Using new and innovative technologies to assess clinical stage in early intervention youth mental health services: Evaluation study

Background: Globally there is increasing recognition that new strategies are required to reduce disability due to common mental health problems. As 75% of mental health and substance use disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, new and innovative technologies show promise in augmenting traditional clinic-based services. Objective: The aim of this study was to test new and innovative technologies to assess clinical stage in early intervention youth mental health services using a prototypic online system known as the Mental Health eClinic (MHeC). Methods: The online assessment within the MHeC was compared directly against traditional clinician assessment within 2 Sydney-based youth-specific mental health services (headspace Camperdown and headspace Campbelltown). A total of 204 young people were recruited to the study. Eligible participants completed both face-to-face and online assessments, which were randomly allocated and counterbalanced at a 1-to-3 ratio. These assessments were (1) a traditional 45- to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician and (2) an approximate 60-minute online assessment (including a self-report Web-based survey, immediate dashboard of results, and a video visit with a clinician). All assessments were completed within a 2-week timeframe from initial presentation. Results: Of the 72 participants who completed the study, 71% (51/72) were female and the mean age was 20.4 years (aged 16 to 25 years); 68% (49/72) of participants were recruited from headspace Camperdown and the remaining 32% (23/72) from headspace Campbelltown. Interrater agreement of participants’ stage, as determined after face-to-face assessment or online assessment, demonstrated fair agreement (kappa=.39, P\u3c.001) with concordance in 68% of cases (49/72). Among the discordant cases, those who were allocated to a higher stage by online raters were more likely to report a past history of mental health disorders (P=.001), previous suicide planning (P=.002), and current cannabis misuse (P=.03) compared to those allocated to a lower stage. Conclusions: The MHeC presents a new and innovative method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connected with traditional clinical services and assist in providing the right care at the right tim

Developing a mental health eClinic to improve access to and quality of mental health care for young people: Using participatory design as research methodologies

Background: Each year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising. Objective: The aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years and youth health professionals) and our research team to develop the Mental Health eClinic (a Web-based mental health clinic) to improve timely access to, and better quality, mental health care for young people across Australia. Methods: A research and development (R&D) cycle for the codesign and build of the Mental Health eClinic included several iterative PD phases: PD workshops; translation of knowledge and ideas generated during workshops to produce mockups of webpages either as hand-drawn sketches or as wireframes (simple layout of a webpage before visual design and content is added); rapid prototyping; and one-on-one consultations with end users to assess the usability of the alpha build of the Mental Health eClinic. Results: Four PD workshops were held with 28 end users (young people n=18, youth health professionals n=10) and our research team (n=8). Each PD workshop was followed by a knowledge translation session. At the conclusion of this cycle, the alpha prototype was built, and one round of one-on-one end user consultation sessions was conducted (n=6; all new participants, young people n=4, youth health professionals n=2). The R&D cycle revealed the importance of five key components for the Mental Health eClinic: a home page with a visible triage system for those requiring urgent help; a comprehensive online physical and mental health assessment; a detailed dashboard of results; a booking and videoconferencing system to enable video visits; and the generation of a personalized well-being plan that includes links to evidence-based, and health professional–recommended, apps and etools. Conclusions: The Mental Health eClinic provides health promotion, triage protocols, screening, assessment, a video visit system, the development of personalized well-being plans, and self-directed mental health support for young people. It presents a technologically advanced and clinically efficient system that can be adapted to suit a variety of settings in which there is an opportunity to connect with young people. This will enable all young people, and especially those currently not able or willing to connect with face-to-face services, to receive best practice clinical services by breaking down traditional barriers to care and making health care more personalized, accessible, affordable, and available

Prevalence of depressive disorder among emergency department patients in Bogotá

Introducción:Por su alta prevalencia, la depresión se considera un problema de salud mundial. Es importante conocer la prevalencia de este trastorno en los pacientes que acuden a servicios de urgencia en Bogotá. Objetivo:Calcular la prevalencia de síntomas depresivos en la última semana y determinar las características demográficas de personas entre los 18 y 65 años de edad que acuden por patologías no psiquiátricas al servicio de urgencias de un hospital universitario en Bogotá. Método:Estudio de corte transversal de pacientes adultos que asisten al servicio de urgencias de un hospital universitario. La información recopilada incluye datos demográficos, motivo de consulta, diagnóstico y aplicación de la escala del centro de estudios epidemiológicos para depresión (CES-D). Resultados:Se obtuvo una muestra de 470 pacientes que acudieron al servicio de urgencias con una prevalencia de síntomas depresivos en la última semana, del 27,7%. La presencia de sintomatología depresiva se vio asociada con sexo femenino, bajo nivel educativo, acudir en horario de la tarde al servicio de urgencias y diagnóstico de alguna enfermedad del sistema nervioso central. Conclusiones:Se describe por primera vez en Bogotá la prevalencia de síntomas depresivos en la población que acude a los servicios de urgencias de un hospital general. Son necesarios más estudios para dilucidar factores de riesgo asociados a este trastorno en la población que acude a servicios de urgencias.Q4Artículo original22-37Background: Depression is a public health problem worldwide due to its high prevalen-ce. In emergency departments it is often un-derdetected and undertreated. It is important to be informed about the prevalence of this disorder in emergency departments in Bo-gotá. Objective: To determine the prevalence of clinically significant depressive symptoms in the last week among adult patients visi-ting the emergency department (ED) with non-psychiatric complaints, in a teaching hospital in Bogotá. Method: Cross-sectional study in adult patients who visit the ED. Data collected included socio-demographical data, chief complaint, diagnosis, and results of the Center for Epidemiologic Studies Depression Scale (CES-D). Results: Of the 470 patients visiting the ED, 27.7% had clinically signifi-cant depressive symptoms. The presence of depressive symptoms was associated with female sex, low education level, visits to the ED in the afternoon, and the diagnosis of a central nervous system disease. Conclusions: This study identified a high frequency of clinically significant depressive symptoms among ED patients in Bogotá. More studies are needed to determine risk factors associa-ted to this disorder in this kind of population

Using participatory design methodologies to co-design and culturally adapt the Spanish version of the Mental Health eClinic: Qualitative study

Background: The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically diverse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students. Objective: We used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC; (2) inform the development of the MHeC-S alpha prototype; (3) test the usability of the MHeC-S alpha prototype; (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment; and (5) collect information to inform its beta prototype. Methods: A research and development cycle included several participatory design phases: co-design workshops; knowledge translation; language translation and cultural adaptation; and rapid prototyping and user testing of the MHeC-S alpha prototype. Results: We held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random sample of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86; P\u3c.001) and content (kappa=.92; P\u3c.001) and substantial agreement for the user interface (kappa=.785; P\u3c.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype’s 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking. Conclusions: Through a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries

Language Translation, Cultural and Contextual Adaptation of Health Information Technologies to Transform Mental Health Care in Low- and Middle- Income Countries: An Example of a Prototypic Mental Health eClinic for Colombia

There is increasing recognition that new strategies are required to reduce disability due to common mental health problems. Young people living in low- and middle-income countries (LMIC) face a scarcity of health professionals, services and infrastructure, as well as specific policies directed to reduce these problems. Health information technologies (HIT) show promise in augmenting traditional face-to-face services; however, they have slow uptake and implementation by LMICs. This thesis presents a case example of how a HIT co-designed in an industrialized country (i.e. Australia) can be translated, culturally-sensitised and context-adapted for a LMIC (i.e. Colombia). The first paper of the thesis demonstrates the use of participatory design (PD) techniques as research methodologies to co-design the Mental Health eClinic (MHeC; a Web-based mental health clinic). The second paper, compared the MHeC’s online self-report assessments with traditional face-to-face clinical assessment in young people. The third paper, detailed the co-design of a Spanish version of the MHeC (MHeC-S) with Spanish-speaking young people living in Australia. The fourth paper demonstrates the adaptation of the MHeC-S to a Colombian young person population. Overall, findings elucidate an urgent need to provide scalable interventions to young people in LMICs who are currently at risk of experiencing health and technological inequities. A possible solution is to make use of already available HITs that are being developed in industrialized countries. However, they need to be tailored beyond language and considered within a culturally and contextually appropriate framework – which should incorporate the use of PD research methodologies that involve stakeholders and end users early in the process. Ultimately, such adaptation of HITs represents low-cost and scalable alternatives for LMICs to provide young people with accessible, available, affordable mental health care at the right time, first time

NLG-based moderator response generator to support mental health

The global need to effectively address mental health problems and wellbeing is well recognised. Today, online systems are increasingly being viewed as an effective solution for their ability to reach broad populations. As online support groups become popular the workload for human moderators increases. Maintaining quality feedback becomes increasingly challenging as the community grows. Tools that can automatically detect mental health problems from social media posts and then generate smart feedback can greatly reduce human overload. In this paper, we present a system for the automation of interventions using Natural Language Generation (NLG) techniques. In particular, we focus on 'depression' and 'anxiety' related interventions. Psychologists evaluated the quality of the systems' interventions and results were compared against human (i.e. moderator) interventions. Results indicate our intervention system still has a long way to go, but is a step in the right direction as a tool to assist human moderators with their service.6 page(s

Adapting a Mental Health Intervention for Adolescents During the COVID-19 Pandemic: Web-Based Synchronous Focus Group Study

BackgroundAlthough focus groups are a valuable qualitative research tool, face-to-face meetings may be difficult to arrange and time consuming. This challenge has been further compounded by the global COVID-19 pandemic and the subsequent lockdown and physical distancing measures implemented, which caused exceptional challenges to human activities. Online focus groups (OFGs) are an example of an alternative strategy and require further study. At present, OFGs have mostly been studied and used in high-income countries, with little information relating to their implementation in low- and middle-income countries (LMICs). ObjectiveThe aim of this study is to share our experiences of conducting OFGs through a web conferencing service and provide recommendations for future research. MethodsAs part of a broader study, OFGs were developed with adults and adolescents in Colombia during the COVID-19 pandemic. Through a convenience sampling method, we invited eligible participants via email in two different cities of Colombia to participate in OFGs conducted via Microsoft Teams. Researcher notes and discussion were used to capture participant and facilitator experiences, as well as practical considerations. ResultsTechnical issues were encountered, but various measures were taken to minimize them, such as using a web conferencing service that was familiar to participants, sending written instructions, and performing a trial meeting prior to the OFG. Adolescent participants, unlike their adult counterparts, were fluent in using web conferencing platforms and did not encounter technical challenges. ConclusionsOFGs have great potential in research settings, especially during the current and any future public health emergencies. It is important to keep in mind that even with the advantages that they offer, technical issues (ie, internet speed and access to technology) are major obstacles in LMICs. Further research is required and should carefully consider the appropriateness of OFGs in different settings

Eficacia de una evaluación centrada en el paciente con un enfoque centrado en la solución (DIALOG-A) en la atención rutinaria de adolescentes colombianos que sufren depresión y ansiedad : un ensayo controlado aleatorio multicéntrico por conglomerados

Colombia es un país de ingresos medios en América del Sur que históricamente ha luchado con altas tasas de problemas de salud mental, junto con una escasez de atención de salud mental. Existe una creciente preocupación por la salud mental de la población adolescente en esta región. Existe una importante brecha de tratamiento para los jóvenes, especialmente aquellos que viven en las zonas más vulnerables. DIALOG+ es una intervención de bajo costo centrada en el paciente que puede mejorar potencialmente la atención y la calidad de vida de los adolescentes con problemas de salud mental. Este ensayo controlado aleatorio exploratorio tiene como objetivo evaluar la efectividad, aceptabilidad y factibilidad de una versión adaptada de la intervención DIALOG+ (DIALOG-A) en el tratamiento comunitario de adolescentes colombianos con depresión y ansiedad. Métodos: Dieciocho médicos y 108 adolescentes serán reclutados de los servicios de atención primaria de salud ubicados en Bogotá y Duitama, Colombia. Los médicos serán asignados al azar en una proporción de 2:1 a la intervención (12 médicos/72 adolescentes) o al grupo de control (6 médicos/36 adolescentes). En el brazo de intervención, los médicos usarán DIALOG-A con adolescentes mensualmente durante 6 meses. El brazo de control continuará recibiendo atención de rutina. Los resultados se medirán al inicio, 6 y 9 meses después de la aleatorización. Se realizarán entrevistas semiestructuradas con todos los médicos y un subconjunto de adolescentes en el brazo de intervención al final del período de intervención. Se realizará un análisis cuantitativo y cualitativo de los datos. Discusión: Este es el primer estudio que prueba una intervención adaptada y orientada a los recursos (DIALOG-A) en el tratamiento de adolescentes con depresión y ansiedad que acuden a los servicios de atención primaria. Si los resultados son positivos, DIALOG-A puede implementarse en la atención de rutina de los adolescentes con estos problemas de salud mental y brindar información valiosa a otros países de ingresos medios. Número y fecha de registro de pruebaQ3Colombia is a middle-income country in South America which has historically struggled with high rates of mental health problems, coupled with a scarcity of mental health care. There is growing concern for the mental health of the adolescent population within this region. There is a significant treatment gap for young people, especially those living in the most vulnerable areas. DIALOG+ is a low-cost patient-centred intervention that can potentially improve the delivery of care and quality of life for adolescents with mental health problems. This exploratory randomised controlled trial aims to evaluate the effectiveness, acceptability, and feasibility of an adapted version of the DIALOG+ intervention (DIALOG-A) in the community treatment of Colombian adolescents with depression and anxiety. Methods: Eighteen clinicians and 108 adolescents will be recruited from primary healthcare services located in Bogota and Duitama, Colombia. Clinicians will be randomised in a 2:1 radio to either the intervention (12 clinicians/72 adolescents) or to the control group (6 clinicians/36 adolescents). In the intervention arm, clinicians will use DIALOG-A with adolescents monthly over 6 months. The control arm will continue to receive routine care. Outcomes will be measured at baseline, 6- and 9-months following randomisation. Semi-structured interviews with all clinicians and a subset of adolescents in the intervention arm will be conducted at the end of the intervention period. Quantitative and qualitative analysis of the data will be conducted. Discussion: This is the first study to test an adapted resource-orientated intervention (DIALOG-A) in the treatment of adolescents with depression and anxiety attending primary care services. If the results are positive, DIALOG-A can be implemented in the routine care of adolescents with these mental health problems and provide valuable insight to other middle-income countries.Revista Internacional - IndexadaS

Moderator Assistant : a Natural Language Generation-based intervention to support mental health via social media

As online mental health support groups become increasingly popular, they require more support from volunteers and trained moderators who help their users through "interventions" (i.e., responding to questions and providing support). We present a system that supports such human interventions using Natural Language Generation (NLG) techniques. The system generates draft responses aimed at reducing moderators' workload, and improving their efficacy. NLG and human interventions were compared through the ratings of 35 psychology interns. The NLG-based system was capable of generating messages that are grammatically correct with clear language. The system needs improvement, however, moderators can already use it as draft responses.26 page(s

Involving end users in adapting the spanish version of the mental health eClinic for young people in Colombia : A pilot study using participatory design methodologies

ManuscritoBackground: Health information technologies (HIT) hold enormous promise for improving access to, and better quality, mental health care. However, despite rapid spread of such technologies in high-income countries, they have not yet been commonly adopted in low and middle-income countries. People living in these parts of the world are at risk of experiencing not only physical but also technological and social health inequalities. One possible solution is to utilise already available (and successfully implemented) HITs developed in other counties. Objective: Using participatory design methodologies with Colombian end users (young people, their supportive others, health professionals), this study aimed to: conduct co-design workshops to culturally adapt an online mental health clinic (MHeC) for young people; perform one-on-one user testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC, and adapt it to the Colombian context; and, inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). Methods: Utilisation of a research and development (R&D) cycle including four iterative phases: co-design workshops; knowledge translation; tailoring to language, culture and place (or context); rapid prototyping; and then, one-on-one user testing sessions. Results: Two co-design workshops were held with 18 users (young people n=7, health professionals n=11). A total of 10 participated in one-on-one user-testing sessions (young people n=5, supportive others n=2, health professionals n=3). 203 source documents were collected and 605 annotations were coded. A thematic analysis resulted in six main themes (i.e. opinions about the MHeC-C, Colombian context, functionality, content, user interface and technology platforms). Participants liked the idea of having a MHeC specially designed and adapted for Colombian young people and its five key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video visit system and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop some additional functionality (eg. phone network backup, chat, geolocation, and integration with electronic medical records, apps or e-tools) as well as adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. Conclusions: The application of an iterative R&D cycle that also included processes for adaptation to Colombia (language, culture, context), resulted in the development of an evidence-based, language-appropriate, culturally-sensitive, context-adapted HIT that is relevant, applicable, engaging and usable in both the short- and longer-term. The resultant R&D cycle allowed for the adaptation of an already available HIT (i.e. MHeC) to the MHeC-C – a low-cost and scalable technology solution for low-tomiddle income countries such as Colombia, which has the potential to provide young people with accessible, available, affordable and integrated mental health care at the right time