Primary Care Peer-Supported Internet-Mediated Psychological Treatment for Adults With Anxiety Disorders: Mixed Methods Study

Nissling, Linnea; Fahlke, Claudia; Lilja, Josefine L.; Skoglund, Ingmarie; Weineland, Sandra

doi:10.2196/19226

Cited by 8 publications

(14 citation statements)

References 48 publications

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“…The majority (8/17, 47%) of the comparison groups received treatment as usual [ 4 , 20 - 22 , 26 , 34 , 36 , 40 ]. Four comparison groups were waitlist groups [ 23 , 29 , 38 , 39 ], 2 were supportive therapy [ 31 , 35 ], 1 was psychoeducation [ 27 ], 1 was healthy [ 28 ], 1 was a similar neutral intervention [ 37 ], and 1 was a similar active intervention [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The Safety of Digital Mental Health Interventions: Systematic Review and Recommendations

Taher¹,

Hsu²,

Fialho³

et al. 2023

JMIR Ment Health

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Background Evidence suggests that digital mental health interventions (DMHIs) for common mental health conditions are effective. However, digital interventions, such as face-to-face therapies, pose risks to patients. A safe intervention is considered one in which the measured benefits outweigh the identified and mitigated risks. Objective This study aims to review the literature to assess how DMHIs assess safety, what risks are reported, and how they are mitigated in both the research and postmarket phases and building on existing recommendations for assessing, reporting, and mitigating safety in the DMHI and standardizing practice. Methods PsycINFO, Embase, and MEDLINE databases were searched for studies that addressed the safety of DMHIs. The inclusion criteria were any study that addressed the safety of a clinical DMHI, even if not as a main outcome, in an adult population, and in English. As the outcome data were mainly qualitative in nature, a meta-analysis was not possible, and qualitative analysis was used to collate the results. Quantitative results were synthesized in the form of tables and percentages. To illustrate the use of a single common safety metric across studies, we calculated odds ratios and CIs, wherever possible. Results Overall, 23 studies were included in this review. Although many of the included studies assessed safety by actively collecting adverse event (AE) data, over one-third (8/23, 35%) did not assess or collect any safety data. The methods and frequency of safety data collection varied widely, and very few studies have performed formal statistical analyses. The main treatment-related reported AE was symptom deterioration. The main method used to mitigate risk was exclusion of high-risk groups. A secondary web-based search found that 6 DMHIs were available for users or patients to use (postmarket phase), all of which used indications and contraindications to mitigate risk, although there was no evidence of ongoing safety review. Conclusions The findings of this review show the need for a standardized classification of AEs, a standardized method for assessing AEs to statically analyze AE data, and evidence-based practices for mitigating risk in DMHIs, both in the research and postmarket phases. This review produced 7 specific, measurable, and achievable recommendations with the potential to have an immediate impact on the field, which were implemented across ongoing and future research. Improving the quality of DMHI safety data will allow meaningful assessment of the safety of DMHIs and confidence in whether the benefits of a new DMHI outweigh its risks. Trial Registration PROSPERO CRD42022333181; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=333181

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Section: Resultsmentioning

confidence: 99%

“…The main risk of bias among these studies was identifying and accounting for the confounding variables. See Multimedia Appendix 3 [ 19 , 23 , 24 , 27 , 30 , 37 , 40 ] for the results of the CASP tool.…”

Section: Resultsmentioning

confidence: 99%

The Safety of Digital Mental Health Interventions: Systematic Review and Recommendations

Taher¹,

Hsu²,

Fialho³

et al. 2023

JMIR Ment Health

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“…One specific aspect of treatment that was mentioned is the importance of personal contact (see Woodard et al, 2023). While prior work suggests that personal contact increases the efficacy of and engagement with LITs, there is also work to suggest that individual patients enjoy the flexibility afforded by LITs even as they sometimes desire more contact (31,32,33). Additionally, though providers may perceive LITs as a barrier to generating rapport with patients, other studies have found relationships in guided iCBT to be non-inferior to client-therapist relationships (34).…”

Section: Discussionmentioning

confidence: 99%

“I would not want the mechanic to direct me to an engine repair manual”: A qualitative analysis of provider perspectives on low-intensity treatments for patients on waiting lists

Peipert¹,

Adams²,

Lorenzo‐Luaces³

2023

Preprint

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Low-intensity treatments (LITs), such as bibliotherapy or online self-help, have the potential to reach more individuals than traditional face-to-face care by circumventing many of the common barriers to mental health treatment. Despite substantial research evidence supporting their usability and efficacy across a number of clinical presentations, prior work suggests that mental health providers rarely recommend LITs for patients waiting for treatment. The present study analyzed provider open responses about recommending LITs for patients on treatment waiting lists. We surveyed 141 practicing mental health providers, 65 of whom responded to an open text box with additional thoughts on using LITs for patients on treatment waiting lists. Responses were qualitatively coded using a thematic coding process which yielded 11 codes: patient appropriateness, research evidence, feasibility, patient barriers, liability, patient personal contact, additional resources, positive attitudes, trust in programs, systemic problems, and downplaying distress. Results suggest providers are predominantly concerned about the potential of suggesting a LIT that would be ultimately inappropriate for their patient due to a lack of assessment of the patient’s needs. Furthermore, providers noted ambiguity around the legal and ethical liability of recommending a LIT to someone who may not yet be a patient. Guidelines and standards for recommending LITs to patients on treatment waiting lists may help address ambiguity regarding their use in routine care.

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“…1) Informing service users about the option to turn off their camera during video calls or using the phone if they are uncomfortable; 2) Offering a telephone call or text service instead if the service user prefers this. CMO 4.5: More frequent telemental health [49,50,118,123,176] When services adapt flexibly to service users' preferences regarding the pattern and frequency of telemental health 1) Lack of a need to travel means that more frequent shorter sessions may be particularly feasible with…”

Section: Domain 4 Therapeutic Quality and Relationshipsmentioning

confidence: 99%

What works for whom with telemental health? A rapid realist review

Schlief

Saunders

Appleton

et al. 2022

Preprint

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Background: Telemental health (delivering mental health care via video calls, telephone calls or text messages) is increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks reinforcing pre-existing inequalities in service provision. If it is to be widely incorporated in routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach, and when face-to-face care is needed. Objective: The aim of this rapid realist review was to develop theory about which telemental health approaches work, or do not work, for whom, in which contexts and through what mechanisms. Methods: Rapid realist reviewing involves synthesising relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMOs encapsulate theories about what works for whom, and by what mechanisms. Sources included eligible papers from (a) two previous systematic reviews conducted by our team on telemental health, (b) an updated search using the strategy from these reviews, (c) a call for relevant evidence, including "grey literature", to the public and key experts, and (d) website searches of relevant voluntary and statutory organisations. CMOs formulated from these sources were iteratively refined, including through (a) discussion with an expert reference group including researchers with relevant lived experience and front-line clinicians and (b) consultation with experts focused on three priority groups: 1) children and young people, 2) users of inpatient and crisis care services, and 3) digitally excluded groups. Results: A total of 108 scientific and grey literature sources were included. From our initial CMOs, we derived 30 overarching CMOs within four domains: 1) connecting effectively; 2) flexibility and personalisation; 3) safety, privacy and confidentiality; and 4) therapeutic quality and relationship. Reports and stakeholder input emphasised the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation, and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying successful and unsuccessful application of telemental health are discussed. Conclusions: Service user choice, privacy and safety, the ability to connect effectively and fostering strong therapeutic relationships, need to be prioritised in delivering telemental health care. Guidelines and strategies co-produced with service users and frontline staff are needed to optimise telemental health implementation in real-world settings. MS and KRKS are joint first authors.

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Primary Care Peer-Supported Internet-Mediated Psychological Treatment for Adults With Anxiety Disorders: Mixed Methods Study

Cited by 8 publications

References 48 publications

The Safety of Digital Mental Health Interventions: Systematic Review and Recommendations

The Safety of Digital Mental Health Interventions: Systematic Review and Recommendations

“I would not want the mechanic to direct me to an engine repair manual”: A qualitative analysis of provider perspectives on low-intensity treatments for patients on waiting lists

What works for whom with telemental health? A rapid realist review

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