Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands.
Clinical, Neuro and Developmental Psychology, and WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands.
Behav Res Ther. 2022 Dec;159:104226. doi: 10.1016/j.brat.2022.104226. Epub 2022 Nov 11.
Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.
减轻 COVID-19 对精神卫生保健服务的干扰在精神障碍增加的时期至关重要。已经对大流行期间实施基于技术的精神卫生保健的过程进行了许多审查。本综述的研究问题是检查 COVID-19 对精神卫生服务的获取和提供有何影响,以及大流行期间精神卫生服务发生了哪些变化。截至 2022 年 8 月 12 日,系统地搜索了系统评价和荟萃分析,并确定了 38 项系统评价。COVID-19 期间的主要干扰是减少了门诊精神卫生保健的机会,减少了住院患者的入院和提前出院。作为回应,使用同步远程医疗工具(如视频会议)提供类似于 COVID-19 前的远程护理,并且在较小程度上使用异步虚拟精神卫生工具(如应用程序)。在大流行期间,同步工具的实施效率更高,灵活性更大,但某些弱势群体的获取机会有限。从业者和患者使用数字精神卫生工具的主要障碍是技术素养较差,特别是在已经存在不平等的情况下,以及对治疗联盟减少的信念,特别是在严重精神障碍的情况下。由于 IT 基础设施不足、缺乏资金以及缺乏隐私和安全,组织对数字精神卫生干预技术实施的支持不足,这给大流行期间的实施带来了挑战。这些综述的质量较低至中等,涵盖了设计各异的原始研究,并且缺乏在中低收入国家实施的结果。这些证据差距在大流行早期进行的研究中尤为明显。本综述表明,在 COVID-19 大流行期间,从业者和精神卫生保健机构主要使用同步远程医疗工具,并且在较小程度上使用异步工具,以使患者能够继续获得精神卫生保健。已经确定了这些工具的许多障碍,并呼吁进一步改进。此外,更多关于比较有效性和工作机制的高质量研究可能会提高一般精神卫生保健的可扩展性,并在未来的传染病爆发中提高可扩展性。
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