A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study.

BACKGROUND: Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic. OBJECTIVE: This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps. METHODS: Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys. RESULTS: Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03), assessment of a patient's digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed "somewhat comfortable" on any of the above measures. CONCLUSIONS: Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum.

Government political structure and violent death rates: A longitudinal analysis of forty-three countries, 1960-2008.

OBJECTIVES: Currently, little is known regarding the effect of regime type on mortality on a global level. The purpose of this study is to examine the effect of regime type on the rates of violent deaths (homicide, suicide, and combined rates). METHODS: Three measures of democracy were used to quantify regime type, the independent variable. Homicide and suicide rates were obtained from the World Health Organization. Multivariate conditional fixed-effects models were run to examine associations between regime characteristics and logged rates of homicide, suicide, and violent deaths. Models were adjusted for unemployment and economic inequality. RESULTS: Nations that scored higher on democracy indices, especially emerging democracies, experienced increased mortality due to violence. Homicide and suicide were divergent, showing a different time course and decreasing statistical power as a combined variable. Unemployment and inequality were associated with higher violence-related mortality. CONCLUSIONS: Homicide and suicide appear to be more prevalent in democracies. Future analyses should examine which aspects of democracies lead to higher rates of violent death and should seek to use independently collected mortality data.

A case for studying country regimes in the public health model of violence.

Many national and international institutions advocate approaching violence as a problem in public health and preventive medicine, in a manner similar to the way we address other disabling and life-threatening pathologies such as cancer, diabetes, and heart disease. Prevention by a health model requires an ecological perspective. Previous work has found evidence that economic factors, including unemployment and relative poverty, as well as political culture and values, may affect violent death rates, including homicide and suicide. Nevertheless, wider political analyses of the effects that different regimes have on these variables have been notably absent, for understandable reasons given the sheer complexity of patterns of governance throughout the world. In view of the importance and scale of the problem, and implications of the United Nations' 2030 Agenda for Sustainable Development, we feel it is nevertheless important to bring regime types into the conversation of factors that can influence violent death.

Preventing gender-based violence engendered by conflict: The case of Côte d'Ivoire.

Despite a growing awareness of the increased prevalence of intimate partner violence and sexual violence in conflict and post-conflict settings, much less is known about the dynamics, as well as the interventions that would be effective at individual, relational, and structural levels. In addition to the human capital lost by conflict violence, gender-based violence (GBV) poses a grave threat to the post-conflict rehabilitation process. With regard to violence that occurs during and post conflict, research must take into consideration the different types of violence that share similar causes as the larger conflict as well as become widespread as a result of the conflict and use existing frameworks to build future interventions. Researchers are trying to understand the interplay of personal, situational, and socio-cultural factors in conflict settings that combine to cause GBV and lead to guidelines for program planning to address the health and social needs of survivors as well as to prevent further GBV. These actions result from a growing recognition that violence represents a serious public health problem, is an important cause of many physical and psychological illnesses, and can cause social disruptions that impede reconstruction efforts for generations. This review studies the manifestations of GBV during and following the Ivoirian Civil War, juxtaposes them against narratives, as well as lists relevant interventions at the individual, relational, community, and institutional levels. Part of a growing literature that aims to better understand the nature of violence during and after conflict and to plan effective responses to it, this study hopes to suggest solutions for the situation of Côte d'Ivoire and elsewhere.

Economic correlates of violent death rates in forty countries, 1962-2008: A cross-typological analysis.

OBJECTIVES: Our goal was to identify if there might be advantages to combining two major public health concerns, i.e., homicides and suicides, in an analysis with well-established macro-level economic determinants, i.e., unemployment and inequality. METHODS: Mortality data, unemployment statistics, and inequality measures were obtained for 40 countries for the years 1962-2008. Rates of combined homicide and suicide, ratio of suicide to combined violent death, and ratio between homicide and suicide were graphed and analyzed. A fixed effects regression model was then performed for unemployment rates and Gini coefficients on homicide, suicide, and combined death rates. RESULTS: For a majority of nation states, suicide comprised a substantial proportion (mean 75.51%; range 0-99%) of the combined rate of homicide and suicide. When combined, a small but significant relationship emerged between logged Gini coefficient and combined death rates (0.0066, p < 0.05), suggesting that the combined rate improves the ability to detect a significant relationship when compared to either rate measurement alone. Results were duplicated by age group, whereby combining death rates into a single measure improved statistical power, provided that the association was strong. CONCLUSIONS: Violent deaths, when combined, were associated with an increase in unemployment and an increase in Gini coefficient, creating a more robust variable. As the effects of macro-level factors (e.g., social and economic policies) on violent death rates in a population are shown to be more significant than those of micro-level influences (e.g., individual characteristics), these associations may be useful to discover. An expansion of socioeconomic variables and the inclusion of other forms of violence in future research could help elucidate long-term trends.