Is there Satisfaction with Telehealth PTSD Treatment?

Research Paper Title

Factors contributing to veterans’ satisfaction with PTSD treatment delivered in person compared to telehealth.

Background

Telehealth is an increasingly popular treatment delivery modality for mental healthcare, including evidence-based treatment for complex and intense psychopathologies such as post-traumatic stress disorder (PTSD). Despite the growing telehealth literature, there is a need for more confirmatory research on satisfaction with PTSD telehealth treatment, particularly among veterans, for whom the most rapid and permanent expansion of telehealth services has been implemented through the Department of Veterans Affairs.

Methods

The current paper integrates data from two concurrent PTSD treatment outcome studies that compared prolonged exposure therapy delivered both in person and via telehealth for veterans (N = 140). Using two different measures of satisfaction (the Charleston Psychiatric Outpatient Satisfaction Scale-Veteran Affairs Version (CPOSS) and the Service Delivery Perception Questionnaire (SDPQ)), the researchers hypothesized that PTSD improvement would predict satisfaction, but that delivery modality (in person vs telehealth) would not.

Results

Results only partially supported the hypotheses, in that PTSD symptom improvement was associated with greater satisfaction, and in-person treatment modality was associated with satisfaction as measured by the CPOSS (but not the SDPQ). Subgroup differences by sex were found, such that male veterans, typically with combat-related trauma, were more satisfied with their PTSD treatment compared to female veterans, who were most frequently seen in this study for military sexual trauma.

Conclusions

Altogether, results illustrate a need for additional satisfaction studies with diverse samples and large sample sizes. Future research may benefit from examining satisfaction throughout treatment, identifying predictors of greater PTSD improvement, and further examining demographic subgroups.

Reference

White, C.N., Kauffman, B.Y. & Acierno, R. (2021) Factors contributing to veterans’ satisfaction with PTSD treatment delivered in person compared to telehealth. Journal of Telemedicine and Telecare. doi: 10.1177/1357633X20987704. Online ahead of print.

What are the Challenges of Mental Healthcare during COVID-19?

Research Paper Title

Current and Future Challenges in the Delivery of Mental Healthcare during COVID-19.

Background

The USA is in the midst of the COVID-19 pandemic.

The researchers assess the impact of COVID-19 on psychiatric symptoms in healthcare workers, those with psychiatric comorbidities, and the general population.

They highlight the challenges ahead and discuss the increased relevance of telepsychiatry.

Methods

The researchers analysed all available literature available as of 25 March 2020, on PubMed, Ovid Medline, and PsychInfo.

They utilised the MeSH term “covid AND (psychiatry OR mental health)” and included all articles.

Duplicates were removed resulting in 32 articles, of which 19 are cited. Four additional references are included to examine suicide data. During the review process, an additional 7 articles were identified which are also included.

Results

Frontline healthcare workers are currently experiencing increased psychiatric symptoms and this is more severe in females and nurses. Non-frontline healthcare workers, as well as the general population, are experiencing vicarious traumatisation.

People with psychiatric comorbidities, and the general population, face increased psychiatric symptom burden. Migrant workers, the elderly, children, and the homeless may be disproportionately impacted. Suicide rates may be impacted.

Conclusions

The COVID-19 pandemic has resulted in a severe disruption to the delivery of mental healthcare.

Psychiatric facilities are facing unprecedented disruptions in care provision as they struggle to manage an infected population with comorbid psychiatric symptoms.

Telepsychiatry is a flawed but reasonable solution to increase the availability of mental healthcare during COVID-19.

Reference

Gautam, M., Thakrar, A., Akinyemi, E. & Mahr, G. (2020) Current and Future Challenges in the Delivery of Mental Healthcare during COVID-19. SN Comprehensive Clinical Medicine. 1-6. doi: 10.1007/s42399-020-00348-3. Online ahead of print.

Can We Use Telehealth to Reach Underserved Veterans?

Research Paper Title

The Impact of Co-occurring Anxiety and Alcohol Use Disorders on Video Telehealth Utilisation Among Rural Veterans.

Background

Co-occurring anxiety and alcohol use disorders lead to poorer treatment outcomes for both disorders.

Compounding risk for poor outcomes related to these disorders, individuals living in rural areas face barriers receiving evidence-based mental health treatment.

Video to home telehealth (VTH) has been implemented broadly within the Veterans Health Administration to improve access to care for rural veterans. However, VTH may not be utilised equally across disorders and comorbidities, including co-occurring anxiety and alcohol use disorders, potentially contributing to gaps in care that are not available in person.

Methods

A cohort of veterans who received at least one VTH mental health visit between fiscal years 2016-2019 was compiled from VA administrative data.

Multilevel linear growth curve models were used to examine growth in VTH use over time among veterans with anxiety only, alcohol use disorder only, and co-occurring disorders.

Results

Fixed effects were significant for both time and diagnosis group and a significant interaction between time and group.

For each subsequent fiscal year, the percentage of total MH visits that were VTH increased for all groups but less so for those with co-occurring anxiety and alcohol use diagnoses.

Conclusions

Despite VTH being an important tool to reach underserved rural veterans, rural veterans with AUD and co-occurring anxiety and AUD are at risk for not receiving care using this modality.

Findings suggest that veterans with co-occurring anxiety and AUD are especially at risk for being underserved, given that a major goal of VTH is to increase access to mental health services.

Reference

Ecker, A.H., Amspoker, A.B., Hogan, J.B. & Lindsay, J.A. (2020) The Impact of Co-occurring Anxiety and Alcohol Use Disorders on Video Telehealth Utilization Among Rural Veterans. Journal of Technology in Behavioral Science. 1-6. doi: 10.1007/s41347-020-00150-x. Online ahead of print.

Potential Web- & Mobile-based Interventions for Promoting Mental Health & Preventing Mental Illness at University

Research Paper Title

Mental Health-Related Digital Use by University Students: A Systematic Review.

Background

Mental health problems are common among students at university, representing a major public health concern.

The internet and new technologies are widely used by students and represent a significant resource to them for mental health information and support.

The aim of this systematic review is to summarise and critique studies of mental health-related digital use (including purposes, advantages, and barriers) by students worldwide, to support the implementation of future digital mental health interventions targeting university students.

Methods

The researches searched for peer-reviewed articles published between January 2008 and May 2018 by using Pubmed, Google Scholar, PsycINFO, PsycARTICLES, Psychology and Behavioural Sciences Collection, and SocINDEX. Studies were coded by author, year of publication, country, research design, recruitment and sampling, data collection, analysis method, key findings, and mean quality score.

Outcomes were synthetised through the textual narrative synthesis method.

Results

Of the 1,487 titles and abstracts screened, 24 articles were critically reviewed. Sample sizes ranged from 19 to 6,034 participants.

The two key findings were that students worldwide have a high need for mental health information and are prepared to use digital tools for their mental health and well-being.

However, they are currently struggling to discern trustworthy information online and are expressing a desire for reliable devices handling their sensitive data.

Conclusions

Through the description of patterns in university students’ mental health-related digital use, this review outlines important features for potential web- and mobile-based interventions for promoting mental health and preventing mental illness at the university.

Reference

Montagni, I., Tzourio, C., Cousin, T., Sagara, J.A., Bada-Alonzi, J. & Hogan, A. (2020) Mental Health-Related Digital Use by University Students: A Systematic Review. Telemedicine Journal and e-Health. 26(2), pp.131-146. doi: 10.1089/tmj.2018.0316. Epub 2019 Mar 19.

Outlining Tele-Mental Health & In-Person Care

Research Paper Title

Use of Tele-Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models.

Background

Although use of tele-mental health services is growing, there is limited research on how tele-mental health is deployed.

This project aimed to describe how health centres use tele-mental health in conjunction with in-person care.

Methods

The 2018 Substance Abuse and Mental Health Services Administration Behavioural Health Treatment Services Locator database was used to identify community mental health centres and federally qualified health centres with telehealth capabilities.

Maximum diversity sampling was applied to recruit health centre leaders to participate in semi-structured interviews.

Inductive and deductive approaches were used to develop site summaries, and a matrix analysis was conducted to identify and refine themes.

Results

Twenty health centres in 14 states participated. All health centres used telepsychiatry for diagnostic assessment and medication prescribing, and 10 also offered therapy via telehealth.

Some health centres used their own staff to provide tele-mental health services, whereas others contracted with external providers. In most health centres, tele-mental health was used as an adjunct to in-person care.

In choosing between tele-mental health and in-person care, health centres often considered patient preference, patient acuity, and insurance status or payer.

Although most health centres planned to continue offering tele-mental health, participants noted drawbacks, including less patient engagement, challenges sharing information within the care team, and greater inefficiency.

Conclusions

Tele-mental health is generally used as an adjunct to in-person care.

The results of this study can inform policy makers and clinicians regarding the various delivery models that incorporate tele-mental health.

Reference

Uscher-Pines, L., Raja, P., Qureshi, N., Huskamp, H.A., Busch, A.B. & Mehrotra, A. (2020) Use of Tele-Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models. Psychiatric Services (Washington, D.C.). 71(5), pp.419-426. doi: 10.1176/appi.ps.201900386. Epub 2020 Jan 30.

What is the Role of Telehealth in Reducing the Mental Health Burden from COVID-19?

Research Paper Title

The Role of Telehealth in Reducing the Mental Health Burden from COVID-19.

Background

The psychological impact of the coronavirus disease 2019 (COVID-19) pandemic must be recognized alongside the physical symptoms for all those affected. Telehealth, or more specifically telemental health services, are practically feasible and appropriate for the support of patients, family members, and health service providers during this pandemic. As of March 18, 2020, there were >198,000 COVID-19 infections recorded globally, and 7,900 deaths. Psychological symptoms relating to COVID-19 have already been observed on a population level including anxiety-driven panic buying and paranoia about attending community events. Students, workers, and tourists who have been prevented from accessing their training institutions, workplaces, homes, respectively, are expected to have developed psychological symptoms due to stress and reduced autonomy and concerns about income, job, security, and so on. The Chinese, Singaporean, and Australian governments have highlighted the psychological side effects of COVID-19, and have voiced concerns regarding the long-term impacts of isolation and that the fear and panic in the community could cause more harm than COVID-19.

In the absence of a medical cure for COVID-19, the global response is a simple public health strategy of isolation for those infected or at risk, reduced social contact to slow the spread of the virus, and simple hygiene such as hand washing to reduce the risk of infection. While the primary intervention of isolation may well achieve its goals, it leads to reduced access to support from family and friends, and degrades normal social support systems and causes loneliness, and is a risk for worsening anxiety and depressive symptoms. If left untreated, these psychological symptoms may have long-term health effects on patients and require treatment adding to the cost burden of managing the illness. Clinical and nonclinical staff are also at risk of psychological distress as they are expected to work longer hours with a high risk of exposure to the virus. This may also lead to stress, anxiety, burnout, depressive symptoms, and the need for sick or stress leave, which would have a negative impact on the capacity of the health system to provide services during the crisis.

Treatment protocols for people with COVID-19 should address both the physiological and psychological needs of the patients and health service providers. Providing psychological treatment and support may reduce the burden of comorbid mental health conditions and ensure the well-being of those affected. Our challenge is to provide mental health services in the context of patient isolation, which highlights the role of telehealth (through videoconference, e-mail, telephone, or smartphone apps). The provision of mental health support (especially through telehealth) will likely help patients maintain psychological well-being and cope with acute and post-acute health requirements more favourably.

Examples of and evidence to support the effectiveness of telemental health are fairly diverse, especially in the context of depression, anxiety, and PTSD. Videoconferencing, online forums, smartphone apps, text-messaging, and e-mails have been shown to be useful communication methods for the delivery of mental health services.

China is actively providing various telemental health services during the outbreak of COVID-19. These services are from government and academic agencies and include counseling, supervision, training, as well as psychoeducation through online platforms (e.g., hotline, WeChat, and Tencent QQ). Telemental health services have been prioritised for people at higher risk of exposure to COVID-19, including clinicians on the frontline, patients diagnosed with COVID-19 and their families, policemen, and security guards. Early reports also showed how people in isolation actively sought online support to address mental health needs, which demonstrated both a population interest and acceptance of this medium.

Additional telehealth services have been previously funded by the Australian Government (Better Access Initiative programme), to address mental health needs of rural and remote patients during emergency situations, such as long-term drought and bushfires. In response to COVID-19, the Australian Government has responded with additional funded services through the Medicare Benefits Schedule, enabling a greater range of telehealth services to be delivered, including telehealth consultations with general practitioners and specialists. However, the expanded telehealth programme is restricted to special needs groups and the wider population does not have access to the programme. A major benefit of expanding telehealth, including mental health, with no restrictions would reduce person-to-person contact between health service providers and COVID-19 and reduce the risk of exposure of non-infected but susceptible patients in waiting room areas. To date, most of the Australian Government’s focus has been on managing medical needs of people during the epidemic, rather than providing resources to meet short- and long-term mental health implications. An expansion of access to telemental health support services with a focused public education campaign to promote these services would begin to address this need.

Communication of all health needs is important when patients are having to be isolated. The researchers support the use of telehealth as a valuable way of supporting both physical and psychosocial needs of all patients irrespective of geographical location. Simple communication methods such as e-mail and text messaging should be used more extensively to share information about symptoms of burnout, depression, anxiety, and PTSD during COVID-19, to offer cognitive and/or relaxation skills to deal with minor symptoms, and to encourage access to online self-help programmes. For people with COVID-19, telehealth can be used to monitor symptoms and also to provide support when needed.

While there is growing awareness of mortality rates associated with COVID-19, we should also be cognisant of the impact on mental health – both on a short- and a long-term basis. Telemental health services are perfectly suited to this pandemic situation – giving people in remote locations access to important services without increasing risk of infection.

Reference

Zhou, X., Snoswell,, C.L., Harding, L.E., Bambling, M., Edirippulige, S., Bai, X. & Smith, A.C. (2020) The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemedicine and e-Health. 26(4). https://doi.org/10.1089/tmj.2020.0068.

Primary Healthcare & Categories of Mental Health Programmes

Research Paper Title

Innovative Mental Health Initiatives in India: A Scope for Strengthening Primary Healthcare Services.

Background

Mental health burden is a major health concern worldwide.

In the last few decades, we are witnessing innovations that are successfully addressing gaps in the mental health service delivery in Indian context.

This is an opportune time to explore existing innovative mental health initiatives in the country and integrate viable interventions to primary healthcare facilities to strengthen public mental healthcare delivery.

Methods

A descriptive review of literature on innovative mental health programs in India was carried out.

The initial search from google scholar and PubMed database yielded 1152 articles, of which 1,114 were excluded that did not meet inclusion criteria.

Full texts of 38 articles were reviewed and finally 22 studies were included for the study.

Results

Based on the review, most innovations are broadly summarised into five categories:

  1. Quality improvement mental health programmes;
  2. Community-based mental health programmes;
  3. Non-specialist mental health programmes;
  4. Mobile technology-based mental health programmes; and
  5. Tele-mental health programmes.

These promising innovations in treatment and care can be customised as per the context for scale up and integrated into the primary healthcare system through the District Mental Health Programme.

Conclusions

The innovative approach not only makes mental health services more accessible and affordable but also empowering in nature by encouraging community members in early detection, prevention of mental illness and appropriate treatment referral to existing primary health care services.

Reference

Pandya, A., Shah, K., Chauhan, A. & Saha, S. (2020) Innovative Mental Health Initiatives in India: A Scope for Strengthening Primary Healthcare Services. Journal of Family Medicine and Primary Care. 9(2), pp.502-507. doi: 10.4103/jfmpc.jfmpc_977_19. eCollection 2020 Feb.