测试一种创新的数字精神卫生保健服务模式的可行性、可接受性和潜在功效,旨在增加获得护理的机会:数字诊所的公开试验。

IF 5.8 2区 医学 Q1 PSYCHIATRY
Jmir Mental Health Pub Date : 2025-01-29 DOI:10.2196/65222
Natalia Macrynikola, Kelly Chen, Erlend Lane, Nic Nguyen, Jennifer Pinto, Shirley Yen, John Torous
{"title":"测试一种创新的数字精神卫生保健服务模式的可行性、可接受性和潜在功效,旨在增加获得护理的机会:数字诊所的公开试验。","authors":"Natalia Macrynikola, Kelly Chen, Erlend Lane, Nic Nguyen, Jennifer Pinto, Shirley Yen, John Torous","doi":"10.2196/65222","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Mental health concerns have become increasingly prevalent; however, care remains inaccessible to many. While digital mental health interventions offer a promising solution, self-help and even coached apps have not fully addressed the challenge. There is now a growing interest in hybrid, or blended, care approaches that use apps as tools to augment, rather than to entirely guide, care. The Digital Clinic is one such model, designed to increase access to high-quality mental health services.</p><p><strong>Objective: </strong>To assess the feasibility, acceptability, and potential efficacy of the Digital Clinic model, this study aims to conduct a nonrandomized open trial with participants experiencing depression, anxiety, or both, at various levels of clinical severity.</p><p><strong>Methods: </strong>Clinicians were trained in conducting brief transdiagnostic evidence-based treatment augmented by a mental health app (mindLAMP); digital navigators were trained in supporting participants' app engagement and digital literacy while also sharing app data with both patients and clinicians. Feasibility and acceptability of this 8-week program were assessed against a range of benchmarks. Potential efficacy was assessed by calculating pre-post change in symptoms of depression (Patient Health Questionnaire-9; PHQ-9), anxiety (7-item Generalized Anxiety Disorder; GAD-7), and comorbid depression and anxiety (Patient Health Questionnaire Anxiety and Depression Scale; PHQ-ADS), as well as rates of clinically meaningful improvement and remission. Secondary outcomes included change in functional impairment, self-efficacy in managing emotions, and flourishing.</p><p><strong>Results: </strong>Of the 258 enrolled participants, 215 (83.3%) completed the 8-week program. Most were White (n=151, 70.2%) and identified as cisgender women (n=136, 63.3%), with a mean age of 41 (SD 14) years. Feasibility and acceptability were good to excellent across a range of domains. The program demonstrated potential efficacy: the average PHQ-9 score was moderate to moderately severe at baseline (mean 13.39, SD 4.53) and decreased to subclinical (mean 7.79, SD 4.61) by the end of the intervention (t<sub>126</sub>=12.50, P<.001, Cohen d=1.11). Similarly, the average GAD-7 score decreased from moderate at baseline (mean 12.93, SD 3.67) to subclinical (mean 7.35, SD 4.19) by the end of the intervention (t<sub>113</sub>=13, P<.001, Cohen d=1.22). Participation in the program was also associated with high rates of clinically significant improvement and remission.</p><p><strong>Conclusions: </strong>Results suggest that the Digital Clinic model is feasible, acceptable, and potentially efficacious, warranting a future randomized controlled trial to establish the efficacy of this innovative model of care.</p>","PeriodicalId":48616,"journal":{"name":"Jmir Mental Health","volume":"12 ","pages":"e65222"},"PeriodicalIF":5.8000,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822323/pdf/","citationCount":"0","resultStr":"{\"title\":\"Testing the Feasibility, Acceptability, and Potential Efficacy of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care: Open Trial of the Digital Clinic.\",\"authors\":\"Natalia Macrynikola, Kelly Chen, Erlend Lane, Nic Nguyen, Jennifer Pinto, Shirley Yen, John Torous\",\"doi\":\"10.2196/65222\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Mental health concerns have become increasingly prevalent; however, care remains inaccessible to many. While digital mental health interventions offer a promising solution, self-help and even coached apps have not fully addressed the challenge. There is now a growing interest in hybrid, or blended, care approaches that use apps as tools to augment, rather than to entirely guide, care. The Digital Clinic is one such model, designed to increase access to high-quality mental health services.</p><p><strong>Objective: </strong>To assess the feasibility, acceptability, and potential efficacy of the Digital Clinic model, this study aims to conduct a nonrandomized open trial with participants experiencing depression, anxiety, or both, at various levels of clinical severity.</p><p><strong>Methods: </strong>Clinicians were trained in conducting brief transdiagnostic evidence-based treatment augmented by a mental health app (mindLAMP); digital navigators were trained in supporting participants' app engagement and digital literacy while also sharing app data with both patients and clinicians. Feasibility and acceptability of this 8-week program were assessed against a range of benchmarks. Potential efficacy was assessed by calculating pre-post change in symptoms of depression (Patient Health Questionnaire-9; PHQ-9), anxiety (7-item Generalized Anxiety Disorder; GAD-7), and comorbid depression and anxiety (Patient Health Questionnaire Anxiety and Depression Scale; PHQ-ADS), as well as rates of clinically meaningful improvement and remission. Secondary outcomes included change in functional impairment, self-efficacy in managing emotions, and flourishing.</p><p><strong>Results: </strong>Of the 258 enrolled participants, 215 (83.3%) completed the 8-week program. Most were White (n=151, 70.2%) and identified as cisgender women (n=136, 63.3%), with a mean age of 41 (SD 14) years. Feasibility and acceptability were good to excellent across a range of domains. The program demonstrated potential efficacy: the average PHQ-9 score was moderate to moderately severe at baseline (mean 13.39, SD 4.53) and decreased to subclinical (mean 7.79, SD 4.61) by the end of the intervention (t<sub>126</sub>=12.50, P<.001, Cohen d=1.11). Similarly, the average GAD-7 score decreased from moderate at baseline (mean 12.93, SD 3.67) to subclinical (mean 7.35, SD 4.19) by the end of the intervention (t<sub>113</sub>=13, P<.001, Cohen d=1.22). Participation in the program was also associated with high rates of clinically significant improvement and remission.</p><p><strong>Conclusions: </strong>Results suggest that the Digital Clinic model is feasible, acceptable, and potentially efficacious, warranting a future randomized controlled trial to establish the efficacy of this innovative model of care.</p>\",\"PeriodicalId\":48616,\"journal\":{\"name\":\"Jmir Mental Health\",\"volume\":\"12 \",\"pages\":\"e65222\"},\"PeriodicalIF\":5.8000,\"publicationDate\":\"2025-01-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822323/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Jmir Mental Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2196/65222\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Jmir Mental Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2196/65222","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0

摘要

背景:心理健康问题日益普遍;然而,许多人仍然无法获得护理。虽然数字心理健康干预提供了一个有希望的解决方案,但自助甚至指导应用程序并没有完全解决这一挑战。现在,人们对混合或混合护理方法越来越感兴趣,这种方法使用应用程序作为工具来增强而不是完全指导护理。数字诊所就是这样一种模式,旨在增加获得高质量精神卫生服务的机会。目的:为了评估数字临床模型的可行性、可接受性和潜在疗效,本研究旨在对患有不同临床严重程度的抑郁、焦虑或两者兼有的参与者进行非随机开放试验。方法:临床医生接受培训,通过心理健康应用程序(mindLAMP)进行简短的跨诊断循证治疗;数字导航员接受了培训,以支持参与者的应用程序参与和数字素养,同时还与患者和临床医生分享应用程序数据。这个为期8周的项目的可行性和可接受性根据一系列基准进行了评估。通过计算抑郁症状的前后变化来评估潜在疗效(患者健康问卷-9;PHQ-9),焦虑(7项广泛性焦虑障碍;GAD-7)和共病抑郁和焦虑(患者健康问卷焦虑和抑郁量表;PHQ-ADS),以及临床有意义的改善和缓解率。次要结果包括功能障碍的改变、情绪管理的自我效能和繁荣。结果:258名参与者中,215名(83.3%)完成了为期8周的项目。大多数为白人(n=151, 70.2%)和确定为顺性女性(n=136, 63.3%),平均年龄41岁(SD 14)岁。可行性和可接受性在一系列领域中从好到好。该项目显示了潜在的疗效:PHQ-9平均评分在基线时为中度至中度严重(平均13.39,SD 4.53),在干预结束时降至亚临床(平均7.79,SD 4.61) (t126=12.50, P113=13, p)。结论:结果表明数字诊所模式是可行的,可接受的,并且可能有效,需要未来的随机对照试验来建立这种创新的护理模式的疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Testing the Feasibility, Acceptability, and Potential Efficacy of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care: Open Trial of the Digital Clinic.

Testing the Feasibility, Acceptability, and Potential Efficacy of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care: Open Trial of the Digital Clinic.

Testing the Feasibility, Acceptability, and Potential Efficacy of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care: Open Trial of the Digital Clinic.

Background: Mental health concerns have become increasingly prevalent; however, care remains inaccessible to many. While digital mental health interventions offer a promising solution, self-help and even coached apps have not fully addressed the challenge. There is now a growing interest in hybrid, or blended, care approaches that use apps as tools to augment, rather than to entirely guide, care. The Digital Clinic is one such model, designed to increase access to high-quality mental health services.

Objective: To assess the feasibility, acceptability, and potential efficacy of the Digital Clinic model, this study aims to conduct a nonrandomized open trial with participants experiencing depression, anxiety, or both, at various levels of clinical severity.

Methods: Clinicians were trained in conducting brief transdiagnostic evidence-based treatment augmented by a mental health app (mindLAMP); digital navigators were trained in supporting participants' app engagement and digital literacy while also sharing app data with both patients and clinicians. Feasibility and acceptability of this 8-week program were assessed against a range of benchmarks. Potential efficacy was assessed by calculating pre-post change in symptoms of depression (Patient Health Questionnaire-9; PHQ-9), anxiety (7-item Generalized Anxiety Disorder; GAD-7), and comorbid depression and anxiety (Patient Health Questionnaire Anxiety and Depression Scale; PHQ-ADS), as well as rates of clinically meaningful improvement and remission. Secondary outcomes included change in functional impairment, self-efficacy in managing emotions, and flourishing.

Results: Of the 258 enrolled participants, 215 (83.3%) completed the 8-week program. Most were White (n=151, 70.2%) and identified as cisgender women (n=136, 63.3%), with a mean age of 41 (SD 14) years. Feasibility and acceptability were good to excellent across a range of domains. The program demonstrated potential efficacy: the average PHQ-9 score was moderate to moderately severe at baseline (mean 13.39, SD 4.53) and decreased to subclinical (mean 7.79, SD 4.61) by the end of the intervention (t126=12.50, P<.001, Cohen d=1.11). Similarly, the average GAD-7 score decreased from moderate at baseline (mean 12.93, SD 3.67) to subclinical (mean 7.35, SD 4.19) by the end of the intervention (t113=13, P<.001, Cohen d=1.22). Participation in the program was also associated with high rates of clinically significant improvement and remission.

Conclusions: Results suggest that the Digital Clinic model is feasible, acceptable, and potentially efficacious, warranting a future randomized controlled trial to establish the efficacy of this innovative model of care.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Jmir Mental Health
Jmir Mental Health Medicine-Psychiatry and Mental Health
CiteScore
10.80
自引率
3.80%
发文量
104
审稿时长
16 weeks
期刊介绍: JMIR Mental Health (JMH, ISSN 2368-7959) is a PubMed-indexed, peer-reviewed sister journal of JMIR, the leading eHealth journal (Impact Factor 2016: 5.175). JMIR Mental Health focusses on digital health and Internet interventions, technologies and electronic innovations (software and hardware) for mental health, addictions, online counselling and behaviour change. This includes formative evaluation and system descriptions, theoretical papers, review papers, viewpoint/vision papers, and rigorous evaluations.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信