TechCare – Mobile Assessment and Therapy for Psychosis: Feasibility Study of an Intervention for Clients within the Early Intervention Service

Background: Mobile digital health technologies, mHealth, is a growing field globally with a potential to improve mental health. Technological advances have shown promise across healthcare and particularly when delivering interventions for mental health problems such as psychosis. The use of mobile devices provides greater autonomy to service users who would otherwise be seen as a ‘hard to reach group’, with complex relationships between psychotic experiences, trust and engagement with services. A non-stigmatising approach is implicit within technological developments, as many service users experience mental health stigma, which can compound problematic engagement, treatment adherence and outcomes. This study was an original piece of work and has created new insights into mHealth technologies for individuals experiencing psychosis. Aim: The aim of the project was to develop and conduct a feasibility study of the mobile phone application (App) ‘TechCare’ for individuals with psychosis in the North West of England. Methods/Design: The feasibility study followed the National Institute of Health Research (NIHR) guidance on feasibility study design and consisted of both qualitative and quantitative components. The study was conducted across three strands as follows: 1) Qualitative work & Systematic review; 2) Test-run and Intervention refinement (developing the TechCare App); 3) Feasibility trial. The TechCare App assessed participants’ symptoms and responses and provided for a personalised guided self-help based psychological intervention, with the aim of reducing participants’ symptoms. In Strand 1 of the study, 16 service users and 16 health professionals from Lancashire Care NHS Foundation Trust, Early Intervention Service (EIS) were recruited to explore their experience of psychosis and give their opinions on the existing evidence based treatment (Cognitive Behavioural Therapy (CBT)) and how the mobile App could be developed (service users and staff). In Strand 2, a test-run with a small number (n= 4) of participating service users, was conducted to refine the mobile intervention (TechCare). Finally, in Strand 3 the TechCare App was examined in a feasibility study with a total of 12 service users. The study was also registered on ClinicalTrials.gov Identifier: NCT02439619. Results: The systematic review, found 7 studies which met the inclusion criteria, from a total of 5690 records. The included studies describing the feasibility of using mHealth technologies for psychosis, functionality and access to mHealth interventions and study outcomes. Overall, the systematic review results suggested that mHealth for psychosis is acceptable and feasible in the target population. Furthermore, the TechCare App had been developed, working alongside service users who consulted on the development of the App. The qualitative result of the study showed that the TechCare App was found to be an acceptable means of receiving interventions for the service users, with key themes around, the participant’s experience of using the App, the further development and refinement of the intervention and the usability of the intervention. In addition, the Strand 3 feasibility study, results showed that out of the 12 participants, a total of 83.33% of participants completed the 6 week intervention. Overall participants responded to the App notifications on average 2.95 time per day (Range: 0-11), with a reduction in average scores on the TechCare App, from baseline to week 6 for the depression scale questions (Week 1, M=29.13 (SD=18.29); Week 6 was M=17.50 (SD=11.92)) and paranoia scale questions (Week 1 M=38.00, SD=28.27; Week 6, M=33.92, SD=27.88). Discussion: The results of the study show promise in the feasibility and acceptability of the TechCare App. Based on these results I can now take the research forward as part of a future clinical and cost effectiveness trial. It has been suggested that there is a need, for a rapid increase in the evidence base for the clinical effectiveness of digital technologies, considering mHealth research can potentially be helpful in addressing the demand on mental health services in the UK and mental health inequalities

Reporting and understanding the safety and adverse effect profile of mobile apps for psychosocial interventions: An update

Recent years have seen a rapidly increasing trend towards the delivery of health technology through mobile devices. Smartphones and tablet devices are thus becoming increasingly popular for accessing information and a wide range of services, including health care services. Modern mobile apps can be used for a variety of reasons, ranging from education for the patients and assistance to clinicians to delivery of interventions. Mobile phone apps have also been established to benefit patients in a scope of interventions across numerous medical specialties and treatment modalities. Medical apps have their advantages and disadvantages. It is important that clinicians have access to knowledge to make decisions regarding the use of medical apps on the basis of risk-benefit ratio. Mobile apps that deliver psycho social interventions offer unique challenges and opportunities. A number of reviews have highlighted the potential use of such apps. There is a need to describe, report and study their side effects too. The adverse effects associated with these apps can broadly be divided into: (1) those resulting from the security and safety concerns; (2) those arising from the use of a particular psycho social intervention; and (3) those due to the interaction with digital technology. There is a need to refine and reconsider the safety and adverse effects in this area. The safety profile of a mobile PSI app should describe its safety profile in: (1) privacy and security; (2) adverse effects of psychotherapy; and (3) adverse effects unique to the use of apps and the internet. This is, however, a very new area and further research and reporting is required to inform clinical decision making

mHealth based interventions for the assessment and treatment of psychotic disorders: a systematic review

The relative burden of mental health disorders is increasing globally, in terms of prevalence and disability. There is limited data available to guide treatment choices for clinicians in low resourced settings, with mHealth technologies being a potentially beneficial avenue to bridging the large mental health treatment gap globally. The aim of the review was to search the literature systematically for studies of mHealth interventions for psychosis globally, and to examine whether mHealth for psychosis has been investigated. A systematic literature search was completed in Embase, Medline, PsychINFO and Evidence Based Medicine Reviews databases from inception to May 2016. Only studies with a randomised controlled trial design that investigated an mHealth intervention for psychosis were included. A total of 5690 records were identified with 7 studies meeting the inclusion criteria. The majority of included studies, were conducted across Europe and the United Sates with one being conducted in China. The 7 included studies examined different parameters, such as Experiential Sampling Methodology (ESM), medication adherence, cognitive impairment, social functioning and suicidal ideation in veterans with schizophrenia. Considering the increasing access to mobile devices globally, mHealth may potentially increase access to appropriate mental health care. The results of this review show promise in bridging the global mental health treatment gap, by enabling individuals to receive treatment via their mobile phones, particularly for those individuals who live in remote or rural areas, areas of high deprivation and for those from low resourced settings

Multicentre randomised controlled trial of a group psychological intervention for postnatal depression in British mothers of South Asian origin (ROSHNI-2): study protocol

Background: In the UK, postnatal depression is more common in British SouthAsian women than White Caucasion women. Cognitive–behavioural therapy (CBT) is recommended as a first-line treatment, but there is little evidence for the adaptation of CBT for postnatal depression to ensure its applicability to different ethnic groups.Aims: To evaluate the clinical and cost-effectiveness of a CBT-based positive health programme group intervention in British South Asian women with postnatal depression.Method: We have designed a multicentre, two-arm, partially nested, randomised controlled trial with 4- and 12-month follow-up, comparing a 12-session group CBT-based intervention (positive health programme) plus treatment as usual with treatment as usual alone, for British South Asian women with postnatal depression. Participants will be recruited from primary care and appropriate community venues in areas of high South Asian density across the UK. It has been estimated that randomising 720 participants (360 into each group) will be sufficient to detect a clinically important difference between a 55% recovery rate in the intervention group and a 40% recovery rate in the treatmentas-usual group. An economic analysis will estimate the costeffectiveness of the positive health programme. A qualitative process evaluation will explore barriers and enablers to study participation and examine the acceptability and impact of the programme from the perspective of British South Asian women and other key stakeholders

Joint Research Day, UClan, Burnley 2018

The Joint Research Day between Uclan and ELHT took place on the 27th of November, at Victoria Mills, Burnley. The event brought together researchers and clinicians to showcase recent research, share new ideas about clinical problems that need tackling and seek collaborative interest between ELHT and UCLan staff. Uclan researchers from various academic/ research disciplines such as engineering, computer science, psychology, and health participated. The event was an opportunity to: • Hear about current local research projects, • Get involved in planned research, • Develop research ideas, • Develop collaborative partnerships. The program included • Keynote lectures by Professor St John Crean, Pro Vice Chancellor, Uclan (the second keynote speaker to be announced), • Presentations and posters of local studies. • Workshops

Development of a mHealth Intervention (TechCare) for First Episode Psychosis: A Focus Group Study With Mental Health Professionals

Aims Research in the area of mHealth, has shown much promise in the development of mobile phone interventions which look at the assessment and treatment in real-time of psychiatric disorders. Within the context of Severe Mental Illnesses (SMI), such as psychosis, communication and understanding between health professionals and service users in the reporting of distress and reoccurrence of symptoms is essential in reducing the chances of relapse. An alternative pathway which uses mobile technology to engage with services, may hold the key to gaining a deeper understanding of the lived experiences of those with mental health difficulties, in particular experiences of recovery from SMI's. AIM: The aim of the study was to explore the perspectives and opinions of health professionals on the development and refinement of the TechCare App for psychosis. A qualitative approach was adopted for data collection, which provided an understanding of factors in relation to the development of the intervention. Methods A total of two focus groups were held with health professionals to elicit their views on optimising the utility of the TechCare App. The total sample size for the focus groups was n = 16 with a total of 6 males and 10 females. This qualitative study was part of a feasibility study, investigating a novel intervention (TechCare) (Husain et al., 2016; Gire et al., 2021) which monitored participants symptoms and provided a tailored psychosocial response in real-time. Data obtained from the focus groups was transcribed. Framework analysis were used to analyse the data for emerging themes, focusing on feasibility, acceptability and further development. Results The key themes that emerged from the data were; access and usage of digital technologies, implications for clinical practice, challenges & barriers to delivery and development and refinement considerations for the TechCare App. Conclusion Results of the focus group with health professionals provided a unique perspective of conducting mHealth research within an EIS context, and the differing challenges professionals anticipated facing in delivering the TechCare App intervention. The main finding of the focus group was that professionals saw the potential for the TechCare App to increase access to digital technologies, providing service users with an alternative medium to communicate with EIS health professionals. However, the participants felt that despite mHealth Apps being a useful platform to deliver interventions, face-to-face contact should remain an important aspect of routine care

The epidemiology of common mental disorders in Libya: a systematic review

Abstract: Introduction: There has been a global increase in the prevalence of common mental disorders (CMD), particularly in conflict hotspots. The limited amount of resources is one of the key barriers to effective treatment within Low- and Middle-income countries (LAMICs). The lack of service provision for mental health disorders in LAMICs has resulted in limited opportunities to conduct mental health research. Libya is a North African country that has suffered from ongoing conflict with the current political unrest in Libya further impacting the mental health of the population. Main text: The aim of this review is to conduct a synthesis of evidence regarding the estimated prevalence and associated risk factors of CMD in Libya. A search was completed in the academic databases; PubMed, Medline, EMBASE, PsychINFO, CINHAL, and the Institute for Development, Research, Advocacy and Applied Care (IDRAAC) from inception to March 2020. Only studies that investigated prevalence and associated risk factors of CMD in Libya were included. A total of 219 studies were identified of which 15 met the inclusion criteria for the review. There were (n = 3) papers investigated the prevalence of depression, (n = 4) studies were focused on stress-related disorders and the remaining papers looked at both anxiety and depression. Statistically, sample sizes of the included studies ranged from (n = 41–13,031) for the prevalence studies (mean = 1188.6, median = 233). Conclusion: The status of Libya as a conflict hotspot has led to a reduced level of epidemiological data on mental health, with a vital need to conduct research in CMD. Libya requires better clinical governance which can allow for more scientific research into CMD and enabling the Libyan government to develop evidence-based policy initiatives for CMD