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      Proposing a standardized, step-by-step model for creating post-traumatic stress disorder (PTSD) related mobile mental health apps in a framework based on technical and medical norms Translated title: Propuesta de un modelo estandarizado, etapificado para crear aplicaciones móviles de salud mental relacionadas con Trastorno de Estrés Postraumático (TEPT) en un marco basado en normas técnicas y medicas Translated title: Propuesta de un modelo estandarizado, etapificado para crear aplicaciones móviles de salud mental relacionadas con Trastorno de Estrés Postraumático (TEPT) en un marco basado en normas técnicas y medicas

      research-article
      , ,
      European Journal of Psychotraumatology
      Taylor & Francis
      PTSD, mobile mental health, mHealth, mMHealth, medical device, mobile app, trauma, IEC norm, user-centered-design, TEPT, salud mental movil, mHealth, aparato médico, aplicación móvil, trauma, norma IEC, diseño centrado en el usuario, 创伤后应激障碍, 移动心理健康, mHeahlth, mMHealth, 医疗装置, 移动应用, 创伤, IEC规范, 以用户为中心的设计, • Coping with post-traumatic stress disorder (PTSD) can be flanked by mental health apps. Unfortunately, the quality of design and evaluation of these apps is somewhat lacking.• A step-by-step model for the creation of such apps is proposed.• Emphasis is put on conforming to medical and technical norms, replicable methods of evaluation and standardizing the design process.• This would make apps more testable and comparable, enabling caregivers to make certified recommendations for their use.

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          ABSTRACT

          Background: Prevalence of post-traumatic stress disorder (PTSD) is a problem all over the world. There are high barriers for entry into formal psychotherapy, which results in a lack of mental health care for a significant part of the population. Mobile mental Health (mMHealth) applications (apps) seem to be a promising new development for countering this lack of care, building on the success of mHealth (Mobile Health) apps in general. Unfortunately, the overall quality of such apps stands in high contrast to their number. The aim of this manuscript is to propose a standard for creating PTSD-related mMHealth apps incorporating a process for evaluation and assessment of their usability and impact.

          Methods: This is done by first defining each step of the process and its relation to the other steps. The steps themselves, divided into those concerned with development, evaluation and implementation, are bound to the established medical and technical norms pertaining to them. Existing protocols from recent literature have been integrated into these steps.

          Results: As a result, a comprehensive model covering the process of creating, assessing and implementing an mMHealth app from start to finish was developed. The model may be adapted to other disorders or specialized for certain symptoms of PTSD.

          Conclusion: Adopting such a model could result in a ‘blueprint’ for creating mMHealth apps in a standardized way, thereby facilitating the testing and comparing of such apps.

          Antecedentes: La prevalencia del Trastorno de Estrés Postraumatico (TEPT) es un problema en todo el mundo. Existen altas barreras para ingresar a psicoterapia formal, lo cual resulta en falta de atención de salud mental para una parte significativa de la población. Las aplicaciones (apps) móviles de salud mental (mMHealth) parecen un desarrollo nuevo y prometedor para contrarrestar esta carencia de cuidado, basado en el éxito general de las aplicaciones mHealth. Desafortunadamente, la calidad general de estas aplicaciones contrasta con su número. El objetivo de este manuscrito es proponer un estándar para crear aplicaciones mMHealth relacionadas con TEPT que incorporen un proceso para la evaluación y valoración de su utilidad e impacto.

          Método: Se hizo definiendo primero cada paso del proceso y su relación con los otros pasos. Los pasos en sí, divididos en aquellos concernientes con el desarrollo, evaluación e implementación, están sujetos a las normas médicas y técnicas establecidas pertinentes. Los protocolos existentes en la literatura reciente se han integrado en estos pasos.

          Resultados: Como resultado se desarrolló un modelo integral que cubre el proceso de creación, evaluación e implementación de una aplicación mMHealth desde el comienzo hasta el final. El modelo podría ser adaptado a otros trastornos o especializado para ciertos síntomas de TEPT.

          Conclusiones: La adopción de este modelo podría resultar en un ‘prototipo’ para crear aplicaciones mMHealth de una manera estandarizada, facilitando así la prueba y comparación de dichas aplicaciones.

          背景:创伤后应激障碍(PTSD)的患病率是一个全球问题。因为接受正式心理治疗存在很大阻碍,导致大部分人口缺乏精神保健。移动心理健康(mMHealth)应用程序(app)似乎是一个有前景的新发展,mHealth应用程序(移动健康)如果成功应用可以解决这种精神保健的缺乏。可惜的是,这些应用程序的整体质量不佳,与其数量形成鲜明对比。本问的目的是提出一个标准,用于开发与PTSD相关的mMHealth应用程序,其中包含了评估其可用性和影响的过程。

          方法:首先定义流程的每个步骤及其与其他步骤的关系。这些步骤本身分为与发展、评估和实施有关的步骤,必须遵守与其相关的既定医学和技术规范。来自最近文献的现有协议已集合到这些步骤中。

          结果:最终提出一个涵盖从无到有开发、评估和实施mMHealth应用程序的过程的综合模型。该模型可以适应其他疾病或专门针对创伤后应激障碍的某些症状。

          结论:采用这样的模型可以产生以标准化方式创建mMHealth应用程序的‘蓝图’,从而便于测试和比较这些应用程序。

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          Posttraumatic stress disorder in the World Mental Health Surveys

          Background Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. Methods Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. Results The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed. Conclusions PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.
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            mHealth for mental health: Integrating smartphone technology in behavioral healthcare.

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              The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review

              Background The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition. Due to the abundance of devices and ease of access they subsequently allow, the utility of mobile health (mHealth) has never been more endemic. A substantial amount of interactive and psychoeducational apps are readily available to download concerning a wide range of health issues. mHealth has the potential to reduce waiting times for appointments; eradicate the need to meet in person with a clinician, successively diminishing the workload of mental health professionals; be more cost effective to practices; and encourage self-care tactics. Previous research has given valid evidence with empirical studies proving the effectiveness of physical and mental health interventions using mobile apps. Alongside apps, there is evidence to show that receiving short message service (SMS) messages, which entail psychoeducation, medication reminders, and links to useful informative Web pages can also be advantageous to a patient’s mental and physical well-being. Available mHealth apps and SMS services and their ever improving quality necessitates a systematic review in the area in reference to reduction of symptomology, adherence to intervention, and usability. Objective The aim of this review was to study the efficacy, usability, and feasibility of mobile apps and SMS messages as mHealth interventions for self-guided care. Methods A systematic literature search was carried out in JMIR, PubMed, PsychINFO, PsychARTICLES, Google Scholar, MEDLINE, and SAGE. The search spanned from January 2008 to January 2017. The primary outcome measures consisted of weight management, (pregnancy) smoking cessation, medication adherence, depression, anxiety and stress. Where possible, adherence, feasibility, and usability outcomes of the apps or SMS services were evaluated. Between-group and within-group effect sizes (Cohen d) for the mHealth intervention method group were determined. Results A total of 27 studies, inclusive of 4658 participants were reviewed. The papers included randomized controlled trials (RCTs) (n=19), within-group studies (n=7), and 1 within-group study with qualitative aspect. Studies show improvement in physical health and significant reductions of anxiety, stress, and depression. Within-group and between-group effect sizes ranged from 0.05-3.37 (immediately posttest), 0.05-3.25 (1-month follow-up), 0.08-3.08 (2-month follow-up), 0.00-3.10 (3-month follow-up), and 0.02-0.27 (6-month follow-up). Usability and feasibility of mHealth interventions, where reported, also gave promising, significant results. Conclusions The review shows the promising and emerging efficacy of using mobile apps and SMS text messaging as mHealth interventions.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8066
                2019
                15 May 2019
                : 10
                : 1
                : 1611090
                Affiliations
                Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden , Dresden, Germany
                Author notes
                CONTACT Julia Schellong Julia.Schellong@ 123456uniklinikum-dresden.de Medizinische Fakultät Carl Gustav Carus, an der Technischen Universität Dresden , Fetscherstraße 74, 01307Dresden, Germany
                Article
                1611090
                10.1080/20008198.2019.1611090
                6522973
                31143412
                b0d4360a-12e2-4168-a589-088232b2f8ec
                © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 March 2018
                : 01 April 2019
                : 15 April 2019
                Page count
                Figures: 1, Tables: 3, References: 100, Pages: 13
                Funding
                Funded by: German Defense Forces
                Award ID: M-SAKE-FA001
                This work was supported by the German Defense Forces [M-SAKE-FA001].
                Categories
                Clinical Practice Article

                Clinical Psychology & Psychiatry
                ptsd,mobile mental health,mhealth,mmhealth,medical device,mobile app,trauma,iec norm,user-centered-design,tept,salud mental movil,aparato médico,aplicación móvil,norma iec,diseño centrado en el usuario,创伤后应激障碍,移动心理健康,mheahlth,医疗装置,移动应用,创伤,iec规范,以用户为中心的设计,• coping with post-traumatic stress disorder (ptsd) can be flanked by mental health apps. unfortunately, the quality of design and evaluation of these apps is somewhat lacking.• a step-by-step model for the creation of such apps is proposed.• emphasis is put on conforming to medical and technical norms, replicable methods of evaluation and standardizing the design process.• this would make apps more testable and comparable, enabling caregivers to make certified recommendations for their use.

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