area of child and adolescent mental health, given its population and their needs. To address this deficit, in the recent past, various centres in India have begun specialty training in the field of child and adolescent psychiatry with the lead being taken by the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. This is a welcome step in the right direction. However, specialty training of this nature cannot exist in a vacuum. There is a need for a comprehensive and cohesive child and adolescent mental health policy which must include adopting certain standards in training in the various sub-specialties of child and adolescent mental health. From this national policy, provisions must be made for a spectrum of care from specialized tertiary care to high-quality community-based care. Dedicated, skilled mental health professionals who will impart training at the highest level as well help train a cadre of specialists (psychiatrists, pediatricians) and non-specialists with various degrees of exposure and training in the field of child and adolescent mental health are the need of the hour to have a stepped model of care. This will go a long way in ensuring effective and equitable distribution of the sparse human resources. Similar issues may operate in other low- and middle-income countries and thus the discussion may be relevant to such populations as well.
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Affiliation(s)
| | - Preeti Jacob
- Department of Child and Adolescent Psychiatry, NIMHANS, Bangalore, 560029, India
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Zadka Ł, Olajossy M. COVID-19 Pandemic as the Beginning of a Golden Era for Telepsychiatry in Poland's Healthcare System. Front Psychiatry 2020; 11:555559. [PMID: 33519538 PMCID: PMC7838124 DOI: 10.3389/fpsyt.2020.555559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Łukasz Zadka
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, Wroclaw, Poland.,Polish Psychiatric Association, Warsaw, Poland
| | - Marcin Olajossy
- Polish Psychiatric Association, Warsaw, Poland.,2nd Department of Psychiatry and Psychiatric Rehabilitation Medical University of Lublin, Medical University of Lublin, Lublin, Poland
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Whaibeh E, Mahmoud H, Vogt EL. Reducing the Treatment Gap for LGBT Mental Health Needs: the Potential of Telepsychiatry. J Behav Health Serv Res 2019; 47:424-431. [DOI: 10.1007/s11414-019-09677-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
Aims and MethodThe aims of this review were to explore the effectiveness and patient and provider acceptability of telepsychiatry consultations in intellectual disability, contrasting this with direct face-to-face consultations and proposing avenues for further research and innovation. Computerised searches of databases including AMED and EMBASE were conducted. RESULTS: Four USA studies of intellectual disability telepsychiatry services have been reported. The majority (75%) focused on children with intellectual disability. Sample sizes ranged from 38 to 900 participants, with follow-up from 1 to 6 years. Outcome measures varied considerably and included cost savings to patients and healthcare providers, patient and carer satisfaction and new diagnoses.Clinical implicationsThe innovations summarised suggest a requirement to further explore telepsychiatry models. Despite some promising outcomes, there is a relative dearth in the existing literature. Further studies in other healthcare systems are required before concluding that telepsychiatry in intellectual disability is the best approach for providing psychiatric services to this population.Declaration of interestNone.
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Mazhari S, Ghaffari Nejad A, Mofakhami O, Raaii F, Bahaadinbeigy K. Evaluating the Diagnostic Agreement between Telepsychiatry Assessment and Face-to-Face Visit: A Preliminary Study. IRANIAN JOURNAL OF PSYCHIATRY 2019; 14:236-241. [PMID: 31598127 PMCID: PMC6778603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: Despite accumulated evidence that demonstrates clinical outcome of telepsychiatry is comparable with conventional method; little research has been done on telepsychiatry in developing countries. This study aimed to evaluate the diagnostic agreement between telepsychiatry assessment and face-to-face assessment. Moreover, patient and doctor satisfaction was assessed by self-report questionnaire. Method : This study was conducted in an inpatient department of a university-affiliated hospital in Kerman University of Medical Sciences, Iran. The study sample consisted of 40 inpatients aged over 18 years who were selected from October 2016 to February 2017. All patients were visited onc e by face-to-face conventional method and once by interactive video teleconsultation by 2 psychiatric consultants. Results: Results of this study revealed that the diagnostic agreement between the 2 interviewers was 75%. Moreover, about 85% of the patients preferred telepsychiatry for follow-up visits. Also, more than 82% of the patients would recommend telepsychiatry to others although 95% of them perceived contact via telepsychiatry as uncomfortable to some extent. Conclusion: Telepsychiatry service can be used for psychiatric evaluation in Iran, and it has a desirable effect on patient and doctor satisfaction. The results of this study showed the capacity of moving towards using telepsychiatry.
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Affiliation(s)
- Shahrzad Mazhari
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.,Department of Psychiatry, Shahid-Beheshti Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Ghaffari Nejad
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Department of Psychiatry, Shahid-Beheshti Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Omid Mofakhami
- Department of Psychiatry, Shahid-Beheshti Hospital, Kerman University of Medical Sciences, Kerman, Iran.,Corresponding Author: Address: Department of Psychiatry, Shahid-Beheshti Hospital, Kerman University of Medical Sciences, Kerman, Iran. P.O. Box: 76175-113. Tel: 034-32116328, Fax: 034-32110931,
| | - Farzaneh Raaii
- Department of Psychiatry, Shahid-Beheshti Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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44
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Victor AM. Telepsychiatry and comprehensive mental health India. Perspect Psychiatr Care 2019; 55:459-463. [PMID: 30479029 DOI: 10.1111/ppc.12342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/30/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Telemedicine in psychiatry is a validated and effective practice of medicine that increases access to health care. Telepsychiatry is also termed as telemental health or E-mental health using video conferencing which is broadly defined to provide and support psychiatric mental health services across distances. The consumption of knowledge in the mental health field has been renowned sporadically since the sixth decade of the last century. PRACTICE IMPLICATIONS It is imperative for nurses to see the telehealth technology as a medium for care, and not a tool to replace high-quality nursing practices. Patient safety will be maintained with telenurses who are able to focus on patient care and not the technology itself.
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Affiliation(s)
- Agnes Monica Victor
- Psychiatric and Mental Health Nursing Department, College of Nursing, King Saud bin Abdulaziz University for Health Sciences (MC 3105), Riyadh, Kingdom of Saudi Arabia
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45
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Malhotra S, Chakrabarti S, Shah R. A model for digital mental healthcare: Its usefulness and potential for service delivery in low- and middle-income countries. Indian J Psychiatry 2019; 61:27-36. [PMID: 30745651 PMCID: PMC6341930 DOI: 10.4103/psychiatry.indianjpsychiatry_350_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Using digital technology to deliver mental health care can possibly serve as a viable adjunct or alternative to mainstream services in lessening the mental health gap in a large number of resource deficient and LAMI countries. Conventional models of telepsychiatric services available so far, however, have been inadequate and ineffective, as these address only a small component of care, and rely on engagement of specialists who are grossly insufficient in numbers. AIM To describe an innovative digital model of mental health care, enabling and empowering the non-specialists to deliver high quality mental health care in remote areas. METHODS The model is powered by an online, fully automated clinical decision support system (CDSS), with interlinked modules for diagnosis, management and follow-up, usable by non-specialists after brief training and minimal supervision by psychiatrist, to deliver mental health care at remote sites. RESULTS The CDSS has been found to be highly reliable, feasible, with sufficient sensitivity and specificity. This paper describes the model and initial experience with the digital mental health care system deployed in three geographically difficult and remote areas in northern hill states in India. The online system was found to be reasonably comprehensive, brief, feasible, user-friendly, with high levels of patient satisfaction. 2594 patients assessed at the three remote sites and the nodal center represented varied diagnoses. CONCLUSIONS The digital model described here has the potential to serve as an effective alternative or adjunct for delivering comprehensive and high quality mental health care in LAMI countries like India in the primary and secondary care settings.
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Affiliation(s)
- Savita Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ruchita Shah
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Heravian A, Chang BP. Mental health and telemedicine in the acute care setting: Applications of telepsychiatry in the ED. Am J Emerg Med 2018; 36:1118-1119. [DOI: 10.1016/j.ajem.2017.10.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 01/18/2023] Open
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Steinberg EA, Moss M, Buchanan CL, Goebel J. Adherence in pediatric kidney transplant recipients: solutions for the system. Pediatr Nephrol 2018; 33:361-372. [PMID: 28349215 DOI: 10.1007/s00467-017-3637-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 12/13/2022]
Abstract
Non-adherence remains a significant problem among pediatric (and adult) renal transplant recipients. Non-adherence among solid organ transplant recipients results in US$15-100 million annual costs. Estimates of non-adherence range from 30 to 70% among pediatric patients. Research demonstrates that a 10% decrement in adherence is associated with 8% higher hazard of graft failure and mortality. Focus has begun to shift from patient factors that impact adherence to the contributing healthcare and systems factors. The purpose of this review is to describe problems within the systems implicated in non-adherence and potential solutions that may be related to positive adherence outcomes. Systems issues include insurance and legal regulations, provider and care team barriers to optimal care, and difficulties with transitioning to adult care. Potential solutions include recognition of how systems can work together to improve patient outcomes through improvements in insurance programs, a multi-disciplinary care team approach, evidence-based medical management, pharmacy-based applications and interventions to simplify medication regimens, improved transition protocols, and telehealth/technology-based multi-component interventions. However, there remains a significant lack of reliability in the application of these potential solutions to systems issues that impact patient adherence. Future efforts should accordingly focus on these efforts, likely by leveraging quality improvement and related principles, and on the investigation of the efficacy of these interventions to improve adherence and graft outcomes.
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Affiliation(s)
- Elizabeth A Steinberg
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Mary Moss
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, USA
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jens Goebel
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Malhotra S, Chakrabarti S, Shah R, Sharma M, Sharma KP, Malhotra A, Upadhyaya SK, Margoob MA, Maqbool D, Jassal GD. Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliabilityof diagnostic module. Indian J Med Res 2017; 146:196-204. [PMID: 29265020 PMCID: PMC5761029 DOI: 10.4103/ijmr.ijmr_757_15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND & OBJECTIVES A knowledge-based, logically-linked online telepsychiatric decision support system for diagnosis and treatment of mental disorders was developed and validated. We evaluated diagnostic accuracy and reliability of the application at remote sites when used by non-psychiatrists who underwent a brief training in its use through video-conferencing. METHODS The study was conducted at a nodal telepsychiatry centre, and three geographically remote peripheral centres. The diagnostic tool of application had a screening followed by detailed criteria-wise diagnostic modules for 18 psychiatric disorders. A total of 100 consecutive consenting adult outpatients attending remote telepsychiatry centres were included. To assess inter-rater reliability, patients were interviewed face to face by non-specialists at remote sites using the application (active interviewer) and simultaneously on online application via video-conferencing by a passive assessor at nodal centre. Another interviewer at the nodal centre rated the patient using Mini-International Neuropsychiatric Interview (MINI) for diagnostic validation. RESULTS Screening sub-module had high sensitivity (80-100%), low positive predictive values (PPV) (0.10-0.71) but high negative predictive value (NPV) (0.97-1) for most disorders. For the diagnostic sub-modules, Cohen's kappa was >0.4 for all disorders, with kappa of 0.7-1.0 for most disorders. PPV and NPV were high for most disorders. Inter-rater agreement analysis revealed kappa >0.6 for all disorders. INTERPRETATION & CONCLUSIONS Diagnostic tool showed acceptable to good validity and reliability when used by non-specialists at remote sites. Our findings show that diagnostic tool of the telepsychiatry application has potential to empower non-psychiatrist doctors and paramedics to diagnose psychiatric disorders accurately and reliably in remote sites.
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Affiliation(s)
- Savita Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ruchita Shah
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Minali Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kanu Priya Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Akanksha Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Suneet K. Upadhyaya
- Department of Psychiatry, Hemwati Nandan Bahuguna Base Hospital, Srinagar, Uttarakhand, India
| | - Mushtaq A. Margoob
- Department of Psychiatry, Institute of Mental Health & Neuro Sciences, Srinagar, Jammu & Kashmir, India
| | - Dar Maqbool
- Department of Psychiatry, Institute of Mental Health & Neuro Sciences, Srinagar, Jammu & Kashmir, India
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Naskar S, Victor R, Das H, Nath K. Telepsychiatry in India - Where Do We Stand? A Comparative Review between Global and Indian Telepsychiatry Programs. Indian J Psychol Med 2017; 39:223-242. [PMID: 28615754 PMCID: PMC5461830 DOI: 10.4103/0253-7176.207329] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A wide discrepancy exists in India between the existing mental healthcare repertoire and the alarmingly high burden of individuals requiring immediate attention from requisite mental healthcare services. Providing equitable mental healthcare across a vast country characterized by profound cultural variations and territorial caveats has remained a major public health concern. Against this gloomy backdrop, the emergence of distant communications technology offers solace and optimism as an ingenious approach to bridge the existing gap between clients and mental health professionals. Using inexpensive equipment and basic technical knowhow, telepsychiatry expands the scope of the discipline to distant and hazy suburbs and villages from its urban centers of excellence. The current academic endeavor intends to perform a systematic review of relevant literature from India as well as from other countries. The various models of telepsychiatry-both asynchronous and synchronous models-in practice have been elaborated on with a focus on effectiveness, feasibility and acceptability of this latest modality. A sincere attempt to chronicle the remarkable journey of telepsychiatry in India, beginning in the dawn of the 21st century to the current Indian scenario, has been made. The legal and ethical issues, along with a few words of caution and contemplation, have been briefly touched on. A set of recommendations has been provided with the hope that policy makers and administrators in the domain of mental health may benefit from them. It is anticipated that telepsychiatry will be adequately utilized in India to tackle the raging menace of inadequate mental healthcare services.
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Affiliation(s)
- Subrata Naskar
- Department of Neuropsychiatry, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Robin Victor
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Himabrata Das
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Kamal Nath
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
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Villani M, Kovess-Masfety V. How Do People Experiencing Schizophrenia Spectrum Disorders or Other Psychotic Disorders Use the Internet to Get Information on Their Mental Health? Literature Review and Recommendations. JMIR Ment Health 2017; 4:e1. [PMID: 28049620 PMCID: PMC5241504 DOI: 10.2196/mental.5946] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/23/2016] [Accepted: 11/25/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Studies show that the Internet has become an influential source of information for people experiencing serious psychiatric conditions such as schizophrenia spectrum disorders or other psychotic disorders, among which the rate of Internet users is growing, with rates ranging from 33.3% to 79.5% given the country. Between 20.5% and 56.4% of these Internet users seek mental health information. OBJECTIVE Focusing on this population's Web searches about their mental health, this paper examines what type of content they look for and what could be the benefits and disadvantages of this navigation. METHODS We conducted a literature review through medical and psychological databases between 2000 and 2015 using the keywords "Internet," "Web," "virtual," "health information," "schizophrenia," "psychosis," "e-mental health," "e-support," and "telepsychiatry." RESULTS People experiencing schizophrenia spectrum disorders or other psychotic disorders wish to find on the Internet trustful, nonstigmatizing information about their disease, flexibility, security standards, and positive peer-to-peer exchanges. E-mental health also appears to be desired by a substantial proportion of them. In this field, the current developments towards intervention and early prevention in the areas of depression and bipolar and anxiety disorders become more and more operational for schizophrenia spectrum disorders and other psychotic disorders as well. The many benefits of the Internet as a source of information and support, such as empowerment, enhancement of self-esteem, relief from peer information, better social interactions, and more available care, seem to outbalance the difficulties. CONCLUSIONS In this paper, after discussing the challenges related to the various aspects of the emergence of the Internet into the life of people experiencing schizophrenia spectrum disorders or other psychotic disorders, we will suggest areas of future research and practical recommendations for this major transition.
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Affiliation(s)
- Murielle Villani
- Fondation Pierre Deniker, Paris, France.,Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Boulogne-Billancourt, France
| | - Viviane Kovess-Masfety
- Fondation Pierre Deniker, Paris, France.,Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Boulogne-Billancourt, France.,École des Hautes Études en Santé Publique, Paris, France
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