Challenges and barriers in mental healthcare systems and their impact on the family: A systematic integrative review

Carbonell, Ángela; Navarro-Pérez, José-Javier; Mestre, Maria-Vicenta

doi:10.1111/hsc.12968

Cited by 87 publications

(49 citation statements)

References 76 publications

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“…We will develop a search strategy in consultation with a medical librarian to identify a comprehensive search of published literature around multi-domain and multi-level barriers and facilitators to the integration of digital technology in mental health systems. We will refer to other systematic reviews in similar areas [ 45 , 46 , 48 ]. The initial search strategy was developed in Medline using three broad concepts: digital health, barriers and facilitators, and mental health systems.…”

Section: Methods and Analysismentioning

confidence: 99%

“…To our knowledge this will be the first qualitative systematic review on the barriers and facilitators to the integration of digital technologies in mental health systems. Previous reviews in this field have focused on: (i) the effectiveness of digital technologies for the treatment of mental health disorders [7][8][9][10][11]; (ii) health or mental health systems' needs, challenges and barriers, without including digital technologies [45,46]; (iii) financial and health resource benefits that digital technologies provide to healthcare settings [14,47]; (iv) barriers and facilitators to the integration of e-services, without a specific focus on mental health settings [48], and (v) the optimisation of technology integration in primary mental health care [49].…”

Section: Rationalementioning

confidence: 99%

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Barriers and facilitators to the integration of digital technologies in mental health systems: A protocol for a qualitative systematic review

et al. 2021

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Introduction Digital technology has the potential to improve health outcomes and health system performance in fragmented and under-funded mental health systems. Despite this potential, the integration of digital technology tools into mental health systems has been relatively poor. This is a protocol for a synthesis of qualitative evidence that will aim to determine the barriers and facilitators to integrating digital technologies in mental health systems and classify them in contextual domains at individual, organisational and system levels. Methods and analysis The methodological framework for systematic review of qualitative evidence described in Lockwood et al. 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, Scopus, PsycInfo, Web of Science and Google Scholar, as well as hand searching of reference lists and reviews will identify relevant studies for inclusion. Study selection will be carried out independently by two authors, with discrepancies resolved by consensus. The quality of selected studies will be assessed using JBI Critical Appraisal Checklist for Qualitative Research. Data will be charted using JBI QUARI Data Extraction Tool for Qualitative Research. Findings will be defined and classified both deductively in a priori conceptual framework and inductively by a thematic analysis. Results will be reported based on the Enhancing transparency in reporting the synthesis of qualitative research. The level of confidence of the findings will be assessed using GRADE-CERQual. Ethics and dissemination This study does not require ethics approval. The systematic review will inform policy and practices around improving the integration of digital technologies into mental health care systems.

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Section: Methods and Analysismentioning

confidence: 99%

Section: Rationalementioning

confidence: 99%

Barriers and facilitators to the integration of digital technologies in mental health systems: A protocol for a qualitative systematic review

et al. 2021

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“…In Pakistan, pre-pandemic rates of anxiety were already higher than in most low-and middle-income countries [18], especially among women during pregnancy and the postnatal period [19]. Coupled with a lack of healthcare services [20] and a large treatment gap for mental illnesses [21], the current pandemic could have a profound impact on the well-being of women during the pre-and postnatal period.…”

Section: Introductionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on Pregnant Women with Perinatal Anxiety Symptoms in Pakistan: A Qualitative Study

Rauf

Zulfiqar

Mumtaz

et al. 2021

IJERPH

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The impact of coronavirus disease 2019 (COVID-19) on people with existing mental health conditions is likely to be high. We explored the consequences of the pandemic on women of lower socioeconomic status with prenatal anxiety symptoms living in urban Rawalpindi, Pakistan. This qualitative study was embedded within an ongoing randomized controlled trial of psychosocial intervention for prenatal anxiety at a public hospital in Rawalpindi. The participants were women with symptoms of anxiety who had received or were receiving the intervention. In total, 27 interviews were conducted; 13 women were in their third trimester of pregnancy, and 14 were in their postnatal period. The data were collected through in-depth interviews and analyzed using framework analysis. Key findings were that during the pandemic, women experienced increased perinatal anxiety that was linked to greater financial problems, uncertainties over availability of appropriate obstetric healthcare, and a lack of trust in health professionals. Women experienced increased levels of fear for their own and their baby’s health and safety, especially due to fear of infection. COVID-19 appears to have contributed to symptoms of anxiety in women already predisposed to anxiety in the prenatal period. Efforts to address women’s heightened anxiety due to the pandemic are likely to have public health benefits.

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“…At least half of the affected people remain untreated [3][4][5] because of many reasons [6][7][8], including low perceived need for treatment and self-reliance [7,8], stigma [9], difficulty accessing specialist care [10], fragmentation of the mental health care system [11], and high costs of treatment [12]. Access to psychiatrists and clinical psychologists is challenging, particularly in low-and middle-income countries [13] and for people of lower socioeconomic status, poorer health, and rural and hard-to-reach communities in high-income economies [14,15]. Since the onset of the COVID-19 pandemic, these inadequacies have been exacerbated by physical isolation, and fear and uncertainty [16,17] led to a sudden increase in mental health concerns [18].…”

Section: Introduction Backgroundmentioning

confidence: 99%

Self-guided Cognitive Behavioral Therapy Apps for Depression: Systematic Assessment of Features, Functionality, and Congruence With Evidence

Martinengo¹,

Stona²,

Griva³

et al. 2021

J Med Internet Res

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Background Mental health disorders affect 1 in 10 people globally, of whom approximately 300 million are affected by depression. At least half of the people affected by depression remain untreated. Although cognitive behavioral therapy (CBT) is an effective treatment, access to mental health specialists, habitually challenging, has worsened because of the COVID-19 pandemic. Internet-based CBT is an effective and feasible strategy to increase access to treatment for people with depression. Mental health apps may further assist in facilitating self-management for people affected by depression; however, accessing the correct app may be cumbersome given the large number and wide variety of apps offered by public app marketplaces. Objective This study aims to systematically assess the features, functionality, data security, and congruence with evidence of self-guided CBT-based apps targeting users affected by depression that are available in major app stores. Methods We conducted a systematic assessment of self-guided CBT-based apps available in Google Play and the Apple App Store. Apps launched or updated since August 2018 were identified through a systematic search in the 42matters database using CBT-related terms. Apps meeting the inclusion criteria were downloaded and assessed using a Samsung Galaxy J7 Pro (Android 9) and iPhone 7 (iOS 13.3.1). Apps were appraised using a 182-question checklist developed by the research team, assessing their general characteristics, technical aspects and quality assurance, and CBT-related features, including 6 evidence-based CBT techniques (ie, psychoeducation, behavioral activation, cognitive restructuring, problem solving, relaxation, and exposure for comorbid anxiety) as informed by a CBT manual, CBT competence framework, and a literature review of internet-based CBT clinical trial protocols. The results were reported as a narrative review using descriptive statistics. Results The initial search yielded 3006 apps, of which 98 met the inclusion criteria and were systematically assessed. There were 20 well-being apps; 65 mental health apps, targeting two or more common mental health disorders, including depression; and 13 depression apps. A total of 28 apps offered at least four evidence-based CBT techniques, particularly depression apps. Cognitive restructuring was the most common technique, offered by 79% (77/98) of the apps. Only one-third of the apps offered suicide risk management resources, whereas 17% (17/98) of the apps offered COVID-19–related information. Although most apps included a privacy policy, only a third of the apps presented it before account creation. In total, 82% (74/90) of privacy policies stated sharing data with third-party service providers. Half of the app development teams included academic institutions or health care providers. Conclusions Only a few self-guided CBT-based apps offer comprehensive CBT programs or suicide risk management resources. Sharing of users’ data is widespread, highlighting shortcomings in health app market governance. To fulfill their potential, self-guided CBT-based apps should follow evidence-based clinical guidelines, be patient centered, and enhance users’ data security.

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Challenges and barriers in mental healthcare systems and their impact on the family: A systematic integrative review

Cited by 87 publications

References 76 publications

Barriers and facilitators to the integration of digital technologies in mental health systems: A protocol for a qualitative systematic review

Barriers and facilitators to the integration of digital technologies in mental health systems: A protocol for a qualitative systematic review

The Impact of the COVID-19 Pandemic on Pregnant Women with Perinatal Anxiety Symptoms in Pakistan: A Qualitative Study

Self-guided Cognitive Behavioral Therapy Apps for Depression: Systematic Assessment of Features, Functionality, and Congruence With Evidence

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