Stigma Towards Depression in Rural Ireland: A Qualitative Exploration.

The configuration of one's social environment influences the course and experience of depression. Research suggests that experiencing depression is associated with stigmatisation and the concomitant experiencing of discrimination across many facets of social life. This is identified as a particularly important factor in rural communities. Contemporary work is absent in relation to understanding the stigma towards depression in Ireland, and its manifestation in rural Ireland specifically. Evidence is presented which suggests that depression is a significant source of stigmatisation in this setting, and that entrenched views centring upon disability and fear are prevalent.

Roadmap for developing a national quality indicator set for general practice.

PURPOSE: The purpose of this paper is to describe a national, comprehensive quality indicator set to support delivering high-quality clinical care in Irish general practice. DESIGN/METHODOLOGY/APPROACH: Potential general practice quality indicators were identified through a literature review. A modified two-stage Delphi process was used to rationalise international indicators into an indicator set, involving both experts from key stakeholder groups (general practitioners (GPs), practice nurses, practice managers, patient and health policy representatives) and predominantly randomly selected GPs. An illustrative evaluation approach was used to road test the indicator set and supporting materials. FINDINGS: In total, 80 panellists completed the two Delphi rounds and staff in 13 volunteer practices participated in the road test. The original 171 indicators was reduced to 147 during the Delphi process and further reduced to 68 indicators during the road test. The indicators were set out in 14 sub-domains across three areas (practice infrastructure, practice processes and procedures, and practice staff). Practice staff planned 77 quality improvement activities after their assessment against the indicators and 31 (40 per cent) were completed with 44 (57 per cent) ongoing and two (3 per cent) not advanced after a six-month road test. A General Practice Indicators of Quality indicator set and support materials were produced at the conclusion. PRACTICAL IMPLICATIONS: It is important and relatively easy to customise existing quality indicators to a particular setting. The development process can be used to raise awareness, build capacity and drive quality improvement activity in general practices. ORIGINALITY/VALUE: The authors describe in detail a method to develop general practice quality indicators for a regional or national population from existing validated indicators using consensus, action research and an illuminative evaluation.

Implementing digital mental health interventions at scale: one-year evaluation of a national digital CBT service in Ireland.

BACKGROUND: In recent years, exponential growth in digital innovations and internet access has provided opportunities to deliver health services at a much greater scale than previously possible. Evidence-based technology-enabled interventions can provide cost-effective, accessible, and resource-efficient solutions for addressing mental health issues. This study evaluated the first year of a supported digital cognitive behavioral therapy (CBT) service provided by the national health service in Ireland, which has been accessible to individuals who receive a referral from one of five referring groups: General Practitioners, Primary Care Psychology, Counselling Primary Care, Community Mental Health, and Jigsaw (a nationwide youth mental health service). METHODS: A retrospective, observational study examining data from the service between April 2021 to April 2022 was conducted. Descriptive statistics on referrals, account activations, user demographics, program usage, and user satisfaction were extracted, and pre-to-post clinical outcomes for depression measured by the Patient Health Questionnaire-9 and for anxiety measured by the Generalised Anxiety Disorder-7 were analysed using linear mixed effect models. RESULTS: There were 5,298 referrals and 3,236 (61%) account activations within the year. Most users were female (72.9%) and aged between 18 and 44 years (75.4%). The CBT programs were associated with significant reductions in both depression (ß = 3.34, 95% CI [3.03, 3.65], p < 0.001) and anxiety (ß = 3.64, 95% CI [3.36, 3.93], p < 0.001), with large effect sizes (Cohen's d > 0.8). Time spent using the programs was also found to be a predictor of the variability in these clinical outcomes (p < 0.001), and accounting for this resulted in significantly better model fits (p < 0.001). User satisfaction ratings were also very high, exceeding 94%. CONCLUSIONS: Efforts to improve the representation of male and older adult users are warranted. However, overall, the results demonstrate how digital CBT can be provided at scale and lead to symptom reductions with large effect sizes for patients seeking help for depression and anxiety. The findings substantiate the continued use and expansion of this service in Ireland and the more widespread implementation of similar services in other international public healthcare settings.

The incubot: A 3D printer-based microscope for long-term live cell imaging within a tissue culture incubator.

Commercial live cell imaging systems represent a large financial burden to research groups, while current open source incubator microscopy systems lack adaptability and are sometimes inadequate for complex imaging experimentation. We present here a low-cost microscope designed for inclusion within a conventional tissue culture incubator. The build is constructed using an entry level 3D printer as the basis for the motion control system, with Raspberry Pi imaging and software integration, allowing for reflected, oblique, and fluorescence imaging of live cell monolayers. The open source nature of the design is aimed to facilitate adaptation by both the community at large and by individual researchers/groups. The development of an adaptable and easy-to-use graphic user interface (GUI) allows for the scientist to be at the core of experimental design through simple modifications of the base GUI code, or generation of an entirely purpose-built script. This adaptability will allow scientists to adapt this equipment for their experimental needs, as opposed to designing experiments to fit their current equipment. The build can be constructed for a cost of roughly €1000 and thus serves as a low-cost and adaptable addition to the open source microscopy community.