The Right to Mental Health in the Digital Era

People with mental illness usually experience higher rates of disability and mortality. Often, health care systems do not adequately respond to the burden of mental disorders worldwide. The number of health care providers dealing with mental health care is insufficient in many countries. Equal access to necessary health services should be granted to mentally ill people without any discrimination. E-mental health is expected to enhance the quality of care as well as accessibility, availability and affordability of services. This paper examines under what conditions e-mental health can contribute to realising the right to health by using the avail- ability, accessibility, acceptability and quality (AAAQ) framework that is developed by the Committee on Economic, Social and Cultural Rights. Research shows e-mental health facilitates dissemination of information, remote consultation and patient monitoring and might increase access to mental health care. Furthermore, patient participation might increase, and stigma and discrimination might be reduced by the use of e-mental health. However, e-mental health 146 might not increase the access to health care for everyone, such as the digitally illiterate or those who do not have access to the Internet. The affordability of this service, when it is not covered by insurance, can be a barrier to access to this service. In addition, not all e-mental health services are acceptable and of good quality. Policy makers should adopt new legal policies to respond to the present and future developments of modern technologies in health, as well as e-Mental health. To analyse the impact of e-mental health on the right to health, additional research is necessary

Telemedicine a need for ethical and legal guidelines in South Africa

Background: Telemedicine is viewed as a new way of offering medical services. It is seen as a means of overcoming the growing shortage of health practitioners in developing countries. The aim of this paper is to highlight the need for the formulation of guidelines for the ethical practice of telemedicine in South Africa. Methods: Full-length, peer-reviewed journal papers were obtained for review by searching the electronic databases Pubmed, CINAHL and CAB International, using the Boolean-linked keywords ethics AND telemedicine, ethics AND telecare, ethics AND telehealth, and ethics AND ehealth. Additional searches were made of Google Scholar using the same search strategies, and of the web pages of national telemedicine associations. Results: A total of 152 relevant papers were identified. Twenty-one telemedicine guidelines were obtained. Only four countries and one international association have developed ethical guidelines. Several medical disciplines have established national guide-lines for their speciality. Common ethical issues identified include the doctor-patient relationship, informed consent, confidentiality, data security, adequacy of records, data standards and quality, clinical competence, licensure and medical responsibility. These are discussed with reference to the developing world where appropriate. Conclusion: Resource constraints and other issues relevant to developing countries may require the formulation of guidelines that do not necessarily conform with those of the developed world. It is in the interests of patients and practitioners that ethical guidelines for the practice of telemedicine are developed for South Africa. If telemedicine is to be used to overcome shortages of health practitioners, it is important that contentious issues are resolved in a pragmatic way that is appropriate to our circumstances and in the best interests of the majority of our population. South African Family Practice Vol. 50 (2) 2008: pp. 60-60

Internet-based interventions for perinatal depression and anxiety symptoms: an ethnographic qualitative study exploring the views and opinions of midwives in Switzerland

BACKGROUND: Mental disorders such as depression and anxiety are common during pregnancy and postpartum, but are frequently underdiagnosed and untreated. In the last decades, internet-based interventions have emerged as a treatment alternative showing similar effectiveness to face-to-face psychotherapy. We aimed to explore midwives' perceptions of the acceptability of internet-based interventions for the treatment of perinatal depression and anxiety symptoms. METHODS: In this ethnographic qualitative study, semi-structured interviews were conducted with 30 midwives. We followed the Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ). Audio-recorded interviews were transcribed verbatim and analysed using framework analysis. The identified framework categories were rated individually by two independent raters. Krippendorff's alpha coefficient was used to ensure the reliability of the rating. RESULTS: Four main themes emerged: midwives' experience with patients' mental health issues; the role of healthcare workers in women's utilisation of internet-based interventions in the perinatal period; the overall perception of internet-based interventions; and recommendation of internet-based interventions to perinatal women. Twenty-five of the 30 participants viewed internet-based interventions as an acceptable type of intervention, which they would recommend to a subgroup of patients (e.g. women who are well-educated or younger). All except for two midwives identified themselves and medical doctors as key figures regarding patients' utilisation of internet-based interventions, although a third of the interviewees highlighted that they needed sufficient information about such interventions. Finally, several participants suggested features which could be relevant to develop more acceptable and feasible internet-based interventions in the future. DISCUSSION: Participants' overall perception of internet-based interventions for perinatal depression and anxiety symptoms was positive. This study underlines the importance of considering midwives' views about internet-based interventions for perinatal mental health care. Our findings have implications for the practice not only of midwives but also of other maternity care professionals. Future studies examining the views of other health professionals are warranted

An interactive web-based method of outreach to college students at risk for suicide

Abstract. Objective and Participants: From 2002 to 2005, the authors tested an interactive, Web-based method to encourage college students at risk for suicide to seek treatment. Methods: The authors invited students at 2 universities to complete an online questionnaire that screened for depression and other suicide risk factors. Respondents received a personalized assessment and were able to communicate anonymously with a clinical counselor online. At-risk students were urged to attend in-person evaluation and treatment. Results: A total of 1,162 students (8% of those invited) completed the screening questionnaire; 981 (84.4%) were designated as at high or moderate risk. Among this group, 190 (19.4%) attended an inperson evaluation session with the counselor, and 132 (13.5%) entered treatment. Students who engaged in online dialogues with the counselor were 3 times more likely than were those who did not to come for evaluation and enter treatment. Conclusions: The method has considerable promise for encouraging previously untreated, at-risk college students to get help. Keywords: college students, outreach, suicide prevention, Webbased screening uicide is the third leading cause of death among US adolescents and young adults, claiming more young lives than any cause other than accidents and homicides

Psicoterapia On-line: regulamentação e reflexo nas plataformas de atendimento

In the area of telepsychology, there is an increase in the offer of on-line Psychotherapy platforms, which aim to connect patients and therapists. The purpose of this article is to present an analysis of nine Brazilian platforms, in dialogue with international standards selected through bibliographic research. Through computer-mediated observation and content analysis, 14 common aspects between the platforms were organized, allowing questions about profile, registration, indication, search engines, prices and payments, tests, definitions, security, restrictions, types of care and services offered. It discusses the online environment, security risks, marketing logic and the ethical domain pertinent to such practice.En el área de la telepsicología, se incrementa la oferta de plataformas de Psicoterapia Online, que tienen como objetivo conectar a los pacientes con los terapeutas. El propósito de este artículo es presentar un análisis de nueve plataformas brasileñas, en diálogo con estándares normativos internacionales seleccionados mediante un relevamiento bibliográfico. A través de la observación mediada por computadora y el análisis de contenido, se organizaron 14 aspectos comunes entre las plataformas, lo que permitió abordar preguntas sobre perfil, registro, indicación, buscadores, precios y pagos, pruebas, definiciones, seguridad, restricciones, tipos de asistencia y servicios ofrecidos. Se discute sobre el entorno online, los riesgos de seguridad, la lógica de marketing y el dominio ético pertinentes a dicha práctica.Na área da telepsicologia, nota-se um aumento da oferta de plataformas de Psicoterapia on-line, que visam conectar pacientes a terapeutas. O objetivo deste artigo é apresentar uma análise de nove plataformas brasileiras, em diálogo com normativas internacionais selecionadas através de levantamento bibliográfico. Por meio da observação mediada por computador e da análise de conteúdo, foram organizados 14 aspectos comuns entre as plataformas, permitindo a abordagem de questões sobre perfil, cadastro, indicação, buscadores, preços e pagamentos, testes, definições, segurança, restrições, tipos de atendimento e serviços oferecidos. Discute-se acerca do ambiente on-line, dos riscos de segurança, da lógica mercadológica e do domínio ético pertinentes a tal prática

Academic Advising In Higher Education: Distance Learners And Levels Of Satisfaction Using Web Camera Technology

The purpose of this study was to determine the efficacy of in-seat face-to-face advising in contrast to web camera advising of College of Arts and Sciences psychology majors in the 2005-2006 academic year. Satisfaction levels were determined and analyzed based on random assignment to either the control group (in-seat face-to face) or the experimental group (web camera) advising. The data collected for this study consisted of participants\u27 responses to the Academic Advising Inventory (AAI) administered to undergraduate psychology majors (N = 102). Overall, students were satisfied with advising services regardless of the advising group to which they were randomly assigned. Although there was not a statistically significant difference between students who were advised in-seat face-to-face and those advised via web camera advising, the data reflected a slight preference for advisement via web camera

Factors Related to Preference for Online Psychological Treatments Among Active Internet Users

Internet-based approaches to psychological treatment have risen in popularity and have been shown to be efficacious in treating a wide array of issues (McNeilly & Howard, 1991; Lipsey & Wilson, 1993). The purpose of this study was to move beyond evaluation of treatment efficacy and instead identify the factors that might be related to a preference for these non-traditional modes of treatment, which is an essential aspect of rigorous behavioral research. Using an online survey, 1404 self-reported adults in the United States provided information about demographics and Internet behavior as well as measures of personality, depression, anxiety, and attitudes toward receiving help. Finally, the participants were instructed to watch three short video vignettes depicting face-to-face therapy, online guided self-help, and text-based Internet psychotherapy before indicating their preferences for each modality. Results suggest that individuals who preferred either of the two online approaches had significantly lower extraversion, difficulty attending routine in-person meetings, more negative attitudes toward receiving help, and lower satisfaction with previous treatment than participants who preferred face-to-face therapy. It appears that there may be distinct factors that distinguish individuals with an interest in Internet-based psychological treatment from those who prefer traditional face-to-face therapy. This study begins the process of exploring the types of people that are likely to be interested in Internet-based psychological treatment

A Randomized Waitlist-controlled Trial of Voice Over Internet Protocol-delivered Behavior Therapy for Chronic Tic Disorders

Videoconferencing is efficacious, acceptable and equivalent to face to face for a range of psychotherapies, including a Comprehensive Behavioral Interventions for Tics (CBIT), but limited due to lack of portability, and restricted accessibility. An alternative is Voice over Internet Protocol (VoIP) transmission, allowing home delivery of treatment. The present study examined the preliminary efficacy, feasibility, and acceptability of CBIT-VoIP. Twenty youth (8-17) with CTDs participated in a randomized, waitlist-controlled trial of CBIT. Assessments were conducted via VoIP and internet surveys. Significantly greater reductions in total clinician-rated and parent-reported tic severity were found in the CBIT relative to the waitlist-control group, with 33.3% of those in CBIT considered treatment responders. Treatment satisfaction and the therapeutic alliance were high. Higher parent satisfaction with videoconferencing was associated with higher decreases in clinician-rated tic severity. Positive relationships were found between child computer usage at baseline and satisfaction with videoconferencing at post-assessment. VoIP was generally feasible, with some challenges due to audio and visual disruptions

Nadmierna masa ciała - konteksty psychospołeczne i pedagogiczno-edukacyjne

Currently, the phenomenon of being overweight constitutes an extremely important health problem of contemporary societies and, at the same time, is characterized by a large complexity both from the point of view of its frequency of occurrence, causes, consequences, as well as ways of defining, diagnosing, and suggested therapeutic approaches. It is especially the epidemiological data showing a constant increasing tendency of overweight and obesity that provide funding for the very phenomenon being developmental in nature. What is also characteristic is the fact that being overweight has become the problem of the public health fairly recently in many countries, and is not a marginal phenomenon in Poland when it comes to its epidemiological and developmental dimension either. From the point of view of education, however, what is particularly alarming is an increase in obesity determinants among children and the youth. The variety and complexity of the problem is to a large extent determined by the possible causes of being overweight and obese, among which, again, it is impossible to indicate one factor or situation that would be responsible for the epidemic of obesity in industrialized countries. In this case, one often mentions genetic inclinations for putting on weight, and inheriting overweight which an individual has no influence on. At the same time, one should not forget about individual choices related to health, as well as psychological factors and personality features. In the context of possible causes of the occurrence and maintenance of overweight and obesity, a lot of attention was paid to the most important components of a lifestyle, such as eating habits and the level of physical activity, them being the elements that currently play the biggest role in the etiology of the very phenomenon, and are its most popular determinants. Also, modern mass culture and its components, especially an aggressive food commercial, play a crucial role here. The main aim of the publication is an attempt to diagnose the role of overweight in a psycho-social functioning of people in their life environment. The research findings may contribute to paying greater attention to the problems overweight people face, the basis of which are often negative social experiences related to the appearance of an individual. Besides, in terms of pedagogy, the very results may contribute to discussing issues connected with not only a healthy lifestyle, but also the role of an attitude of intolerance, as well as sensitizing to the need of acceptance on various levels of education. At the same time, basing on the diagnosis of the very phenomenon, the author’s suggestion of preventative and educational influences directed at promoting a healthy lifestyle, and an attitude of tolerance towards other people in a school environment is offered

E-Mail in der Psychotherapie – Entwicklung und Evaluation eines E-Mail basierten Nachsorgeprogramms für die stationäre Psychotherapie

Hintergrund: Die stationäre Psychotherapie ist in Deutschland ein wesentlicher Bestandteil der medizinischen Versorgung von Menschen, die an einer psychischen Störung leiden. Angesichts knapper ambulanter Therapieangebote sehen sich Patienten nach Abschluss der stationären Behandlung jedoch häufig vor die Frage gestellt, wie die Erfolge aus der intensiven Behandlungsphase im Alltag weiter ausgebaut oder aufrechterhalten werden können. Um diese Lücke zu füllen, wurde die E-Mail Brücke als internet-basierte Nachsorge im Einzelsetting konzipiert. In der vorliegenden Arbeit werden Konzept, Aufbau und Ablauf der E-Mail Brücke beschrieben und die Ergebnisse einer Evaluationsstudie berichtet. Methode: In der E-Mail Brücke senden die Teilnehmer mindestens einmal pro Woche an einem zuvor fixierten Termin eine E-Mail an ihren Therapeuten, wobei sie sich an einer Instruktion orientieren, die an die Prinzipien des therapeutischen Schreibens angelehnt ist. Therapeuten antworten binnen 24 bis 48 Stunden. Im Sinne des Nachsorgeprinzips ist die Teilnahme am Programm auf 12 bis 15 Wochen begrenzt. In einer prospektiven kontrollierten Beobachtungsstudie wurden Compliance, Akzeptanz und Effektivität der Intervention an einer Stichprobe von N = 247 (Akzeptanzfragestellungen) und N = 137 Teilnehmern (Effektivitätsfragestellung) untersucht. Hauptzielkriterium der Studie waren beobachtete gesundheitliche Verschlechterungen, operationalisiert als reliable Verschlechterungen der Gesamtsymptomatik (KPD-38) zwischen Ende der Klinikbehandlung und 12 Monats-Follow Up. Aufgrund des quasi-experimentellen Designs wurden potenzielle Verzerrungen zwischen der Interventions- und der Kontrollgruppe mittels Propensity Score Matching balanciert. Ergebnisse: Von den N = 247 Teilnehmer haben 19 die E-Mail Brücke vorzeitig abgebrochen (8%). Im Mittel verschickten Teilnehmer 15 und Therapeuten 17 E-Mails, wobei sich eine große Varianz im Nutzerverhalten zeigte. Im Rahmen der Akzeptanzbefragung äußerten sich Teilnehmer und Therapeuten sehr zufrieden mit der Intervention, technische Probleme wurden selten berichtet. In Bezug auf die Hauptfragestellung der Studie zeigten 19 der 137 E-Mail Teilnehmer (13.9%) und 36 Patienten (26.2%) der Kontrollgruppe im Beobachtungszeitraum eine Verschlechterung ihrer Gesamtsymptomatik (OR = 0.41; 95%-KI: 0.19-0.84; p = .01). Die zum Zeitpunkt der 12-Monatsbefragung retrospektiv eingeschätzte Zufriedenheit mit der stationären Behandlung (ZUF-8) fiel in beiden Gruppen hoch aus und unterschied sich nicht zwischen den Gruppen. In Bezug auf Krankschreibungen, Arbeitsfähigkeit und Inanspruchnahme unterschieden sich die Gruppen insgesamt nicht. Jedoch haben Patienten der E-Mail Brücke, die bei Entlassung noch keinen expliziten Wunsch nach einer weitergehenden Behandlung geäußert hatten, im Follow Up Zeitraum wesentlich häufiger (83%) eine Behandlung angetreten als Patienten der Kontrollgruppe (38%). Unter Patienten, die eine zusätzliche Psychotherapie angetreten hatten, erzielten Teilnehmer der E-Mail Brücke zudem deutlichere Verbesserungen als Patienten der Kontrollgruppe. Diskussion: Mit der E-Mail Brücke wird in der vorliegenden Arbeit eine der ersten Online-Interventionen für die psychotherapeutische Nachsorge im Einzelsetting vorgestellt. Die eigens entwickelte E-Mail Plattform hat sich als technisch zuverlässig und sicher erwiesen. Konzept und Setting der E-Mail Brücke stießen bei Teilnehmern und Therapeuten auf große Akzeptanz, wie die geringe Abbruchquote, die hohe Nutzerbeteiligung und die Zufriedenheitsraten belegen. Die Resultate der Studie gelten unter Vorbehalt einiger methodischer Schwächen, die in der vorliegenden Arbeit diskutiert werden. Der zentrale Kritikpunkt betrifft das quasi-experimentelle Design der Studie. Angesichts der positiven Befunde dieser Studie scheint eine klinische Prüfung im Rahmen einer multizentrischen randomisierten kontrollierten Studie angezeigt