Barriers to and Facilitators of Engagement With mHealth Technology for Remote Measurement and Management of Depression: Qualitative Analysis

BACKGROUND: Mobile technology has the potential to provide accurate, impactful data on the symptoms of depression, which could improve health management or assist in early detection of relapse. However, for this potential to be achieved, it is essential that patients engage with the technology. Although many barriers to and facilitators of the use of this technology are common across therapeutic areas and technology types, many may be specific to cultural and health contexts. OBJECTIVE: This study aimed to determine the potential barriers to and facilitators of engagement with mobile health (mHealth) technology for remote measurement and management of depression across three Western European countries. METHODS: Participants (N=25; 4:1 ratio of women to men; age range, 25-73 years) who experienced depression participated in five focus groups held in three countries (two in the United Kingdom, two in Spain, and one in Italy). The focus groups investigated the potential barriers to and facilitators of the use of mHealth technology. A systematic thematic analysis was used to extract themes and subthemes. RESULTS: Facilitators and barriers were categorized as health-related factors, user-related factors, and technology-related factors. A total of 58 subthemes of specific barriers and facilitators or moderators emerged. A core group of themes including motivation, potential impact on mood and anxiety, aspects of inconvenience, and ease of use was noted across all countries. CONCLUSIONS: Similarities in the barriers to and facilitators of the use of mHealth technology have been observed across Spain, Italy, and the United Kingdom. These themes provide guidance on ways to promote the design of feasible and acceptable cross-cultural mHealth tools. ©Sara Simblett, Faith Matcham, Sara Siddi, Viola Bulgari, Chiara Barattieri di San Pietro, Jorge Hortas López, José Ferrão, Ashley Polhemus, Josep Maria Haro, Giovanni de Girolamo, Peter Gamble, Hans Eriksson, Matthew Hotopf, Til Wykes, RADAR-CNS Consortium. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 30.01.2019

Monitoring and predicting the risk of violence in residential facilities. No difference between patients with history or with no history of violence

none34noopende Girolamo, Giovanni; Buizza, Chiara; Sisti, Davide; Ferrari, Clarissa; Bulgari, Viola; Iozzino, Laura; Boero, Maria Elena; Cristiano, Giuseppe; De Francesco, Alessandra; Giobbio, Gian Marco; Maggi, Paolo; Rossi, Giuseppe; Segalini, Beatrice; Candini, Valentina; Andreose, Suor; Basso, Pasquale; Beneduce, Rossella; Bertolotti, Pietro; Braida, Vanda; Bonelli, Marina; Bongiorno, Fanny; Bussi, Riccardo; Castagno, Elisa; Dominicis, Fabio; Ghersi, Loredana; Greppo, Stefania; Sodano, Alessandro Jaretti; Leporatti, Massimo; Presti, Eleonora Lo; Milone, Valeria; Panigada, Fausto; Pasquadibisceglie, Livia; Rigamonti, Danilo; Rillosi, Lucianade Girolamo, Giovanni; Buizza, Chiara; Sisti, Davide; Ferrari, Clarissa; Bulgari, Viola; Iozzino, Laura; Boero, Maria Elena; Cristiano, Giuseppe; De Francesco, Alessandra; Giobbio, Gian Marco; Maggi, Paolo; Rossi, Giuseppe; Segalini, Beatrice; Candini, Valentina; Andreose, Suor; Basso, Pasquale; Beneduce, Rossella; Bertolotti, Pietro; Braida, Vanda; Bonelli, Marina; Bongiorno, Fanny; Bussi, Riccardo; Castagno, Elisa; Dominicis, Fabio; Ghersi, Loredana; Greppo, Stefania; Sodano, Alessandro Jaretti; Leporatti, Massimo; Presti, Eleonora Lo; Milone, Valeria; Panigada, Fausto; Pasquadibisceglie, Livia; Rigamonti, Danilo; Rillosi, Lucian

VIOLENCE IN SCHIZOPHRENIA SPECTRUM DISORDERS: ASSOCIATIONS WITH CLINICAL AND NEUROCOGNITIVE FACTORS

La tesi si è focalizzata sullo studio del comportamento violento in pazienti con una diagnosi di Disturbo dello Spettro Schizofrenico (DSS) e una storia di violenza, appaiati a dei controlli. Il protocollo ha incluso anche un periodo di osservazione di un anno. Il progetto di ricerca è stato condotto in alcune strutture residenziali (studio 1) e presso alcuni Centri di Salute Mentale (studio 2) del nord Italia, con gli obiettivi di: (i) analizzare le caratteristiche socio-demografiche, cliniche e neuropsicologiche di pazienti con DSS e una storia di violenza comparati a pazienti con DSS, senza tale storia, appaiati per genere ed età; (ii) quantificare i comportamenti violenti esibiti dai pazienti con DSS durante un anno di osservazione, e identificarne i possibili fattori protettivi e di rischio; (iii) caratterizzare i pazienti con DSS che hanno esibito condotte particolarmente violente durante l’anno di osservazione. I risultati mostrano specifiche condizioni cliniche e di funzionamento cognitivo caratterizzanti i pazienti con storia di violenza, ed evidenziano diversi fattori associati all’esibizione di comportamenti violenti nei due servizi.This thesis addresses the phenomenon of violence by patients with Schizophrenia Spectrum Disorders (SSDs) who had a history of violence, compared to matched controls. The research protocol also included a 1-year observation period. The research project has been carried out in ordinary psychiatric residential facilities (study 1) and in Community Mental Health Centres (study 2) in northern Italy. The aims were: (i) to investigate the demographic, clinical, and neurocognitive features of patients with SSDs who had a history of violence, matched by age, gender and diagnosis to controls; (ii) to quantify violence exhibited by patients with SSDs during 1 year, and to identify protective and risk factors for such violence; (iii) to characterize patients exhibiting considerable violence during the study period. The results of the project show different clinical and cognitive characteristics for patients with a history of violence and for controls, and different factors associated with violence exhibited in the two care settings

From lab to life: Fine-grained behavior monitoring in the elderly's home

Sensor-based activity monitoring systems promise to prolong independent living of frail elderly people, including those affected by cognitive disorders. Different solutions are already available on the market, which use wireless sensors installed in the home to track the daily living routines of the senior. Those systems provide caregivers with statistics about detected activities; some of them may trigger real-time notifications when they identify a risk situation. Long-term monitoring of finegrained behavioral anomalies can be an important tool to support the diagnosis of neurodegenerative diseases. However, current commercial systems can only monitor high-level activity routines. For this reason, in a previous work we devised a novel method to recognize fine-grained abnormal behaviors of elderly people at home based on sensor data. Experiments in the lab showed the effectiveness of that method. In this paper we present our experience about the implementation of the system in the home of an elderly person with diagnosis of mild cognitive impairment. After illustrating the current implementation, we discuss preliminary results and outline research directions. In particular, a preliminary clinician's assessment indicates the potential utility of this system to support the diagnosis, and the benefits that would be gained by extending the system to monitor additional parameters, including neurovegetative aspects and motor behavior. We also discuss directions for addressing the encountered technological issues, for improving our reasoning algorithms with more extensive support of uncertainty, and for 'closing the loop' by making the senior an active part of the system

Moderate efficiency of clinicians' predictions decreased for blurred clinical conditions and benefits from the use of BRASS index. A longitudinal study on geriatric patients' outcomes

Abstract OBJECTIVES: Accurate prognosis is an essential aspect of good clinical practice and efficient health services, particularly for chronic and disabling diseases, as in geriatric populations. This study aims to examine the accuracy of clinical prognostic predictions and to devise prediction models combining clinical variables and clinicians' prognosis for a geriatric patient sample. STUDY DESIGN AND SETTING: In a sample of 329 consecutive older patients admitted to 10 geriatric units, we evaluated the accuracy of clinicians' prognosis regarding three outcomes at discharge: global functioning, length of stay (LoS) in hospital, and destination at discharge (DD). A comprehensive set of sociodemographic, clinical, and treatment-related information were also collected. RESULTS: Moderate predictive performance was found for all three outcomes: area under receiver operating characteristic curve of 0.79 and 0.78 for functioning and LoS, respectively, and moderate concordance, Cohen's K = 0.45, between predicted and observed DD. Predictive models found the Blaylock Risk Assessment Screening Score together with clinicians' judgment relevant to improve predictions for all outcomes (absolute improvement in adjusted and pseudo-R(2) up to 19%). CONCLUSION: Although the clinicians' estimates were important factors in predicting global functioning, LoS, and DD, more research is needed regarding both methodological aspects and clinical measurements, to improve prognostic clinical indices

Clinical and neuropsychological features of violence in schizophrenia: A prospective cohort study

The increased risk of violence in schizophrenia has been linked to several environmental, clinical and neuropsychological factors, including executive dysfunction. However, data about the nature of these effects are mixed and controversial. The main aim of this study was to investigate the relationship between clinical and neuropsychological factors with violence risk in patients with schizophrenia, taking into account current psychopathology and lifetime alcohol use. We compared a sample of patients living in Residential Facilities (RFs) with schizophrenia and a past history of interpersonal violence (vSZ, N=50) to patients with schizophrenia matched on age, gender and alcohol abuse/dependence but with no violence history (nvSZ, N=37). We then established the association between the clinical and neuropsychological factors that predicted violence over a 1year follow-up period. The results revealed that vSZ patients living in RFs were characterized by greater compulsory hospital admissions, higher anger and less negative symptoms as compared to nvSZ patients. vSZ patients performed better on executive and motor tasks than nvSZ; however, these differences appeared to be explained by the lower negative psychotic symptom in the vSZ group. Both groups were involved in episodes of violence during the follow-up period; among the two, the vSZ patients were more likely to be violent. Negative symptoms predicted less verbal aggression at 1year follow-up. Overall, these findings support a key role of negative rather than positive symptoms in driving violence risk among SZ patients living in RFs, in a manner that negative symptoms are linked to a lower risk of violence

Patient personality and psychotherapist reactions in individual psychotherapy setting: a systematic review.

Despite the importance of psychotherapists' subjective experiencse working with patients with mental issues, little is known about the relationship between therapists' emotional reactions and patients' personality problems. The present study is a systematic review of quantitative research on the association between patients' personality pathology and psychotherapists' emotional, cognitive and behavioural reactions in individual psychotherapy setting. A systematic database search (from January 1980 to August 2019) supplemented by manual searches of references and citations identified seven relevant studies. Significant and consistent relationships were found between therapist reactions and specific personality traits or disorders. In general, odd and eccentric patients tend to evoke feelings of distance and disconnection; emotionally dysregulated patients tend to evoke anxiety and incompetence, and anxious and withdrawn patients tend to evoke sympathy and concern. However, the relatively small sample of studies and methodological inconsistencies across studies limit firm conclusions and suggest the need for more systematic research. Findings from this review indicate that patients who share the same personality disorder or symptoms tend to evoke specific and similar cognitive, emotional and behavioural reactions in their therapists. This suggests that therapists overall reactions toward patients may be source of valuable diagnostic information

Patient personality and psychotherapist reactions in individual psychotherapy setting: a systematic review

Despite the importance of psychotherapists' subjective experiencse working with patients with mental issues, little is known about the relationship between therapists' emotional reactions and patients' personality problems. The present study is a systematic review of quantitative research on the association between patients' personality pathology and psychotherapists' emotional, cognitive and behavioural reactions in individual psychotherapy setting. A systematic database search (from January 1980 to August 2019) supplemented by manual searches of references and citations identified seven relevant studies. Significant and consistent relationships were found between therapist reactions and specific personality traits or disorders. In general, odd and eccentric patients tend to evoke feelings of distance and disconnection; emotionally dysregulated patients tend to evoke anxiety and incompetence, and anxious and withdrawn patients tend to evoke sympathy and concern. However, the relatively small sample of studies and methodological inconsistencies across studies limit firm conclusions and suggest the need for more systematic research. Findings from this review indicate that patients who share the same personality disorder or symptoms tend to evoke specific and similar cognitive, emotional and behavioural reactions in their therapists. This suggests that therapists overall reactions toward patients may be source of valuable diagnostic information

Aggression in mental health residential facilities: A systematic review and meta-analysis

Objectives: To estimate the prevalence of aggression exhibited by patients living in community residential facilities and to identify risk factors for such aggression. Methods: A systematic review with meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) dataset (registration number: CRD42016042475). PubMed, Scopus and Web of Science were searched for studies published prior to February 21st 2017. Studies reporting the number of patients who perpetrated aggressive behavior in residential facilities were included. Methodological quality, publication bias, and the role of moderators were assessed. A pooled effect size was calculated for each outcome. Factors affecting between-study heterogeneity were analyzed using sub-groups and meta-regression analysis. Results: Ten studies met the inclusion criteria, for a total sample of 3760 patients. The pooled prevalence of aggression in residential facilities was 29% (95% CI 0.17\u20130.42) with a high heterogeneity and variability among studies. History of violence, personality disorders, lifetime substance and alcohol misuse were found significantly associated with aggression. Conclusion: Aggression in residential care services is common. Certain individual factors are associated to an increased risk for such aggression