BMJ Mental Health, Год журнала: 2023, Номер 26(1), С. e300664 - e300664
Опубликована: Фев. 1, 2023
Язык: Английский
The Lancet Psychiatry, Год журнала: 2024, Номер 11(9), С. 731 - 774
Опубликована: Авг. 13, 2024
Язык: Английский
Процитировано
79
World Psychiatry, Год журнала: 2024, Номер 23(1), С. 139 - 149
Опубликована: Янв. 12, 2024
The mental health care available for depression and anxiety has recently undergone a major technological revolution, with growing interest towards the potential of smartphone apps as scalable tool to treat these conditions. Since last comprehensive meta‐analysis in 2019 established positive yet variable effects on depressive symptoms, more than 100 new randomized controlled trials (RCTs) have been carried out. We conducted an updated objectives providing precise estimates effects, quantifying generalizability from this evidence base, understanding whether app trial characteristics moderate effect sizes. included 176 RCTs that aimed or symptoms. Apps had overall significant although small symptoms (N=33,567, g=0.28, p<0.001; number needed treat, NNT=11.5) generalized (N=22,394, g=0.26, p<0.001, NNT=12.4) compared control groups. These were robust at different follow‐ups after removing sample higher risk bias trials. There was less variability outcome scores post‐test conditions (ratio variance, RoV=–0.14, 95% CI: –0.24 –0.05 symptoms; RoV=–0.21, –0.31 –0.12 symptoms). Effect sizes significantly larger when incorporated cognitive behavioral therapy (CBT) features chatbot technology. primary target administered CBT mood monitoring features. found social (g=0.52) obsessive‐compulsive (g=0.51) post‐traumatic stress (g=0.12), large acrophobia (g=0.90), non‐significant negative panic (g=–0.12), results should be considered caution, because most high based conclude but anxiety, specific – such technology are associated
Язык: Английский
Процитировано
52
World Psychiatry, Год журнала: 2024, Номер 23(1), С. 1 - 2
Опубликована: Янв. 12, 2024
The potential of artificial intelligence (AI) in health care is being intensively discussed, given the easy accessibility programs such as ChatGPT. While it usually acknowledged that this technology will never replace clinicians, we should be aware imminent changes around AI supporting: a) routine office work billing, b) clinical documentation, c) medical education, and d) monitoring symptoms. These likely happen rapidly. In summer 2023, largest electronic records provider US, Epic Systems, announced partnering with OpenAI to integrate ChatGPT technology1. profound impact these have on context delivery mental warrants attention, but often overlooked more fundamental question nature terms improving prevention, diagnosis treatments. Research non-clinical samples suggests may augment text-based support programs, assessments focused perceived empathy rather than outcomes. former an important development, only first step towards progressing from feasibility acceptability efficacy effectiveness. A century accessible self-help books, 60 years chatbots (Eliza was created 1959), nearly 30 home Internet access free online cognitive behavioral therapy chatrooms, over a decade smartphone-based apps text message recent expansion video-based telehealth, together highlight resources not panacea for prevention. true target preventive replicating previous developing new models able provide personalized, environmentally culturally responsive, scalable works effectively users across all countries regions. Computer-based existed decades transformed care. Many studies date suggest can diagnose conditions standardized exam questions or simple case examples2. This research, there evidence improvement models, approach belies reality how made utilized future 21st inclusive, draw diverse sources information, outcomes-driven. information exam, patient self-report, digital phenotyping, genetics, neuroimaging, judgement into novel diagnostic categories better reflect underlying illness offer practical value guiding effective treatments cures. Currently, lack about guide treatment. Impressive show help select psychiatric medications3, rely complete labelled data sets, which reality, prospective validation. study oncology points emerging challenge: when 3.5 asked cancer treatment recommendations, chatbot most mix incorrect recommendations correct ones, making errors difficult detect even experts4. realizing personalized psychiatry improve outcomes patients. For are clear next steps. Utilizing well-established framework evaluation health, include advances equity, privacy, evidence, engagement, interoperability5. Since current datasets used trained non-psychiatric sources, today major clearly state their products must purposes. Even proper training, risks bias carefully explored, numerous examples harm other fields6. rapid glance at images generated by program "schizophrenia"7 visualized extent extreme stigma harmful informed what conceptualize illness. second area focus unable protect personal information. Large language scraped encompass sensitive European Union exploring whether OpenAI's complies General Data Protection Regulation's requirement consent strong public justifications met process privacy issues emerge risk clinicians input chatbots. problem caused American Psychiatric Association release advisory 2023 noting enter any chatbot8. order allow integration care, authorities need determine meet regulations. third generation ability perform binary classification (e.g., presence depression none) limited value. differential based multimodal records, genetic results, neuroimaging data) remains appealing yet untested. Evidence supporting elusive, eating disorder community (and repudiation within one week) Tessa highlights robust necessary currently collected9. Like devices, claims supported high-quality randomized controlled trials employ placebo groups non-therapeutic chatbot). Fourth, engagement critical. We already know has been minimal, learn those experiences. challenge, clinician uptake also widely cited barrier require careful attention implementation frameworks. consistently that, while innovation important, concomitant recipients (i.e., education training both patients clinicians) well regulation, reimbursement, workflow). principles non-adoption, abandonment, scale-up, spread sustainability (NASSS) remain relevant tangible targets avoiding failure. Fifth related, integrated system. era standalone rapidly ending, realization tools fragment cannot scale, rarely sustainable. requires, addition interoperability, designing interacts aspects There collaboration patients, family members, administrators, regulators, course developers. generative technologies continue evolve, opportunity evolve well. Clinicians do become experts AI, capabilities, benefits decision-making role play
Язык: Английский
Процитировано
21
World Psychiatry, Год журнала: 2024, Номер 23(3), С. 312 - 332
Опубликована: Сен. 16, 2024
Rising concerns about social isolation and loneliness globally have highlighted the need for a greater understanding of their mental physical health implications. Robust evidence documents connection factors as independent predictors health, with some strongest on mortality. Although most data are observational, points to directionality effects, plausible pathways, in cases causal link between later outcomes. Societal trends across several indicators reveal increasing rates those who lack connection, significant portion population reporting loneliness. The scientific study has substantially extended over past two decades, particularly since 2020; however, its relevance mortality remains underappreciated by public. Despite breadth evidence, challenges remain, including common language reconcile diverse relevant terms disciplines, consistent multi‐factorial measurement assess risk, effective solutions prevent mitigate risk. urgency future is underscored potentially longer‐term consequences COVID‐19 pandemic, role digital technologies societal shifts, that could contribute further declines social, health. To reverse these meet challenges, recommendations offered more comprehensively address gaps our understanding, foster
Язык: Английский
Процитировано
20
World Psychiatry, Год журнала: 2024, Номер 23(2), С. 176 - 190
Опубликована: Май 10, 2024
In response to the mass adoption and extensive usage of Internet-enabled devices across world, a major review published in this journal 2019 examined impact Internet on human cognition, discussing concepts ideas behind "online brain". Since then, online world has become further entwined with fabric society, extent which we use such technologies continued grow. Furthermore, research evidence ways affects mind advanced considerably. paper, sought draw upon latest data from large-scale epidemiological studies systematic reviews, along randomized controlled trials qualitative recently emerging topic, order now provide multi-dimensional overview impacts psychological, cognitive societal outcomes. Within this, detail empirical how effects differ according various factors as age, gender, types. We also new examining more experiential aspects individuals' lives, understand specifics their interactions Internet, lifestyle, determine benefits or drawbacks time. Additionally, explore nascent but intriguing areas culturomics, artificial intelligence, virtual reality, augmented reality are changing our understanding can interact brain behavior. Overall, importance taking an individualized approach mental health, cognition social functioning is clear. emphasize need for guidelines, policies initiatives around make full available neuroscientific, behavioral levels presented herein.
Язык: Английский
Процитировано
15
World Psychiatry, Год журнала: 2025, Номер 24(1), С. 52 - 80
Опубликована: Янв. 15, 2025
The understanding of responses to traumatic events has been greatly influenced by the introduction diagnosis post‐traumatic stress disorder (PTSD). In this paper we review initial versions diagnostic criteria for condition and associated epidemiological findings, including sociocultural differences. We consider evidence reactions occurring in multiple contexts not previously defined as traumatic, implications that these observations have diagnosis. More recent developments such DSM‐5 dissociative subtype ICD‐11 complex PTSD are reviewed, adding there several distinct phenotypes. describe psychological foundations PTSD, involving disturbances memory well identity. A broader focus on identity may be able accommodate group communal influences experience trauma impact resource loss. then summarize current concerning biological with a particular genetic neuroimaging studies. Whereas progress prevention disappointing, is now an extensive supporting efficacy variety treatments established trauma‐focused interventions – cognitive behavior therapy (TF‐CBT) eye movement desensitization reprocessing (EMDR) non‐trauma‐focused therapies, which also include some emerging identity‐based approaches present‐centered compassion‐focused therapies. Additionally, promising neither nor pharmacological, or combine pharmacological approach, 3,4‐methylenedioxymethamphetamine (MDMA)‐assisted psychotherapy. advances priority areas adapting resource‐limited settings across cultural contexts, community‐based approaches. conclude identifying future directions work mental health.
Язык: Английский
Процитировано
9
World Psychiatry, Год журнала: 2024, Номер 23(3), С. 364 - 386
Опубликована: Сен. 16, 2024
Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code Ethics the World Psychiatric Association offers guidance, many mental health care professionals are unaware it and principles supports. Furthermore, following codes ethics is not always sufficient to address dilemmas arising from possible clashes among their principles, continuing changes in knowledge, culture, attitudes, socio‐economic context. In this paper, we identify topics that pose difficult challenges contemporary psychiatry; may have a significant impact on clinical practice, education research activities; require revision profession's ethics. These include: relationships between human rights care, training; legislation; digital early intervention end‐of‐life decisions by people conditions; conflicts interests training research; role lived experience family/informal supporters shaping agenda policy, training. For each topic, highlight concerns, suggest strategies them, call attention risks these entail, gaps be narrowed further research. We conclude that, order effectively current psychiatry, need rethink policies, services, training, methods ethics, concurrent input range stakeholders, open minded discussions, new models an adequate organizational capacity roll‐out implementation across routine contexts,
Язык: Английский
Процитировано
13
JMIR Human Factors, Год журнала: 2025, Номер 12, С. e60096 - e60096
Опубликована: Март 3, 2025
Abstract Background Digital self-monitoring tools, such as the experience sampling method (ESM), enable individuals to collect detailed information about their mental health and daily life context may help guide support person-centered care. However, similar many digital interventions, ESM struggles move from research clinical integration. To implementation of tools in care, it is important understand why how clinicians clients adopted, adapted, incorporated these practice. Objective Therefore, this study examined within a psychiatric center appropriated an ESM-based tool therapy. Methods Twelve 24 participated piloting tool, IMPROVE. After utilizing 7 11 took part semistructured interviews. A thematic framework analysis was performed focusing on participants’ prior knowledge expectations, actual use practice, potential future tools. Results Many participants experienced that provided useful clients’ health, especially when engaged collaborative data interpretation. several mismatches between system usability technical competencies, found difficult comply with self-assessments. Importantly, most wanted future. Conclusions Clinicians’ choice adopt integrate practice seems depend upon perceived balance added benefits effort required achieve them. Enhancing user or redesigning reduce workload burden could overcome barriers. Future should involve end users development for care further investigate perspectives nonadopters.
Язык: Английский
Процитировано
1
JAMA Network Open, Год журнала: 2024, Номер 7(6), С. e2416767 - e2416767
Опубликована: Июнь 18, 2024
Importance Older adults are particularly vulnerable to loneliness and its physical psychosocial sequelae, but scalable interventions lacking, especially during disasters such as pandemics. Objective To compare the effects of layperson-delivered, telephone-based behavioral activation mindfulness vs befriending on among at-risk older adults. Design, Setting, Participants This assessor-blinded, 3-arm randomized clinical trial screened Chinese through household visits community referrals from April 1, 2021, 30, 2023, in Hong Kong. Eligible participants (≥65 years age) who were lonely, digitally excluded, living alone, below poverty line provided consent participate into activation, mindfulness, groups. Assessments conducted at baseline, 1 month, 3 months. Intervention As part Helping Alleviate Loneliness Kong Adults (HEAL-HOA) dual trial, 148 laypersons trained deliver a twice-weekly 30-minute intervention via telephone for 4 weeks. Main Outcomes Measures The primary outcome was measured by UCLA Scale (range, 20-80) De Jong Gierveld 0-6), with higher scores both scales indicating greater loneliness. Secondary outcomes depression, perceived stress, life satisfaction, psychological well-being, sleep quality, social support, network. Results A total 1151 (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) (n = 335), 460) or 356) group. Most widowed divorced (932 [81.0%]), had education (782 [67.9%]), more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that significantly reduced group difference [MD], −1.96 [95% CI, −3.16 −0.77] points; P &lt; .001]) (MD, −1.49 −2.60 −0.37] .004) months compared befriending. not −0.06 −0.26 0.13] &gt; .99]) 0.22 0.03 0.40] .01) In groups, quality improved befriending, stress increased. Psychological well-being support No statistically significant between-group differences observed Conclusion Relevance this delivered remotely appeared promising reducing later addressing pressing mental health challenges faced aging populations professional geriatric workforce shortages. Further research should explore ways maximize relevance cost-effectiveness these interventions. Trial Registration Clinical Registry Identifier: ChiCTR2300072909
Язык: Английский
Процитировано
5
World Psychiatry, Год журнала: 2025, Номер 24(1), С. 50 - 51
Опубликована: Янв. 15, 2025
Mental disorders are the top causes of morbidity and mortality globally1. However, over half individuals with these lack adequate access to mental health services. Even access, quality care often remains suboptimal, as a third do not receive an follow-up treatment, which increases risk suicide other adverse events2. Despite availability effective treatments for disorders, only fraction offered interventions and, if so, fewer complete recommended regimens3. Frontline providers (notably nurses, counselors clinical social workers), who provide much individuals, time, tools or training implement evidence-based treatments. While innovations in information technologies may enhance individual interventions, from modalities can vary widely, there potential safety risks when provided without direct practitioner supervision4. The rapid growth artificial intelligence also brings forth opportunities well challenges data privacy accuracy therapeutic delivery, most date unprepared new ensure full benefit their patients. Learning systems promising approaches improving outcomes persons community practices, because they infrastructure help frontline deliver more effectively5. First defined by US Institute Medicine (now National Academy Medicine), learning system involves process scientific discovery, available (e.g., electronic records), policies, organizational culture aligned support progressive research innovation improvement simultaneously, so that practices automatically embedded into routine practice. There three core features systems: community; underlying curate, summarize manage data; repeatable cycle initiatives. communities typically include patient (as family caregiver), provider, researcher, leader representatives identify common priority goal pathway In particular, should have line authority responsibility decision-making, technology governance, administrative requirements maximize practice change. ascertainment records, symptom diagnostic assessments, sources. This includes governance standardized processes) allow use purposes, appropriate ad ethics reviews. Data utilization, procedural, laboratory, medication, information; processes such completion guideline-recommended care; patient-centered outcomes; co-occurring conditions; determinants environmental factors, increasingly, genomic information. A enables immediately gaps population, understand how reduce outcomes, evaluate implementation strategies scale up spread time. Finally, supports initiatives aim given identified community. Using infrastructure, continuous generation analysis data, uses knowledge determine treatment pragmatic trial) increase scale-up time via For example, researchers start analyses genomic, physiological record factors condition. Then curated evidence syntheses, longitudinal studies, trials optimal at point offer real-world Community well-suited systems, part above primarily derived measurement-based care2 collaborative model (CCM)6. Developed better adapt address chronic illness management, including care, CCM alignment leadership support, informatics, ongoing needs patients using guidelines, self-management linkage resources. CCMs been shown improve settings both physical conditions6. initial "evolutionary leap" occurred it became possible automate CCM, namely systematic curation at-risk populations measure status embed audit feedback reminders. To this end, able promote through demonstration evaluation discoveries methods. evolution health, emerging examples be found across different community-based worldwide, INTegration programme South Africa (MhINT)7, OnTrack New York (OnTrackNY)'s coordinated specialty system8, Disparities Elimination Coordinated Interventions Prevent Control Heart Lung Disease (DECIPHeR) Center Johns Hopkins University Michigan9. Specifically, MhINT focuses on role empower task-share management primary setting. OnTrackNY leverages detection early psychosis population-based cohort. DECIPHeR is leveraging policy changes state level enable increased reimbursement integrated cardiovascular disease serious illness. Collectively, seek leverage clinicians especially faced financial constraints, sustain best Overall, hold promise disorders. next evolutionary leap holds great lives people ways. First, interest further development, validation informatics ascertainment, synthesis inform secure way minimizes bias. Second, advances trial methods rigorous, cost-efficient generalizable studies novel Quintuple Aim goals, improved experience, value, equity access. leveraged methods, automation ultimately empowering adopt readily.
Язык: Английский
Процитировано
0