Efficacy of a mental health app intervention on family members of OCD patients

INTRODUCION. Obsessive-compulsive disorder (OCD) has a high cost for families, who frequently take part in compulsions, reassure patients, assume part of their responsibilities, try to conceal the disorder, and show stigmatizing attitudes (Ociskova et al., 2013; Stengler-Wenzke et al., 2004). esTOCma is a gamified mental health mobile application (app) that offers information about OCD, suggests where to find help, and helps fight stigmatizing attitudes. The objective of this study is to test esTOCma efficacy in a sample of OCD family members. Specifically, we will analyze if, after using the app, there is a change in the following variables: mental health literacy about OCD, stigma and social distance associated with OCD, intention to seek help when having OCD. Furthermore, we will test families’ satisfaction with the app. METHOD. Participants were extracted from a total of 296 users who downloaded the app for free from Google Play Store or Apple’s App Store and identified themselves as a family member of a person diagnosed with OCD. From the initial sample, participants who used the app until completion and completed a pre- and post-intervention assessment were selected. The final sample comprised 109 participants of a mean age of 46.03 years old (SD=14.42; range 18-73), 69.7 % women. Participants completed the following measures in the app before and after the intervention: (1) mental health literacy about OCD (MHL) (7 items); (2) Attribution Questionnaire (AQ-27-E); (3) Social Distance Scale (SDS); (4) General Help-Seeking Questionnaire (GHSQ); (5) satisfaction with the app (3 items). RESULTS. On average, it took 20.61 days (SD=18.05) to complete the app. After intervention, participants showed significant changes with moderate to low effect sizes in the variables of interest. Specifically, after using the app, participants showed higher scores in mental health literacy about OCD (t (108) = -3.768, p= < .001, Cohen’s d= 0.389), lower stigma in the AQ-27-E total score (t (108) = -6.484, p= < .001, Cohen’s d= 0.50) and subscales, a lower desire for social distance (t (108) = 5.569, p= < .001, Cohen’s d= 0.618); and greater intention to seek treatment in case of OCD symptoms (t (108) = -5.194, p= < .001, Cohen’s d= 0.553). Most of them (88%) would recommend the app to a friend, appraised what they had learned using the app (96.3%) and stated that the app was very helpful (88.1%). DISCUSSION. Results show that the app is satisfactory and beneficial for family members of OCD patients as it significantly increased their knowledge about the disorder and dismissed stigmatizing beliefs about OCD. Accordingly, esTOCma could help families understand their relatives, obtain guidance to deal with their symptoms and help family members get efficacious treatment. Future studies should analyze strategies to improve the app to make it more attractive and facilitate continued use.RTI2018-098349-B-I0

Mental health literacy and stigma associated with obsessive-compulsive content dimensions: effectiveness of an intervention via smartphone.

Introduction. Obsessive-compulsive disorder (OCD) is a serious and disabling mental illness that presents a high delay in help seeking. Various studies suggest that stigma and mental health literacy (MHL) are two very important factors that favour this delay and that they vary depending on OCD symptoms. Considering that, the aim of this study is to, firstly, analyze the stigma and OCD literacy in relation to the different obsessive-compulsive symptom contents in the general population and, secondly, assess the impact of an intervention carried out through a mobile application (esTOCma) that has been gamified to decrease stigma and increase OCD literacy. Method. A group of 357 people (39.66 (SD = 16.88) years; 66.7% women) were drawn from the general population and randomly assigned to 6 vignettes that describe different obsessive-compulsive contents (OC) (i.e., aggression/harm; sexual; religious/blasphemous/immoral; contamination/washing; doubts/checking; superstition/symmetry/order). Sociodemographic information was collected as well as data regarding desired social distance (SDS), knowledge about OCD (MHL), both at a general level and associated with the vignette, and stigma (AQ-27). Then, participants completed the application and filled out the assessment instruments for a second time. Descriptive statistics, simple variance analyses and repeated measures analysis of variance with Bonferroni adjustments were performed. Results. The analyses show that, prior to the intervention, there were significant small-moderate effect size differences in stigmatizing attitudes (F(5, 351) = 2.561, p = 0.027, ƞ2p = 0.035), social distance desire (F(5, 351) = 2.41, p = 0.036, ƞ2p = 0.033) and MHL (F(5, 351) = 4.698, p = < 0.001, ƞ2p =0.063) between the OC contents. First, regarding stigma, fear and attribution of danger were significantly higher towards the content of aggression/harm, and avoidance was significantly higher towards the religious/blasphemous/immoral OC content. Second, MHL was significantly lower in the doubts/checking content compared to others (aggression/harm; sexual; religious/blasphemous/immoral; contamination/washing); and significantly higher in superstition/symmetry/order compared to religious/blasphemous/immoral. After the intervention, and regardless the OC content dimension, there were significant changes with large effect sizes. Specifically, there was a significant decrease in stigma (F(1, 351) = 111.285, p <0.001, ƞ2p = 0.241) and in desired social distance (F(1, 351) = 120.945, p < 0.001, ƞ2p =0.256). In addition, knowledge about OCD has increased significantly (F(1, 351) = 85.122, p < 0.001, ƞ2p =0.195) in all content groups except for moral. Discussion. Consistent with other studies, these results show that there are relevant differences in stigma between OC contents. Also, regarding the intervention, esTOCma seems to be a useful resource to improve general knowledge about OCD and to reduce stigma, and it could be associated with earlier OCD detection and an increase in help-seeking intention, which could result in greater wellbeing of OCD patients. Moreover, normalizing intrusions and knowledge about the cognitive OCD model could serve as a protective variable in vulnerable individuals

Association of Common Variations on Chromosome 4q25 and Left Atrial Volume in Patients with Atrial Fibrillation

Aims Recent studies have shown that several genetic variants near the PITX2 locus on chromosome 4q25 are associated with atrial fibrillation (AF). However, the mechanism that mediates this association remains unclear. Basic murine studies suggest that reduced PITX2 expression is associated with left atrial dilatation. We sought to examine the association between single nucleotide polymorphisms (SNPs) near PITX2 and left atrial size in patients with AF. Methods We prospectively enrolled 96 consecutive patients (mean age 60 ± 10 years, 72% male) with drug-resistant AF (57% paroxysmal, 38% persistent, and 5% long-standing persistent) who underwent catheter ablation. Following DNA extraction from blood obtained pre-operatively, SNPs rs10033464 and rs2200733 were genotyped using the Sequenom MassARRAY. Left atrial volume (LAV) was determined using three-dimensional imaging (CT or MRI prior to first ablation) and by investigators blinded to genotype results. Results The minor allele frequencies at SNPs rs10033464 and rs2200733 were 0.14 and 0.25, respectively. Using multivariable linear regression, homozygosity for the minor allele at rs10033464 (recessive model) was independently associated with larger LAV ( P = 0.002) after adjustment for age, gender, BMI, height, type, and duration of AF, left ventricular ejection fraction, history of hypertension, valve disease, and antiarrhythmic drug use. The strength of the association was reconfirmed in a bootstrap study with 1000 resamplings. In contrast, no association was found between rs2200733 variant alleles and LAV. Conclusion SNP rs10033464 near the PITX2 locus on 4q25 is associated with LAV. Left atrial dilatation may mediate the association of common variants at 4q25 with AF

Searching the World Wide Web in Low-Connectivity Communities

The Internet has the potential to deliver information to communities around the world that have no other information resources. High telephone and ISP fees - in combination with low-bandwidth connections - make it unaffordable for many people to browse the Web online. We are developing the TEK system to enable users to search the Web using only email. TEK stands for &quot;Time Equals Knowledge,&quot; since the user exchanges time (waiting for email) for knowledge. The system contains three components: 1) the client, which provides a graphical interface for the end user, 2) the server, which performs the searches from MIT, and 3) a reliable email-based communication protocol between the client and the server. The TEK search engine differs from others in that it is designed to return low-bandwidth results, which are achieved by special filtering, analysis, and compression on the server side. We believe that TEK will bring Web resources to people who otherwise would not be able to afford them