Changes in telepsychiatry regulations during the COVID-19 pandemic: 17 countries and regions' approaches to an evolving healthcare landscape

Kinoshita, Shotaro; Cortright, Kelley; Crawford, Allison; Mizuno, Yuya; Yoshida, Kazunari; Hilty, Donald M.; Guinart, Daniel; Torous, John; Correll, Christoph U.; Castle, David; Rocha, Deyvis; Yang, Yuan; Xiang, Yu Tao; Kølbæk, Pernille; Dines, David E.; Elshami, Mohammad; Jain, Prakhar; Kallivayalil, Roy Abraham; Solmi, Marco; Favaro, Angela; Veronese, Nicola; Seedat, Soraya; Shin, Sang-Ho; Pablo, Gonzalo Salazar de; Chang, Cheng-Yen; Su, Kuan‐Pin; Karaş, Hakan; Kane, John M.; Yellowlees, Peter Mackinlay; Kishimoto, Toshifumi

doi:10.1017/s0033291720004584

Cited by 95 publications

(91 citation statements)

References 27 publications

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“…Furthermore, positive attitudes toward the use of mHealth apps to help alleviate the psychosocial consequences of the pandemic were highly prevalent and associated with an objective need (e.g., more severe levels of psychological distress and higher levels of worrying). There have been also other studies which have reported that individuals have a positive attitude toward, and increasingly use, digital interventions during the current COVID-19 pandemic across the whole spectrum of public mental health provision (i.e., mental health promotion, prevention, and treatment of mental disorders) [36][37][38]49,50], and alterations of telemedicine regulations have been reported [51]. However, mHealth apps provide the opportunity of delivering lowthreshold, personalized mental health care in daily life.…”

Section: Discussionmentioning

confidence: 99%

Social isolation, mental health, and use of digital interventions in youth during the COVID-19 pandemic: a nationally representative survey

Rauschenberg¹,

Schick²,

Goetzl³

et al. 2020

Preprint

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Background: Public health measures to curb SARS-CoV-2 transmission rates may have negative psychosocial consequences in youth. Digital interventions may help to mitigate these effects. We aimed to investigate the associations between social isolation, COVID-19-related worries/anxieties, objective social risk indicators, psychological distress and use of digital mobile health (mHealth) interventions in youth during the COVID-19 pandemic.Methods: Data were collected as part of the “Health And Innovation During COVID-19 Survey” —a cross-sectional panel study including a representative sample of individuals aged 16 to 25 years (N=666; Mage 21·3) (assessment period: 07.05.-16.05.2020). Data were collected on social isolation, COVID-19-related worries/anxieties, objective social risk indicators, psychological distress as well as the current use of and attitude towards digital interventions.Outcomes: Social isolation, lack of company, worrying, and objective social risk indicators were associated with psychological distress during the COVID-19 pandemic. Dose-response relationships were found. For instance, psychological distress was progressively more likely to occur as levels of reported social isolation increased (with reporting ‘never’ as reference group: ‘very rarely’: adjusted odds ratio [aOR] 2·4,CI 1·0 – 5·7, p=0·041; ‘rarely’: aOR 3·6, CI 1·7 – 7·7, p=0·001; ‘occasionally’: aOR 8·4, CI 4·0 – 17·5, p<0·001; ‘often’: aOR 20·6, CI 9·3 – 45·7, p<0·001;’very often’: aOR 43·4, CI 14·7 – 128·2, p<0·001). There was evidence that psychological distress, and high levels of social isolation, lack of company, and worrying were associated with a positive attitude towards using digital interventions, whereas only severe levels of psychological distress and worries were associated with actual use (aOR 2·0, CI 1·3 - 3·0, p=0·001; aOR 1·6, CI 1·1 – 2·2, p=0·005, respectively).Interpretation: Public health measures during pandemics may be associated with social isolation and poor mental health outcomes in youth. Digital interventions may help mitigate the negative psychosocial impact without risk for viral infection given there is an objective need and subjective demand.

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Section: Discussionmentioning

confidence: 99%

Social isolation, mental health, and use of digital interventions in youth during the COVID-19 pandemic: a nationally representative survey

Rauschenberg¹,

Schick²,

Goetzl³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Previous barriers to implementing digital clinics have lessened during COVID-19, creating a more hospitable environment in which to establish this new model of care. Significant changes have occurred in the domains of digital health regulation, payment models, and patient and clinician experience with and acceptance of digital tools [ 7 ]. Prior to COVID-19, various regulations around the world limited the scope of practice of digital health.…”

Section: Motivationsmentioning

confidence: 99%

“…In the USA, regulations limiting prescription of controlled substances and the practice of synchronous telehealth across state lines were relaxed, while in countries such as India, national digital health policies were formed for the first time [ 8 ]. Changes in regulation around payment parity for telehealth services were also announced in many countries, making digital care more financially sustainable [ 7 ]. While these regulatory and payment changes are currently temporary, they will likely endure in some fashion.…”

Section: Motivationsmentioning

confidence: 99%

Digital Clinics and Mobile Technology Implementation for Mental Health Care

Connolly

Kuhn

Possemato

et al. 2021

Curr Psychiatry Rep

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Purpose of Review Interest in digital mental health, especially smartphone apps, has expanded in light of limited access to mental health services and the need for remote care during COVID-19. Digital clinics, in which apps are blended into routine care, offer a potential solution to common implementation challenges including low user engagement and lack of clinical integration of apps. Recent Findings While the number of mental health apps available in commercial marketplaces continues to rise, there are few examples of successful implementation of these apps into care settings. We review one example of a digital clinic created within an academic medical center and another within the Department of Veterans Affairs. We then discuss how implementation science can inform new efforts to effectively integrate mental health technologies across diverse use cases. Summary Integrating mental health apps into care settings is feasible but requires careful attention to multiple domains that will influence implementation success, including characteristics of the innovation (e.g., utility and complexity of the app), the recipients of the technology (e.g., patients and clinicians), and context (e.g., healthcare system buy-in, reimbursement, and regulatory policies). Examples of effective facilitation strategies that can be utilized to improve implementation efforts include co-production of technology involving all end users, specialized trainings for staff and patients, creation of new team members to aid in app usage (e.g., digital navigators), and re-design of clinical workflows.

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“…Relatedly, patients’ general attitudes could influence their perceptions of the reasons for the deterioration of their mental health and the reported reasons may therefore not necessarily reflect the impact of the lockdown per se. For instance, patients who were generally unsatisfied with their psychiatric treatment may have consciously or subconsciously used the survey as an opportunity to voice this opinion and thus have attributed their perceived deterioration to “poorer access to psychiatric treatment.” However, psychiatric care has objectively changed during the pandemic, 34,39-41 and it is concerning that nearly 43% of the respondents who reported an overall worsening of their mental health during lockdown attributed it, at least in part, to reduced access to treatment. Fifth, the findings of the present study may not generalize to other countries and health care settings.…”

Section: Discussionmentioning

confidence: 99%

Mental health of patients with mental illness during the COVID-19 pandemic lockdown: A questionnaire-based survey weighted for attrition

Kølbæk

Jefsen

Speed

et al. 2021

Preprint

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ImportanceIndividuals with pre-existing mental illness may be particularly vulnerable to the negative impact that the coronavirus disease 2019 (COVID-19) pandemic seems to have on mental health. Most prior studies on this topic are limited by non-random sampling, lacking information on non-respondents, and self-reporting of mental illness. In the present study, we aimed to overcome these limitations via random sampling, acquisition of clinical and sociodemographic data on both respondents and non-respondents, and weighting of results informed by attrition.ObjectiveTo assess whether patients with mental illness experienced deterioration in mental health during the nationwide COVID-19 lockdown of Denmark in the Spring of 2020.DesignA cross-sectional, questionnaire-based survey coupled with sociodemographic and clinical data from the medical records of all invitees. The latter enabled analysis of attrition and weighting of results.SettingThe psychiatric services of the Central Denmark Region.ParticipantsA total of 992 randomly drawn patients diagnosed with mental illness in the psychiatric services of the Central Denmark Region prior to the lockdown responded to the online survey (response rate of 21.6%).ExposureThe four-week nationwide lockdown during the COVID-19 pandemic (from March 11 to April 15, 2020).Main Outcomes and MeasuresThe online questionnaire included the 18-item Brief Symptom Inventory (BSI-18), the five-item World Health Organization Well-Being Index (WHO-5), and 14 questions evaluating worsening or improvement in symptoms during the lockdown using the pre-pandemic period as reference. Perceived reasons for deterioration of mental health were also reported.ResultsThe weighted mean WHO-5 and BSI-18 scores were 38 and 28, respectively. A total of 52% of the respondents reported that their mental health had deteriorated during the lockdown, while 33% reported no change, and 16% reported improvement. The most commonly reported reasons for deterioration were loneliness, disruption of routines, concerns about coronavirus, less frequent contact with family/friends, boredom, and reduced access to psychiatric care.Conclusion and RelevanceMore than half of the patients with mental illness reported worsening of their mental health during the pandemic lockdown. There should be increased emphasis on ensuring both social and clinical support for individuals with mental illness during pandemics.KEY POINTSQuestionsDid patients with mental illness experience worsening of their mental health during the nationwide COVID-19 lockdown of Denmark in the Spring of 2020?FindingsOf the 925 respondents, 52% reported that their mental health had deteriorated during the lockdown, while 33% reported no change and 16% reported improvement. The most commonly reported reasons for deterioration were loneliness and disruption of routines.MeaningThese findings suggest that there should be increased emphasis on ensuring both social and clinical support for individuals with mental illness during the ongoing and potential future pandemics.

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Changes in telepsychiatry regulations during the COVID-19 pandemic: 17 countries and regions' approaches to an evolving healthcare landscape

Cited by 95 publications

References 27 publications

Social isolation, mental health, and use of digital interventions in youth during the COVID-19 pandemic: a nationally representative survey

Social isolation, mental health, and use of digital interventions in youth during the COVID-19 pandemic: a nationally representative survey

Digital Clinics and Mobile Technology Implementation for Mental Health Care

Mental health of patients with mental illness during the COVID-19 pandemic lockdown: A questionnaire-based survey weighted for attrition

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