Opportunities and Challenges for Digital Social Prescribing in Mental Health: Questionnaire Study.

BACKGROUND: The concept of digital social prescription usually refers to social prescriptions that are facilitated by using technology. Tools that enable such digital social prescriptions may be beneficial in recommending nonmedical activities to people with mental illness. As these tools are still somewhat novel and emerging, little is known about their potential advantages and disadvantages. OBJECTIVE: The objective of this study is to identify the potential opportunities and challenges that may arise from digital social prescriptions. METHODS: We developed a qualitative questionnaire that was disseminated through social media (Facebook and Twitter). A purposive sample targeting digital mental health experts and nonexperts was approached. The questionnaire asked participants' views about digital social prescription; the core elements linked with a definition of digital social prescription; and the strengths, weaknesses, opportunities, and threats associated with digital social prescription. RESULTS: Four core elements were recommended to define the concept of digital social prescription: digital, facilitate, user, and social. The main strength identified was the possibility to rapidly start using digital social prescription tools, which were perceived as cost-effective. The main weaknesses were their poor adherence and difficulties with using such tools. The main opportunities were an increased access to social prescription services and the prevention of serious mental illness. The main threats were certain groups being disadvantaged, patients being subject to unintended negative consequences, and issues relating to confidentiality and data protection. CONCLUSIONS: Although digital social prescriptions may be able to effectively augment the social prescriptions, a careful consideration of practical challenges and data ethics is imperative in the design and implementation of such technologies.

Correction: Opportunities and Challenges for Digital Social Prescribing in Mental Health: Questionnaire Study.

[This corrects the article DOI: .].

Reboxetine: a preliminary report on its use through the Special Access Program.

OBJECTIVE: To describe the effectiveness and tolerability of reboxetine under Special Access Program conditions in Canada in a group of patients with refractory depressive disorders. DESIGN: Retrospective open-label study. SETTING: Six clinical academic settings in Canada, primarily tertiary institutional settings. PATIENTS: Twenty-six female and 19 male outpatients with depressive disorders, primarily unipolar depression. Most of the patients were treatment resistant. INTERVENTION: Reboxetine through the Special Access Program. OUTCOME MEASURE: Severity of depression before treatment with reboxetine was retrospectively assessed with the Clinical Global Impression (CGI) Global Severity Scale; change with treatment was evaluated with the CGI Global Improvement Scale. RESULTS: Before reboxetine treatment, 20 (44%) patients scored in the moderate CGI severity category, 11 (24%) in the marked category and 12 (27%) in the severe category. The dose range for reboxetine was 2-16 mg, with 40 (89%) patients in the 4-10 mg range. With reboxetine treatment, 25 (56%) patients were considered "very much improved" or "much improved"; 8 (18%) patients were "minimally improved"; 7 (16%) received ratings that reflected "no change" or minimal worsening, and 5 (11%) were rated as "much worse" or "very much worse." CONCLUSIONS: Reboxetine was effective at a clinically meaningful level in decreasing severity of depression in 56% of patients. Given the high rate of prior resistance to other antidepressant therapies, there is a definite role for this agent in the treatment of depressive disorders.