背景:数字方法可能有助于增强护理以解决未满足的心理健康需求,特别是精神分裂症和严重精神疾病(SMI)。
目的:召集了一个国际多学科小组,就收集数据方面的挑战和潜在解决方案达成共识,提供治疗,以及精神分裂症和SMI数字心理健康方法的伦理挑战。
方法:使用共识发展小组方法,与两个小组的面对面会议:专家组和小组。成员资格是多学科的,包括有经验的人,在所有阶段平等参与,共同制作共识产出和总结。会议前分享了相关文献,并完成了有关精神分裂症和精神病的数字心理健康干预措施的最新文献的系统搜索,以确保在与专家组开会之前向专家组通报信息。
结果:确定了四个广泛的挑战和建议的解决方案:(1)用户参与真正的联合生产;(2)数字心理健康方法的新方法,包括商定的标准,数据共享,测量危害,预防策略,和机械研究;(3)监管和资金问题;和(4)在现实环境中的实施(包括多学科合作,培训,扩大现有服务供应,以及以社会和人口为中心的方法)。示例提供了以人为中心的研究设计的更多细节,生活经验视角,以及SMI数字心理健康方法中的生物医学伦理学。
结论:该小组就一些建议达成共识:(1)一种新的和改进的数字心理健康研究方法(具有商定的报告标准,数据共享,和共享协议),(2)同等重视社会和人口研究以及生物学和心理学方法,(3)跨不同学科的有意义的合作,这些学科以前没有紧密合作,(4)在整个发展道路上,通过规划和新的资金结构,增加对商业模式和产品的关注,(5)增加对道德问题和潜在危害的关注和报告,和(6)组织变革,以允许与具有SMI生活经验的人进行真正的沟通和合作。这种研究方法,将国际专家会议与患者和公众的参与以及整个过程相结合,共识方法论,讨论,出版,是在快速发展的领域中确定未来研究和临床实施方向的有用方法,并且可以与随时间推移的现实世界临床影响的测量相结合。类似的举措将有助于数字心理健康的其他领域以及类似的快速发展领域,以专注于研究和组织变革,并改善现实世界的临床实施。
BACKGROUND: Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI).
OBJECTIVE: An international multidisciplinary group was convened to reach a
consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI.
METHODS: The
consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the
consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group.
RESULTS: Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical
ethics in digital mental health approaches for SMI.
CONCLUSIONS: The group agreed by
consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation.