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Preview: Evidence-Based Mental Health current issue

Evidence-Based Mental Health current issue



Evidence-Based Mental Health RSS feed -- current issue



 



Injury talk: spontaneous parent-child conversations in the aftermath of a potentially traumatic event

2017-10-23T06:36:25-07:00

Background

While talking about traumatic experiences is considered central to psychological recovery, little is known about how these conversations occur in daily life.

Objective

We investigated spontaneous injury talk among parents and children in the aftermath of a child’s hospitalisation due to physical trauma, and its relationship with children’s socioemotional functioning.

Methods

In a prospective naturalistic observation study, we audio-sampled the daily life of 71 families with the Electronically Activated Recorder after their child (3–16 years old) was discharged from hospital. We collected close to 20 000 snippets of audio information, which were double-coded for conversation characteristics, and measured children’s socioemotional functioning with the Strengths and Difficulties Questionnaire (SDQ) at 6 weeks and 3 months postinjury.

Findings

The children were involved in injury talk for, on average, 46 min/day, 9 min of which referred to emotions. Children had significantly more injury conversations with their mothers than with their fathers. The tone of injury conversations was significantly more positive than that of non-injury conversations. More direct injury talk was associated with fewer problems on the emotion subscale of the SDQ at 3 months. Other associations between aspects of injury talk and children’s socioemotional functioning were mostly non-significant, although they appeared to be stronger at 3 months than at 6 weeks.

Conclusions

Families spontaneously talked about the injury and associated issues for about the same amount of time per day as a therapist might within a session (a ‘therapy hour’).

Clinical implications

Making full use of naturally occurring injury talk may be a valuable direction for parent and family-focused postinjury interventions. However, the study design prevents causal inference, and further exploration is warranted.




Effective? Engaging? Secure? Applying the ORCHA-24 framework to evaluate apps for chronic insomnia disorder

2017-10-23T06:36:25-07:00

Background

Mobile health offers many opportunities; however, the ‘side-effects’ of health apps are often unclear. With no guarantee health apps first do no harm, their role as a viable, safe and effective therapeutic option is limited.

Objective

To assess the quality of apps for chronic insomnia disorder, available on the Android Google Play Store, and determine whether a novel approach to app assessment could identify high-quality and low-risk health apps in the absence of indicators such as National Health Service (NHS) approval.

Methods

The Organisation for the Review of Care and Health Applications- 24 Question Assessment (ORCHA-24), 24 app assessment criteria concerning data privacy, clinical efficacy and user experience, answered on a ‘yes’ or ‘no’ and evidence-driven basis, was applied to assess 18 insomnia apps identified via the Android Google Play Store, in addition to the NHS-approved iOS app Sleepio.

Findings

63.2% of apps (12/19) provided a privacy policy, with seven (36.8%) stating no user data would be shared without explicit consent. 10.5% (2/19) stated they had been shown to be of benefit to those with insomnia, with cognitive behavioural therapy apps outperforming hypnosis and meditation apps (p=0.046). Both the number of app downloads (p=0.29) and user-review scores (p=0.23) were unrelated to ORCHA-24 scores. The NHS-approved app Sleepio, consistently outperformed non-accredited apps across all domains of the ORCHA-24.

Conclusions

Apps for chronic insomnia disorder exhibit substantial variation in adherence to published data privacy, user experience and clinical efficacy standards, which are not clearly correlated with app downloads or user-review scores.

Clinical implications

In absence of formal app accreditation, the ORCHA-24 could feasibly be used to highlight the risk–benefit profiles of health apps prior to downloading.




Digital technology: coming of age?

2017-10-23T06:36:25-07:00

Technological advances have defined our age. Computers, the internet and mobile devices are ubiquitous and virtually essential day-to-day tools. Some would argue that they have expanded our minds—and in doing so created the so-called ‘extended mind’. Irrespective of whether this is the case, they have at the very least permeated every aspect of our lives—to the point that most of us now rely heavily on technology and would be truly lost without our mobile phone, laptop or electronic calendar; and this is particularly true of younger generations. However, though we often refer to these as recent developments, even these technological advances are not that new. Surprisingly, most of these technologies have now been available for at least two decades or more. So what has changed recently? The key advances in recent years have been the increase in reliability and portability of hardware devices, the connectivity between devices and the individuals...




Developing digital interventions for people living with serious mental illness: perspectives from three mHealth studies

2017-10-23T06:36:25-07:00

The rapidly expanding field of mobile health (mHealth) seeks to harness increasingly affordable and ubiquitous mobile digital technologies including smartphones, tablets, apps and wearable devices to enhance clinical care. Accumulating evidence suggests that mHealth interventions are increasingly being adopted and valued by people living with serious mental illnesses such as schizophrenia and bipolar disorder, as a means of better understanding and managing their condition. We draw on experiences from three geographically and methodologically distinct mHealth studies to provide a pragmatic overview of the key challenges and considerations relating to the process of developing digital interventions for this population.




The promise of digital mood tracking technologies: are we heading on the right track?

2017-10-23T06:36:25-07:00

The growing understanding that mood disorders are dynamic in nature and fluctuate over variable epochs of time has compelled researchers to develop innovative methods of monitoring mood. Technological advancement now allows for the detection of minute-to-minute changes while also capturing a longitudinal perspective of an individual’s illness. Traditionally, assessments of mood have been conducted by means of clinical interviews and paper surveys. However, these methods are often inaccurate due to recall bias and compliance issues, and are limited in their capacity to collect and process data over long periods of time. The increased capability, availability and affordability of digital technologies in recent decades has offered a novel, non-invasive alternative to monitoring mood and emotion in daily life. This paper reviews the emerging literature addressing the use of digital mood tracking technologies, primarily focusing on the strengths and inherent limitations of using these new methods including electronic self-report, behavioural data collection and wearable physiological biosensors. This developing field holds great promise in generating novel insights into the mechanistic processes of mood disorders and improving personalised clinical care. However, further research is needed to validate many of these novel approaches to ensure that these devices are indeed achieving their purpose of capturing changes in mood.




Digital mental health and intellectual disabilities: state of the evidence and future directions

2017-10-23T06:36:25-07:00

The use of digital technologies in the management of mental illness, and more generally in the promotion of well-being and mental health, has received much recent attention and is a focus of current health policy. We conducted a narrative review to explore the opportunities and risks of digital technologies in mental healthcare specifically for people with intellectual disability, a sometimes marginalised and socially excluded group. The scope of digital mental health is vast and the promise of cheaper and more effective interventions delivered digitally is attractive. People with intellectual disability experience high rates of mental illness and could benefit from the development of novel therapies, yet seem to have been relatively neglected in the discourse around digital mental health and are often excluded from the development and implementation of new interventions. People with intellectual disability encounter several barriers to fully embracing digital technology, which may be overcome with appropriate support and adaptations. A small, but growing, literature attests to the value of incorporating digital technologies into the lives of people with intellectual disability, not only for promoting health but also for enhancing educational, vocational and leisure opportunities. Clearly further evidence is needed to establish the safety and clinical efficacy of digital mental health interventions for people with and without intellectual disability. A digital inclusion strategy that explicitly addresses the needs of people with intellectual disability would ensure that all can share the benefits of the digital world.




Proportionate methods for evaluating a simple digital mental health tool

2017-10-23T06:36:25-07:00

Background

Traditional evaluation methods are not keeping pace with rapid developments in mobile health. More flexible methodologies are needed to evaluate mHealth technologies, particularly simple, self-help tools. One approach is to combine a variety of methods and data to build a comprehensive picture of how a technology is used and its impact on users.

Objective

This paper aims to demonstrate how analytical data and user feedback can be triangulated to provide a proportionate and practical approach to the evaluation of a mental well-being smartphone app (In Hand).

Methods

A three-part process was used to collect data: (1) app analytics; (2) an online user survey and (3) interviews with users.

Findings

Analytics showed that >50% of user sessions counted as ‘meaningful engagement’. User survey findings (n=108) revealed that In Hand was perceived to be helpful on several dimensions of mental well-being. Interviews (n=8) provided insight into how these self-reported positive effects were understood by users.

Conclusions

This evaluation demonstrates how different methods can be combined to complete a real world, naturalistic evaluation of a self-help digital tool and provide insights into how and why an app is used and its impact on users’ well-being.

Clinical implications

This triangulation approach to evaluation provides insight into how well-being apps are used and their perceived impact on users’ mental well-being. This approach is useful for mental healthcare professionals and commissioners who wish to recommend simple digital tools to their patients and evaluate their uptake, use and benefits.




A qualitative study of a blended therapy using problem solving therapy with a customised smartphone app in men who present to hospital with intentional self-harm

2017-10-23T06:36:25-07:00

Background

Blended therapy describes the use of computerised therapy combined with face-to-face therapy to extend the depth, range and nature of the face-to-face therapy. We wanted to develop a treatment manual for a randomised trial of blended therapy combining face-to-face problem solving and a smartphone app in men who present to hospital with self-harm.

Objective

To develop a treatment manual and to describe the experience of receiving and delivering a blended therapy.

Methods

After completion of the blended therapy, semistructured qualitative interviews were conducted with participants to describe their experience of the treatment. Two independent coders analysed the material using a thematic, grounded theory approach.

Findings

Seven men were enrolled in the study, and six completed the qualitative interviews. The two main themes identified were of trust and connection. Participants attended 85% of their appointments.

Conclusions

In the treatment manual, we emphasised the themes of trust and connection by allowing time to discuss the app in the face-to-face to sessions, ensuring that therapists are familiar with the app and know how to respond to technical queries. Identification of trust and connection generates novel questions about the importance of the therapeutic alliance with technology rather than with people.

Clinical implications

Clinicians and app developers need to pay attention to the therapeutic relationship with technology as trust and good communication can be easily damaged, resulting in disengagement with the app. Blended therapy may result in increased adherence to face-to-face sessions.

Trial registration number

NCT02718248




Adjunctive avatar therapy for mentalization-based treatment of borderline personality disorder: a mixed-methods feasibility study

2017-10-23T06:36:25-07:00

Background

Borderline personality disorder (BPD) is characterised by severe instability in emotions, identity, relationships and impulsive behaviour. One contributing factor to BPD is deficient mentalizing—our ability to understand the mental states of others and ourselves. Psychotherapies can be effective at reducing symptoms of BPD but effects are small. Innovative ways of enhancing existing therapies are therefore essential.

Objective

In a mixed-methods, feasibility and acceptability study, we adjuncted conventional mentalization-based treatment (MBT) for BPD with avatar software (avatar-MBT). We wanted to test whether the enhanced visual narrative afforded by the software would facilitate therapy.

Methods

We used proprietary avatar software in four group MBT sessions. We collected data on uptake (n=15), dropout (n=4) and self-report measures (n=11) of mentalization and mood and conducted qualitative interviews to assess attitudes and beliefs (n=9).

Findings

Thematic analysis revealed five themes on the usefulness of avatar-MBT, including facilitating perspective taking, expression, emotional distancing, the big picture and group participation. The sixth theme suggested avatar-MBT is best placed within a group setting. There was no deterioration in symptoms as monitored by self-report measures.

Conclusions

Qualitative data suggest that avatar-MBT is acceptable to patients with BPD who described it as enhancing conventional MBT and expressed a wish to continue using it. However, controlled trials are required to assess efficacy.

Clinical implications

Results suggest that avatar-MBT may be a viable option to enhance existing BPD treatment. Furthermore, we provide initial evidence that it is feasible to implement a digital adjunct within a group therapy setting.




Acceptability of the Fitbit in behavioural activation therapy for depression: a qualitative study

2017-10-23T06:36:25-07:00

Introduction

Major depressive disorder is characterised by low mood and poor motivation. Literature suggests that increased physical activity has positive effects on alleviating depression. Fitness-tracking devices may complement behavioural activation (BA) therapy to improve physical activity and mental health in patients with depression.

Objectives

To understand patients’ perceived benefit from the Fitbit and explore themes associated with patient experiences. To compare perceived benefit, patient factors, Fitbit usage and Beck’s Depression Inventory (BDI) scores.

Methods

Semistructured interviews were conducted with patients (n=36) who completed a 28-week BA group programme in a mood disorders outpatient clinic. All patients were asked to carry a Fitbit One device. We conducted thematic analyses on the interviews and exploratory quantitative analyses on patient characteristics, Fitbit usage, steps recorded, perceived benefit and BDI scores.

Findings

Twenty-three patients found the Fitbit helpful for their physical activity. Themes of positive experiences included self-awareness, peer motivation and goal-setting opportunities. Negative themes included inconvenience, inaccuracies and disinterest. Age, baseline and change in BDI scores, prior physical activity goals and familiarity with technology were not associated with perceived benefit from the Fitbit or usage. Perceived benefit was significantly (p<0.01) associated with usage.

Conclusions

Overall, the Fitbit is an acceptable tool to complement BA therapy for patients with depression. Many positive themes were concordant with current literature; however, patients also reported negative aspects that may affect use.

Clinical implications

Clinicians and researchers should consider both strengths and limitations of activity trackers when implementing them to motivate patients with depression.

Trial Registration Number

NCT02045771; Pre-results.




Users experiences of an online intervention for bipolar disorder: important lessons for design and evaluation

2017-10-23T06:36:25-07:00

Background

The evidence base for digital interventions for physical and mental health, including severe and enduring mental health difficulties, is increasing. In a feasibility trial, web-based Enhanced Relapse Prevention (ERPonline) for bipolar disorder demonstrated high recruitment and retention rates. Relative to participants in the waitlist control group, those who received ERPonline showed increased monitoring for early warning signs of relapse and had developed more positive illness models.

Objective

To understand users’ motivations and barriers for taking part in an online/telephone-based trial, and for engagement with ERPonline.

Methods

Participants from the trial who had been allocated to receive ERPonline were purposively sampled to participate in telephone-based, in-depth qualitative interviews about their experiences. Interviews (n=19) were analysed using framework analysis to identify themes relevant to study aims.

Findings

Participants took part due to the convenient, flexible and rewarding aspects of the trial design, as well as a desire to improve the mental health of themselves and others. Barriers included extensive assessments, practical difficulties and mood. ERPonline was was generally considered to be accessible, relevant and straightforward, but there were individual preferences regarding design, content and who it was for. Several participants reported positive changes, but there was a sense that digital interventions should not replace routine care.

Conclusions

There are a number of barriers and facilitators to consider when evaluating and implementing digital interventions. Individual preferences and human contact were key factors for both trial design and engagement with an online intervention.

Clinical implications

Digital interventions should be co-produced, personalised, interactive and embedded as one component in a broader package of care.

Trial registration number

ISRCTN56908625; Post-results.




Problem-based, peer-to-peer global mental health e-learning between the UK and Somaliland: a pilot study

2017-10-23T06:36:25-07:00

Background

WHO’s mental health gap action programme intervention guide (mhGAP-IG) is an evidence-based tool aimed at front-line health workers in low-income and middle-income countries (LMICs). Its potential to improve global mental health education, especially through digital technologies, has been little studied. Problem-based learning (PBL) is usually conducted face-to-face, but its remote application could facilitate cross-cultural education.

Objective

To evaluate PBL, applied to peer-to-peer global mental health e-learning (Aqoon), using mhGAP-IG.

Methods

Twelve pairs of UK and Somaliland medical students completed the full programme. Participants self-directedly met online, via the low-bandwidth Medicine Africa website, for PBL-style tutorials focused on modules of the mhGAP-IG, V.2.0. Preparticipation and postparticipation surveys used mixed methods to evaluate Aqoon, including the Attitudes Toward Psychiatry (ATP-30) instrument.

Findings

Median ATP-30 scores for Somaliland (82.0 vs 95.0, p=0.003) and UK students (82.0 vs 95.0, p=0.011) improved significantly following Aqoon. Qualitative feedback showed that participants valued peer connectivity and learning about cultural and psychosocial differences in their partner’s country. Somaliland students were motivated by clinical learning and UK students by global health education. Feedback on the PBL structure was positive.

Conclusions

Digital PBL represents an innovative method to extend the benefits of mhGAP-IG beyond front-line clinical staff, to healthcare students in LMICs.

Clinical implications

Educational resource limitations in LMICs may be overcome using digital platforms and PBL. Replication with non-medical healthcare students is the next step for this model to explore Aqoon’s relevance to pressing global mental health workforce challenges.