Tag: app

Reading of the Week: An Exercise App for Burnout – the New JAMA Psych Paper; Also, Pandemic Mental Health Use and Szalavitz on Portugal

From the Editor

A recent CMA survey found that more than half of physicians report high levels of burnout; surveys of other health care disciplines show a similar result. Not surprisingly, burnout is much discussed. What can be done for health care workers?

In the first selection, Vincent Gosselin Boucher (of the University of British Columbia) and his co-authors consider that question, offering an app-based intervention featuring exercises that can be done at home. The resulting study, just published in JAMA Psychiatry, included 288 health care workers in an RCT. “[A] 12-week app-based exercise intervention yielded significant reductions in depressive symptoms among HCWs that became more pronounced as time progressed.” We review the paper and its implications.

In the second selection, Jonathan H. Cantor (of the RAND Corporation) and his co-authors look at mental health utilization and spending before and during the pandemic, drawing on almost 1.6 million mental health insurance claims in the US. “[U]tilization and spending rates for mental health care services among commercially insured adults increased by 38.8% and 53.7%, respectively, between 2019 and 2022.” 

Finally, in the third selection, author Maia Szalavitz writes about the decriminalization of low-level drug crimes in Portugal. In a New York Times essay, she argues that critics don’t understand what Portugal accomplished – and, in contrast, how many Americans go untreated in correctional facilities. She concludes: “Shifting priorities and funding to provide high-quality treatment and other supports for recovery like housing takes time. Our failure is a century of criminalization – not much-needed attempts to end it.”


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Reading of the Week: Health Care Workers’ Mental Health – There’s an App for That; Also, Treating Opioids (BMJ) & Dr. Bhushan on Her Bipolar (LA Times)

From the Editor

With the pandemic dragging on, health care workers report more and more burnout; some complain of depression and anxiety.

What could help? Dr. Sam N. Gnanapragasam (of King’s College London) and his co-authors consider an app designed to provide CBT and mindfulness techniques in a new British Journal of Psychiatry paper. The RCT study involves 16 English sites with over 1000 health care workers. They conclude: “our study suggests that the app was of modest benefit with no adverse effects for a sample of HCWs in England.” We look at the paper.

How to respond to the opioid crisis? In a new analysis paper for BMJ, Dr. Robert A. Kleinman (of the University of Toronto) and his colleagues argue for a different approach to the prescribing of opioid agonist therapy, drawing on the changes made in response to the pandemic. “Embracing a more flexible model of buprenorphine-naloxone dosing would allow better alignment of prescribing practices with the needs and preferences of clients.”

And in the third selection, Dr. Devika Bhushan writes about bipolar disorder for the Los Angeles Times. The essay is very personal: the pediatrician, who serves as California’s acting surgeon general and graduated from Harvard, describes her own experiences. As she notes, during her training, she “had a secret.” Now, however, she speaks openly about her illness. “Today, I live with bipolar disorder as a chronic and manageable health condition.” 


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Reading of the Week: Apps for the Treatment of Depression (JAMA Psych)? Also, Cannabis & Driving (CJP); Oleynikova on Returning to School (Globe)

From the Editor

The world changed on March 11, the day that the pandemic was declared by the WHO. So did mental health care, with so many of our services becoming virtually delivered. But what’s effective and what should be incorporated into care moving forward?

This week, we have three selections.

The first is a new JAMA Psychiatry paper. With COVID-19, apps are becoming increasingly popular (one therapy app reports a 65% increase in clients over the spring). Can the apps be incorporated into primary care? Andrea K. Graham (of Northwestern University) and her co-authors do a RCT using apps for patients with depression and anxiety. They conclude: “In this trial, a mobile intervention app was effective for depression and anxiety among primary care patients.” But should we be so enthusiastic? And how could apps be used in care?


Canada legalized cannabis for non-medical purposes in 2018. In a short research letter – our second selection – medical student Laura A. Rivera and Dr. Scott B. Patten (both of the University of Calgary) consider driving under the influence of cannabis, drawing on national survey data. “Public policy actions toward prevention of DUIC [driving under the influence of cannabis] appear necessary and will have the greatest impact if they are effective in the 15 to 24 age range and in males.”

Finally, in the third selection, we consider an essay from The Globe and Mail. Like many, Vera Oleynikova thinks about the return to school. She writes about her own experiences, noting a complication: she has struggled with depression. “To be sick for a long time and then to feel well again is a magical thing. You feel brand new and capable of anything. You marvel at your own capacity to do the things that for a long time were unavailable to you because of your illness. Which is why going back to school at 31 felt so right.”


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Reading of the Week: Depression Outcomes: What Matters to Patients (Lancet Psych)? Also, NYT on Mental Health Apps and Startup Culture

From the Editor

“US Food and Drug Administration accepts only three outcome measures as primary endpoints in phase 3 studies to support an indication for major depressive disorder: the Hamilton Depression Rating Scale, the Montgomery-Åsberg Depression Rating Scale, or the Children’s Depression Rating Scale.”

The editors of The Lancet Psychiatry make this point in in the August issue of that journal. Their concern: the FDA view is very narrow and confined to these three scales.

In the first selection, we look at a new paper from The Lancet Psychiatry. Dr. Astrid Chevance (of the Center for Epidemiology and Statistics Paris Sorbonne) and her co-authors consider depression outcomes. To understand different perspectives, they draw on three groups: providers, patients, and caregivers. For the record, the resulting paper is fascinating and includes outcome measures that aren’t captured by these three scales. We consider the paper and the editorial that runs with it.


In the second selection – also on the topic of depression – Kashmir Hill and Aaron Krolik report for The New York Times on a popular therapy app. They note that Talkspace has good marketing and a growing client base. But should you recommend the app to your patients?


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Reading of the Week: Insomnia and Its Treatment

Cognitive behavioral therapy for insomnia (CBT-I) is a multicomponent treatment package that usually includes stimulus control, sleep restriction, and cognitive therapy and has emerged as the most prominent nonpharmacologic treatment for chronic insomnia. Previous meta-analyses have found that CBT-I improves sleep parameters and sleep quality at post treatment and follow-up for adults and older adults. Most of these studies selected individuals with primary insomnia, excluding patients with co-morbid psychiatric and medical conditions. However, patients with insomnia who present to internists and primary care physicians are likely to report comorbid conditions associated with the sleep disturbance. Furthermore, insomnia was previously conceptualized as a symptom arising from the comorbid disorder and treatment was targeted at the underlying disorder. However, accumulating evidence indicates that insomnia can have a distinct and independent trajectory from the comorbid disorder, thus indicating a need for separate treatment from the comorbid condition.

So begins this week’s Reading, which considers CBT-I for people with insomnia. Here’s a quick summary: big study, big journal – and big relevance to your patients.

This week’s Reading: “Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis” by Jade Q. Wu et al. was just published in JAMA Internal Medicine. Find the paper here.


Wu et al. consider a very common problem: insomnia. Many patients – whether they have mental health issues or physical health issues – struggle with insomnia. Boston University health economist Austin Frakt has written about his insomnia for The New York Times. He notes that he decided to receive treatment when:

One weekend afternoon a couple of years ago, while turning a page of the book I was reading to my daughters, I fell asleep. Continue reading