Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework

Background: Despite the potential for improved population mental health and wellbeing, the integration of mental health digital interventions has been difficult to achieve. In this qualitative systematic review, we aimed to identify barriers and facilitators to the implementation of digital technologies in mental healthcare systems, and map these to an implementation framework to inform policy development. Methods: We searched Medline, Embase, Scopus, PsycInfo, Web of Science, and Google Scholar for primary research articles published between January 2010 and 2022. Studies were considered eligible if they reported barriers and/or facilitators to the integration of any digital mental healthcare technologies. Data were extracted using EPPI-Reviewer Web and analysed thematically via inductive and deductive cycles. Results: Of 12,525 references identified initially, 81 studies were included in the final analysis. Barriers and facilitators were grouped within an implementation (evidence-practice gap) framework across six domains, organised by four levels of mental healthcare systems. Broadly, implementation was hindered by the perception of digital technologies as impersonal tools that add additional burden of care onto both providers and patients, and change relational power asymmetries; an absence of resources; and regulatory complexities that impede access to universal coverage. Facilitators included person-cantered approaches that consider patients’ intersectional features e.g., gender, class, disability, illness severity; evidence-based training for providers; collaboration among colleagues; appropriate investment in human and financial resources; and policy reforms that tackle universal access to digital health. Conclusion: It is important to consider the complex and interrelated nature of barriers across different domains and levels of the mental health system. To facilitate the equitable, sustainable, and long-term digital transition of mental health systems, policymakers should consider a systemic approach to collaboration between public and private sectors to inform evidence-based planning and strengthen mental health systems. Protocol registration: The protocol is registered on PROSPERO, CRD42021276838

Exploration of stress management interventions to address psychological stress in stroke survivors: A protocol for a scoping review

Introduction: Several studies have shown that stroke survivors report experiencing high and unremitting levels of stress, which can negatively affect brain repair processes and psychological outcomes and thereby compromise recovery. However, it is presently unclear which interventions have been trialled to manage stress in stroke survivors and whether they translate to clinically relevant outcomes. The aim of this scoping review will be to examine stress management interventions in stroke survivors in order to map the types of interventions trialled, commonly reported stress outcome measures and whether a reduction in stress contributes to reductions in relevant clinical outcomes. Methods and analysis: The methodological framework described in Arksey and O’Malley will be applied to this review. A draft search strategy was developed in collaboration with an experienced senior health research librarian. A systematic search of Medline, Embase, CINAHL, Cochrane library, PsycInfo and Clinicaltrials.gov as well as hand searching of reference lists and reviews will identify relevant studies for inclusion. To be eligible for inclusion, studies must report on the outcomes of an intervention targeting stress management and resilience in stroke survivors. Study selection and critical appraisal of selected studies will be carried out independently by two authors, with discrepancies resolved by consensus. Data will be charted using a standard extraction form. Results will be tabulated and narratively summarised to highlight findings relevant to our research questions and to inform recommendations for future research. Ethics and dissemination: This study does not require ethics approval. This scoping review will provide a synthesis of evidence for stress management interventions in stroke survivors. It will identify and clarify the gaps in stress research specific to stroke pathologies and highlight promising interventions for future research. Findings will be relevant to researchers and healthcare workers and will be disseminated via publications in peer-reviewed journals and presented at conferences

Opposing associations of stress and resilience with functional outcomes in stroke survivors in the chronic phase of stroke: A cross-sectional study

Stroke survivors report significant levels of psychological distress post stroke. To date, most studies conducted have focused on the relationship between psychological stress and functional outcomes in the acute phase of stroke. However, no studies had considered the role of stress over the chronic phase, where stress may continue to exert negative effects on cognitive and psychological processes. Further, the role of potentially modulatory variables, such as psychological resilience, on stroke outcomes has been understudied. The purpose of this study was to consider the relationships between stress and resilience with functional outcomes in long-term survivors of stroke. People (N = 70) who had experienced a stroke between 5 months and 28 years ago were included in the cross-sectional study, along with age-matched controls (N = 70). We measured stress using both the Perceived Stress Scale and biological markers, and resilience using both the Brief Resilience Scale and the Connor-Davidson Resilience Scale. Stroke outcomes were assessed using the Stroke Impact Scale. We found that, compared with age-matched controls, stroke survivors reported greater levels of perceived stress, and lower levels of resilience. In stroke survivors, both perceived stress and resilience were independently associated with stroke outcomes in linear regression models. In particular, these relationships were observed for cognitive outcomes including mood, memory, and communication. The association between stress and stroke outcome did not differ across time post stroke. Given that resilience is a modifiable psychological construct, future research may consider whether strategies directed at enhancing resilience may improve recovery from stroke

Public preferences for vaccination campaigns in the COVID-19 endemic phase:insights from the VaxPref database

Objective: Despite widespread perceptions that SARS-CoV-2 (COVID-19) is no longer a significant threat, the virus continues to loom, and new variants may require renewed efforts to control its spread. Understanding how individual preferences and attitudes influence vaccination behaviour and policy compliance in light of the endemic phase is crucial in preparation for this scenario. Method: This paper presents descriptive data from a global stated choice survey conducted in 22 countries across 6 different continents between July 2022 and August 2023, and reports the methodological work developed to address the need for comparable data. Results: This study included 50,242 respondents. Findings indicated significant heterogeneity across countries in terms of vaccination status and willingness to accept boosters. Vaccine hesitancy and refusal were driven by lower trust in public health bodies, younger age, and lower educational levels. Refusers and hesitant people reported lower willingness to take risks compared to those fully vaccinated (p&lt;0.05). Lower mental health levels were found for the hesitant cohort (p&lt;0.05). Conclusions: Insights from this database can help public health authorities to gain a new understanding of the vaccine hesitancy phenomenon, support them in managing the transition from the pandemic to the endemic phase, and favour a new stream of research to maximise behavioural response to vaccination programs in preparation of future pandemics.</p

Public preferences for vaccination campaigns in the COVID-19 endemic phase:insights from the VaxPref database

Objective: Despite widespread perceptions that SARS-CoV-2 (COVID-19) is no longer a significant threat, the virus continues to loom, and new variants may require renewed efforts to control its spread. Understanding how individual preferences and attitudes influence vaccination behaviour and policy compliance in light of the endemic phase is crucial in preparation for this scenario. Method: This paper presents descriptive data from a global stated choice survey conducted in 22 countries across 6 different continents between July 2022 and August 2023, and reports the methodological work developed to address the need for comparable data. Results: This study included 50,242 respondents. Findings indicated significant heterogeneity across countries in terms of vaccination status and willingness to accept boosters. Vaccine hesitancy and refusal were driven by lower trust in public health bodies, younger age, and lower educational levels. Refusers and hesitant people reported lower willingness to take risks compared to those fully vaccinated (p&lt;0.05). Lower mental health levels were found for the hesitant cohort (p&lt;0.05). Conclusions: Insights from this database can help public health authorities to gain a new understanding of the vaccine hesitancy phenomenon, support them in managing the transition from the pandemic to the endemic phase, and favour a new stream of research to maximise behavioural response to vaccination programs in preparation of future pandemics.</p

Public preferences for vaccination campaigns in the COVID-19 endemic phase: insights from the VaxPref database

Objective Despite widespread perceptions that SARS-CoV-2 (COVID-19) is no longer a significant threat, the virus continues to loom, and new variants may require renewed efforts to control its spread. Understanding how individual preferences and attitudes influence vaccination behaviour and policy compliance in light of the endemic phase is crucial in preparation for this scenario. Method This paper presents descriptive data from a global stated choice survey conducted in 22 countries across 6 different continents between July 2022 and August 2023, and reports the methodological work developed to address the need for comparable data. Results This study included 50,242 respondents. Findings indicated significant heterogeneity across countries in terms of vaccination status and willingness to accept boosters. Vaccine hesitancy and refusal were driven by lower trust in public health bodies, younger age, and lower educational levels. Refusers and hesitant people reported lower willingness to take risks compared to those fully vaccinated (p<0.05). Lower mental health levels were found for the hesitant cohort (p<0.05). Conclusions Insights from this database can help public health authorities to gain a new understanding of the vaccine hesitancy phenomenon, support them in managing the transition from the pandemic to the endemic phase, and favour a new stream of research to maximise behavioural response to vaccination programs in preparation of future pandemics

Neurobiological alterations in the rat medial prefrontal cortex following exposure to chronic psychological stress

Research Doctorate - Doctor of Philosophy (PhD)Persistent exposure to stressful events can produce serious disorders of cognitive function and mood state. Globally, depression affects between 5 and 20% of the world’s population, and represents a large burden of disease. Current treatments are not effective for all people with depression. Research efforts directed towards understanding the neurobiology of stress and depression are increasing in an attempt to better understand, treat, and possibly even prevent mood-related psychopathology. One of the first steps is understanding the response of the prefrontal cortex, part of the brain responsible for the control of stress and emotional responses, to chronic stress. With this in mind, the experiments in this thesis were aimed at elucidating cellular changes in the rat medial prefrontal cortex after exposure to chronic psychological stress. The experiments described in Chapter Two aimed to examine the phenotype of chronically activated neurons in the forebrain following exposure to chronic stress. The medial prefrontal cortex was the only area examined to display a difference in levels of ΔFosB, a marker used for functional imaging of chronic neuronal activation. It was found that these cells were glutamatergic pyramidal projection neurons. The results of Chapter Two, along with emerging evidence that stress activates the neuroimmune system (microglial cells), and that these cells appear to be able to alter neuronal connectivity, led us to investigate how exposure to chronic stress affects microglial activity in the medial prefrontal cortex in Chapter Three. It was found that chronic psychological stress increased microglial cell immunoreactivity, as well as local neuronal activity. In this study, stress also impaired performance on a working memory task, a cognitive function that is prefrontal cortex dependent. Administration of minocycline hydrochloride, a tetracycline antibiotic which is known to inhibit microglial activation, reversed the effects of stress on microglial cells. Additionally, minocycline administration reduced the impact of stress on neuronal activation and working memory performance. This suggests that microglia mediate the effects of stress on prefrontal cortex neuronal function and prefrontal cortex dependent behaviour. In Chapter Four, following on from the results of the previous two studies, we investigated how exposure to chronic stress alters microglial cell morphology. This is an important issue, as experience-dependent changes to microglial cells are only just starting to be elucidated, and form is closely related to function for these cells. Cells from animals exposed to chronic psychological stress were digitally reconstructed and analysed for morphological characteristics. It was found that microglial cells in the medial prefrontal cortex of animals exposed to chronic psychological stress had increased ramification (branching) without an increase in the overall size of the cell. This was associated with an increase in the structural protein β1-integrin, which has been implicated in microglial ramification. These effects were reversed in animals who were administered minocycline. Increased ramification of microglia may be the morphological representation through which microglia exert their effects following exposure to chronic psychological stress. Overall, the experiments presented in this thesis have contributed to our knowledge of how neurons and microglial cells in the medial prefrontal cortex respond to chronic stress, and how some of the effects of stress may be mediated by a neuroinflammatory response evoked by microglia. These results form an important contribution to further understanding the neurobiology of the stress response, and may have implications for the future development of efficacious pharmacotherapies for stress-induced psychopathologies