Exploring the Impact of Education Strategies on Individuals' Attitude Towards Telemental Health Service: Findings from a Survey Experiment Study.

While COVID-19 has caused significant mental health consequences, telemental health services have the potential to mitigate this problem. But due to the sensitive nature of mental health issues, such services are seriously underutilized. Based on an integrated variance-process theoretical framework, this study examines the impact of applying different education strategies on individuals' attitude toward telemental health and subsequently their intention to adopt telemental health. Two different education videos on telemental health (peer- or professional-narrated) were developed based on social identity theory. A survey experiment study was conducted at a major historically black university, with 282 student participants randomly assigned to the two education videos. Individual perceptions of the telemental health service (usefulness, ease of use, subjective norms, relative advantage, trust, and stigma) and their attitude and usage intention data were collected. The results show that ease of use, subjective norms, trust, relative advantage, and stigma significantly influence individuals' attitude toward telemental health in the peer-narrated video group. Only trust and relative advantage were found to be significant factors toward attitude in the professional-narrated video group. This study highlights the importance of designing education strategies and builds a theoretical foundation for understanding the nuanced differences in individuals' responsiveness to different educational materials.

Investigating the Impact of Covid-19 on Telepsychiatry Use Across Sex and Race: A Study of North Carolina Emergency Departments.

Introduction: The COVID-19 pandemic and the intervention measures have increased mental health problems among Americans. Telepsychiatry provides a safe and efficient way to serve mental health patients in emergency departments (EDs). The objective of this study is to evaluate the impact of COVID-19 on telepsychiatry consultations in North Carolina (NC) and analyze the differences across sex and race. Methods: This longitudinal observational study used data from the NC Statewide Telepsychiatry Program to examine temporal changes in ED telepsychiatry consultations from January 2019 to March 2021 (117 weeks), including 4,739 telepsychiatry consultations conducted by 27 hospitals in 24 counties in NC during the period. The outcome measures were telepsychiatry consultation counts. Weekly ED telepsychiatry consultation counts were calculated overall and stratified by sex and race. Results: The overall weekly ED telepsychiatry consultation counts were decreasing before the national lockdown but started increase after the lockdown. Moreover, the counts of telepsychiatry consultations for white patients had a stronger increasing trend than that for black patients. Comparing telepsychiatry counts during the lockdown period (March and April) in 2020 and the same period in 2019, male patients had higher counts while female patients had lower counts, and white patients had higher counts while black patients had lower counts. Discussion: It seems that the COVID-19 crisis has led to a heightening demand for telepsychiatry consultations in NC, and there is a possible race disparity in these demands between black and white mental health patients. These findings underscore the need to further develop telepsychiatry services and enhance access to black patients.

Study of Impact of Telehealth Use on Clinic "No Show" Rates at an Academic Practice.

OBJECTIVE: To examine the clinic no-show rate across different modalities of care delivery (Face to Face, Telephone visits and Audio-Video visits). METHODS: Clinic no show data for adult patients was extracted from the electronic health records used by the psychiatry clinic for 10 months before pandemic and 10 months during pandemic. No show rate was analyzed by visits type (new vs return) and across different modalities (face-to-face vs Telephone vs Audio-Video) before and during COVID pandemic. RESULTS: There were 13,916 scheduled visits during the 10-month period before the pandemic of which 2,522 were no show. There were 13,251 scheduled visits during the 10-month period during the COVID pandemic of which 2,029 were no show. The overall clinic no show rate decreased from pre pandemic to pandemic period (18.1% vs 15.3%) after transitioning to telehealth. Across different modalities during the pandemic, the no-show rate for Telephone visits was significantly lower than for face- to-face visits. No difference was identified for no-show rates between face-to-face visits and audio-video visits during the pandemic. The no-show rate for face-to-face visits before the pandemic compared to during the pandemic also showed no difference. CONCLUSION: Using technology in health care delivery can decrease the clinic no show rate. Digital literacy for patients and providers is critical for successful utilization of telehealth.

Bright Light Therapy as Augmentation of Pharmacotherapy for Treatment of Depression: A Systematic Review and Meta-Analysis.

BACKGROUND: Bright light therapy has demonstrated efficacy and is an accepted treatment for seasonal depression. It has been suggested that bright light therapy may have efficacy in nonseasonal depressions. Also, there is evidence that bright light therapy may improve responsiveness to antidepressant pharmacotherapy. DATA SOURCES: We searched PubMed/MEDLINE, PsycINFO, PsycARTICLES, CINAHL, EMBASE, Scopus, and Academic OneFile for English-language literature published between January 1998 and April 2016, using the keywords bright light therapy AND major depression, bright light therapy AND depress*, bright light therapy AND bipolar depression, bright light therapy AND affective disorders, circadian rhythm AND major depression, circadian rhythm AND depress*, and circadian rhythm AND affective disorder. STUDY SELECTION AND DATA EXTRACTION: Studies that reported randomized trials comparing antidepressant pharmacotherapy with bright light therapy ≥ 5,000 lux for ≥ 30 minutes to antidepressant pharmacotherapy without bright light therapy for the treatment of nonseasonal depression were included. Studies of seasonal depression were excluded. Following review of the initial 112 returns, 2 of the authors independently judged each trial, applying the inclusionary and exclusionary criteria. Ten studies were selected as meeting these criteria. Subjects in these studies were pooled using standard techniques of meta-analysis. RESULTS: Ten studies involving 458 patients showed improvement using bright light therapy augmentation versus antidepressant pharmacotherapy alone. The effect size was similar to that of other accepted augmentation strategies, roughly 0.5. CONCLUSIONS: Analysis of pooled data from randomized trials provides evidence for the efficacy of use of bright light therapy ≥ 5,000 lux for periods ≥ 30 minutes when used as augmentation to standard antidepressant pharmacotherapy in the treatment of major depressive disorder and bipolar depression without a seasonal pattern.

The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2003 update.

BACKGROUND: The Texas Medication Algorithm Project (TMAP) has been a public-academic collaboration in which guidelines for medication treatment of schizophrenia, bipolar disorder, and major depressive disorder were used in selected public outpatient clinics in Texas. Subsequently, these algorithms were implemented throughout Texas and are being used in other states. Guidelines require updating when significant new evidence emerges; the antipsychotic algorithm for schizophrenia was last updated in 1999. This article reports the recommendations developed in 2002 and 2003 by a group of experts, clinicians, and administrators. METHOD: A conference in January 2002 began the update process. Before the conference, experts in the pharmacologic treatment of schizophrenia, clinicians, and administrators reviewed literature topics and prepared presentations. Topics included ziprasidone's inclusion in the algorithm, the number of antipsychotics tried before clozapine, and the role of first generation antipsychotics. Data were rated according to Agency for Healthcare Research and Quality criteria. After discussing the presentations, conference attendees arrived at consensus recommendations. Consideration of aripiprazole's inclusion was subsequently handled by electronic communications. RESULTS: The antipsychotic algorithm for schizophrenia was updated to include ziprasidone and aripiprazole among the first-line agents. Relative to the prior algorithm, the number of stages before clozapine was reduced. First generation antipsychotics were included but not as first-line choices. For patients refusing or not responding to clozapine and clozapine augmentation, preference was given to trying monotherapy with another antipsychotic before resorting to antipsychotic combinations. CONCLUSION: Consensus on algorithm revisions was achieved, but only further well-controlled research will answer many key questions about sequence and type of medication treatments of schizophrenia.