School of Health Policy and Management, York University, Toronto, Ontario, Canada.
North York General Hospital, Toronto, Ontario, Canada.
Asia Pac Psychiatry. 2022 Mar;14(1):e12400. doi: 10.1111/appy.12400. Epub 2020 Jun 30.
Mental health conditions like depression and anxiety are on the rise, but access to care remains a challenge. Immigrants and racialized communities including Chinese Canadians experience high level of access barriers including communication with clinicians. With the aim to facilitate mental health communications, we tested an Interactive Computer-assisted Client Assessment Survey (iCCAS) in Cantonese/Mandarin and English at a nurse practitioner-led primary care clinic in Toronto. The iCCAS offers a touch-screen, pre-consultation survey with questions on depression, anxiety, post-traumatic stress, alcohol abuse, and social context. The program generates point-of-care reports for the clinician and patient.
A pilot randomized controlled trial examined the intervention impact on mental health discussion and symptom detection, compared with the usual care, followed by clinicians' qualitative interviews.
Fifty self-identified Chinese adult patients participated (iCCAS = 26, Usual Care = 24), response rate 79.4%. Participant mean age was 44.8 years and 92% were immigrants. There was an increase of 19% and 15% in the mental health discussion and detection of symptoms in the iCCAS group compared with the usual care. More participants in the iCCAS group were referred to a social worker or psychiatrist. Patients found the use of iCCAS easy and clinicians identified its benefits for themselves (eg, early identification and comfort) and patients (eg, self-awareness and anonymity) and proposed practice-integration.
The studied tool holds promise for enhancing clinician-patient mental health communications in primary care settings for overseas Chinese. Implications are discussed for in-person and virtual healthcare which could also inform responses to mental health crisis related to COVID-19.
抑郁症和焦虑症等心理健康问题呈上升趋势，但获得治疗的机会仍然是一个挑战。包括加拿大华人在内的移民和少数族裔群体在与临床医生沟通方面面临着很高的障碍。为了促进心理健康交流，我们在多伦多一家护士执业主导的初级保健诊所测试了一种广东话/普通话和英语的交互式计算机辅助客户评估调查 (iCCAS)。iCCAS 提供了一个触摸屏、预咨询调查，其中包含有关抑郁、焦虑、创伤后应激、酒精滥用和社会背景的问题。该程序为临床医生和患者生成即时护理报告。
一项试点随机对照试验研究了干预措施对心理健康讨论和症状检测的影响，与常规护理相比，随后对临床医生进行了定性访谈。
50 名自我认同的成年华人患者参与了研究（iCCAS=26，常规护理=24），回应率为 79.4%。参与者的平均年龄为 44.8 岁，92%是移民。与常规护理相比，iCCAS 组的心理健康讨论和症状检测增加了 19%和 15%。更多的 iCCAS 组患者被转介给社会工作者或精神科医生。患者发现使用 iCCAS 很容易，临床医生认为其对自己（例如，早期识别和舒适）和患者（例如，自我意识和匿名性）有好处，并提出了实践整合。
研究工具有可能增强初级保健环境中海外华人临床医生与患者之间的心理健康交流。讨论了对面对面和虚拟医疗保健的影响，这也可能为应对与 COVID-19 相关的心理健康危机提供信息。
