BMJ mental health最新文献_第5页

Acoustic signatures of depression elicited by emotion-based and theme-based speech tasks. 基于情绪和主题的语音任务诱发抑郁的声学特征。

0 PSYCHIATRY

BMJ mental health

Pub Date : 2025-09-29 DOI: 10.1136/bmjment-2025-301858

Qunxing Lin,Xiaohua Wu,Yueshiyuan Lei,Wanying Cheng,Shan Huang,Weijie Wang,Chong Li,Jiubo Zhao

BACKGROUNDMajor depressive disorder (MDD) remains underdiagnosed worldwide, partly due to reliance on self-reported symptoms and clinician-administered interviews.OBJECTIVEThis study examined whether a speech-based classification model using emotionally and thematically varied image-description tasks could effectively distinguish individuals with MDD from healthy controls.METHODSA total of 120 participants (59 with MDD, 61 healthy controls) completed four speech tasks: three emotionally valenced images (positive, neutral, negative) and one Thematic Apperception Test (TAT) stimulus. Speech responses were segmented, and 23 acoustic features were extracted per sample. Classification was performed using a long short-term memory (LSTM) neural network, with SHapley Additive exPlanations (SHAP) applied for feature interpretation. Four traditional machine learning models (support vector machine, decision tree, k-nearest neighbour, random forest) served as comparators. Within-subject variation in speech duration was assessed with repeated-measures Analysis of Variance.FINDINGSThe LSTM model outperformed traditional classifiers, capturing temporal and dynamic speech patterns. The positive-valence image task achieved the highest accuracy (87.5%), followed by the negative-valence (85.0%), TAT (84.2%) and neutral-valence (81.7%) tasks. SHAP analysis highlighted task-specific contributions of pitch-related and spectral features. Significant differences in speech duration across tasks (p<0.01) indicated that affective valence influenced speech production.CONCLUSIONSEmotionally enriched and thematically ambiguous tasks enhanced automated MDD detection, with positive-valence stimuli providing the greatest discriminative power. SHAP interpretation underscored the importance of tailoring models to different speech inputs.CLINICAL IMPLICATIONSSpeech-based models incorporating emotionally evocative and projective stimuli offer a scalable, non-invasive approach for early depression screening. Their reliance on natural speech supports cross-cultural application and reduces stigma and literacy barriers. Broader validation is needed to facilitate integration into routine screening and monitoring.

背景：重度抑郁症（MDD）在世界范围内仍未得到充分诊断，部分原因是依赖于自我报告的症状和临床医生管理的访谈。目的研究基于语音的图像描述分类模型能否有效区分重度抑郁症患者和健康对照者。方法120名被试（重度抑郁症59例，健康对照61例）完成4个语音任务：3个情绪评价图像（积极、中性、消极）和1个主题统觉测试（TAT）刺激。对语音响应进行分割，每个样本提取23个声学特征。采用长短期记忆（LSTM）神经网络进行分类，采用SHapley加性解释（SHAP）进行特征解释。四种传统的机器学习模型（支持向量机、决策树、k近邻、随机森林）作为比较。用重复测量方差分析来评估受试者在言语持续时间上的差异。LSTM模型在捕获时态和动态语音模式方面优于传统的分类器。正价图像任务的准确率最高（87.5%），其次是负价图像任务（85.0%）、TAT任务（84.2%）和中性图像任务（81.7%）。SHAP分析强调了音调相关和光谱特征对特定任务的贡献。不同任务间言语持续时间差异显著（p<0.01），表明情感效价影响言语产生。结论情绪丰富和主题模糊的任务增强了MDD的自动检测，其中正价刺激提供了最大的判别能力。SHAP解释强调了针对不同语音输入定制模型的重要性。临床意义基于语音的模型结合情感唤起和投射刺激为早期抑郁症筛查提供了一种可扩展的、非侵入性的方法。他们对自然语言的依赖支持了跨文化应用，减少了耻辱感和读写障碍。需要更广泛的验证，以促进纳入常规筛查和监测。

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引用次数: 0

Work absence in parents of youth who self-harm. 自残青少年父母的工作缺勤。

0 PSYCHIATRY

BMJ mental health

Pub Date : 2025-09-29 DOI: 10.1136/bmjment-2025-301833

Moa Karemyr,Ester Gubi,Anna Ohlis,Gergö Hadlaczky,David Mataix-Cols,Clara Hellner,Ralf Kuja-Halkola,Johan Bjureberg

BACKGROUNDSelf-harm is a prevalent health concern among youths, with significant psychosocial impacts on both youths and their parents. The aim of this study is to describe the impact of offspring self-harm on parental work absence.METHODSThis cohort study included 176 472 mothers and 161 833 fathers of 17 726 youths with a first self-harm diagnosis between the years of 2006 and 2016 and 177 260 matched youths without self-harm. It examined work absence due to family leave to care for a sick child and sick leave, before and after the child's self-harm. Data were sourced from Swedish population-based registers. Conditional Poisson regression, adjusting for potential confounders, was used to analyse associations between self-harm and work absence in parents of youth with and without self-harm after the self-harm event, as well as in parents of self-harming youth before and after the self-harm event.RESULTSParents of both sexes experienced work absence. Nevertheless, mothers were particularly affected. Youth self-harm was linked to increased family leave (rate ratios: mothers 3.47 (95% CI 3.25 to 3.72), fathers 2.71 (2.47 to 2.98)) and sick leave (mothers 1.25 (1.20 to 1.31), fathers 1.25 (1.17 to 1.33)). Parents of affected youth took more family leave during the self-harm year compared with the previous year (mothers 1.65 (1.55 to 1.75), fathers 1.41 (1.29 to 1.54)), with no corresponding rise in sick leave.CONCLUSIONSParents of self-harming youths experience increased work absence, especially family leave, peaking around self-harm events. These results highlight the broader impact of youth self-harm on families and the need for support systems addressing both youth and caregiver well-being and work-life balance.

背景自残是青少年普遍关注的健康问题，对青少年及其父母都会产生重大的心理社会影响。本研究旨在探讨子女自我伤害对父母缺勤的影响。方法选取2006 - 2016年首次自残青少年17726名，母亲17472名，父亲16833名；匹配无自残青少年177260名。调查调查了在孩子自残之前和之后，由于照顾生病孩子的家庭假和病假而导致的工作缺勤。数据来源于瑞典基于人口的登记册。使用条件泊松回归，调整潜在的混杂因素，来分析自残事件后有自残行为和没有自残行为的青少年的父母，以及自残事件前后有自残行为的青少年的父母的自残和缺勤之间的关系。结果父母双方均有缺勤现象。然而，母亲受到的影响尤其大。青少年自残与增加的家事假(比率比率：母亲3.47（95%可信区间3.25至3.72)，父亲2.71(2.47至2.98)）和病假(母亲1.25（1.20至1.31)，父亲1.25(1.17至1.33)）有关。与前一年相比，受影响青少年的父母在自残年度请了更多的家事假(母亲1.65(1.55至1.75)，父亲1.41(1.29至1.54))，而病假则没有相应增加。结论自残青少年的父母在发生自残事件时，工作缺勤尤其是探亲假增加。这些结果突出了青年自残对家庭的广泛影响，以及需要支持系统解决青年和照顾者的福祉和工作与生活平衡问题。

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引用次数: 0

Interpreting psychiatric digital phenotyping data with large language models: a preliminary analysis. 用大型语言模型解释精神病学数字表型数据：初步分析。

0 PSYCHIATRY

BMJ mental health

Pub Date : 2025-09-23 DOI: 10.1136/bmjment-2025-301817

Matthew Flathers,Winna Xia,Christine Hau,Benjamin W Nelson,Jiaee Cheong,James Burns,John Torous

BACKGROUNDDigital phenotyping provides passive monitoring of behavioural health but faces implementation challenges in translating complex multimodal data into actionable clinical insights. Digital navigators, healthcare staff who interpret patient data and relay findings to clinicians, provide a solution, but workforce limitations restrict scalability.OBJECTIVEThis study provides one of the first systematic evaluation of large language model performance in interpreting simulated psychiatric digital phenotyping data, establishing baseline accuracy metrics for this emerging application.METHODSWe evaluated GPT-4o and GPT-3.5-turbo across over 153 test cases covering various clinical scenarios, timeframes and data quality levels using simulated test datasets currently employed in training human digital navigators. Performance was assessed on the model's capacity to identify clinical patterns relative to human digital navigation experts.FINDINGSGPT-4o demonstrated 52% accuracy (95% CI 46.5% to 57.6%) in identifying clinical patterns based on standard test cases, significantly outperforming GPT-3.5-turbo (12%, 95% CI 8.4% to 15.6%). When analysing GPT-4o's performance across different scenarios, strongest results were observed for worsening depression (100%) and worsening anxiety (83%) patterns while weakest performance was seen for increased home time with improving symptoms (6%). Accuracy declined with decreasing data quality (69% for high-quality data vs 39% for low-quality data) and shorter timeframes (60% for 3-month data vs 43% for 3-week data).CONCLUSIONSGPT-4o's 52% accuracy in zero-shot interpretation of psychiatric digital phenotyping data establishes a meaningful baseline, though performance gaps and occasional hallucinations confirm human oversight in digital navigation tasks remains essential. The significant performance variations across models, data quality levels and clinical scenarios highlight the need for careful implementation.CLINICAL IMPLICATIONSLarge language models could serve as assistive tools that augment human digital navigators, potentially addressing workforce limitations while maintaining necessary clinical oversight in psychiatric digital phenotyping applications.

数字表型提供了行为健康的被动监测，但在将复杂的多模态数据转化为可操作的临床见解方面面临实施挑战。数字导航员（解释患者数据并将结果传递给临床医生的医护人员）提供了一种解决方案，但人力限制限制了可扩展性。目的：本研究首次对大型语言模型在解释模拟精神病学数字表型数据方面的表现进行了系统评估，并为这一新兴应用建立了基线准确性指标。方法：我们使用目前用于训练人类数字导航员的模拟测试数据集，在超过153个测试用例中评估了gpt - 40和GPT-3.5-turbo，涵盖了各种临床场景、时间框架和数据质量水平。性能评估是根据模型识别相对于人类数字导航专家的临床模式的能力。sgpt - 40在基于标准测试病例识别临床模式方面显示出52%的准确率（95% CI 46.5%至57.6%），显著优于GPT-3.5-turbo （12%, 95% CI 8.4%至15.6%）。在分析gpt - 40在不同情况下的表现时，观察到的最强结果是抑郁恶化（100%）和焦虑恶化（83%）模式，而最弱的表现是在家时间增加并改善症状（6%）。准确性随着数据质量的降低（高质量数据为69%，低质量数据为39%）和时间框架的缩短（3个月数据为60%，3周数据为43%）而下降。结论sgpt - 40在零射击解释精神病学数字表型数据方面的52%准确率建立了有意义的基线，尽管表现差距和偶尔的幻觉证实了人类在数字导航任务中的疏忽仍然是必不可少的。不同模型、数据质量水平和临床场景的显著性能差异突出了谨慎实施的必要性。大型语言模型可以作为辅助工具，增强人类数字导航，潜在地解决劳动力限制，同时在精神病学数字表型应用中保持必要的临床监督。

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引用次数: 0

Need to address mental health within climate change education. 需要在气候变化教育中解决心理健康问题。

0 PSYCHIATRY

BMJ mental health

Pub Date : 2025-09-17 DOI: 10.1136/bmjment-2025-301548

Fionnuala Mottishaw,Sarah MacQuarrie

Education plays a crucial role in equipping young people with the skills and knowledge necessary to navigate the challenges of adulthood. In the context of the escalating climate crisis, climate change education (CCE) has an essential role in this aim. Despite an increase of research in the area, where young people have been identified as being particularly concerned about climate change, CCE continues to be under-represented in the UK curriculum. This article explores critical considerations for developing an effective approach to CCE. It emphasises the importance of young people's emotional responses to this aspect of their education that can shape their engagement with the topic. It addresses the need to consider how informal learning through social media and online platforms can have a significant impact on views of the crisis, as well as behaviour. Finally, the article proposes several evidence-based strategies to enhance the integration of CCE into formal education, fostering both critical engagement and actionable understanding among students.

教育在让年轻人掌握应对成年挑战所需的技能和知识方面发挥着至关重要的作用。在气候危机不断升级的背景下，气候变化教育（CCE）在这一目标中发挥着至关重要的作用。尽管该领域的研究有所增加，年轻人被认为特别关注气候变化，但CCE在英国课程中的代表性仍然不足。本文探讨了开发有效的CCE方法的关键考虑因素。它强调了年轻人对这方面教育的情感反应的重要性，这可以影响他们对这一主题的参与。它解决了需要考虑通过社交媒体和在线平台进行的非正式学习如何对危机的看法和行为产生重大影响的问题。最后，本文提出了几个基于证据的策略，以加强CCE与正规教育的整合，促进学生的批判性参与和可操作的理解。

引用次数: 0

Changes in daily living dependency and incident depressive symptoms among older individuals: findings from four prospective cohort studies. 老年人日常生活依赖和抑郁症状的变化：来自四项前瞻性队列研究的结果

0 PSYCHIATRY

BMJ mental health

Pub Date : 2025-09-12 DOI: 10.1136/bmjment-2025-301749

Juxiang Yang,Gang Song,Minheng Zhang,Hongwei Liu,Miaomiao Hou

BACKGROUNDWith rapid population ageing, depressive symptoms in older adults have become a pressing public health concern. While functional dependency is a known risk factor, the impact of changes in dependency over time remains unclear.OBJECTIVETo examine the association between changes in daily living dependency and incident depressive symptoms in older adults across international cohorts.METHODSWe used data from 46 327 adults aged ≥50 years across four longitudinal ageing studies: China Health and Retirement Longitudinal Study (China), Health and Retirement Study (USA), English Longitudinal Study of Ageing (England) and Survey of Health, Ageing and Retirement in Europe (Europe). Daily living dependency was classified into three levels based on difficulties in activities of daily living (ADLs) and instrumental ADLs (IADLs). Change in dependency was assessed using baseline and 2-year follow-up data. Depressive symptoms were measured using the Center for Epidemiologic Studies depressive symptoms Scale or the European Depression Scales (EURO-D). Cox proportional hazard models estimated HRs and 95% CIs for incident depressive symptoms over a median follow-up of 4.2-5.1 years.FINDINGSA total of 12 902 new depressive symptom cases occurred during follow-up. Compared with participants whose dependency status remained unchanged, those who recovered to independency had a significantly reduced risk of depressive symptoms. Functional deterioration, including transitions from independency to ADL or IADL dependency, was associated with increased risk of depressive symptoms (both pooled HRs 1.55), while functional improvement, from ADL or IADL dependency to independency, was linked to reduced risk (HRs 0.83 and 0.80, respectively).CONCLUSIONSImprovement in ADL dependency is linked to a lower risk of depressive symptoms, while worsening dependency significantly increases depressive symptoms risk.CLINICAL IMPLICATIONSRoutine assessment of functional status and early interventions to maintain or restore daily living independency may help prevent depressive symptoms in older adults. Targeted rehabilitation and support services could play a key role in reducing the mental health burden of ageing populations.

背景随着人口快速老龄化，老年人抑郁症状已成为一个紧迫的公共卫生问题。虽然功能依赖是一个已知的风险因素，但依赖关系随时间变化的影响仍不清楚。目的研究国际队列中老年人日常生活依赖改变与抑郁症状之间的关系。方法：我们使用了来自4个纵向老龄化研究的46 327名年龄≥50岁的成年人的数据：中国健康与退休纵向研究（中国）、美国健康与退休研究（美国）、英国老龄化纵向研究（英国）和欧洲健康、老龄化和退休调查（欧洲）。日常生活依赖根据日常生活活动困难（ADLs）和工具性日常生活依赖（IADLs）分为3个等级。使用基线和2年随访数据评估依赖性的变化。使用流行病学研究中心抑郁症状量表或欧洲抑郁量表（EURO-D）测量抑郁症状。Cox比例风险模型估计了在4.2-5.1年的中位随访期间发生抑郁症状的hr和95% ci。结果随访期间共新增抑郁症状12 902例。与依赖状态保持不变的参与者相比，那些恢复独立的人出现抑郁症状的风险显著降低。功能恶化，包括从独立到ADL或IADL依赖的转变，与抑郁症状的风险增加相关（两者的总hr均为1.55），而功能改善，从ADL或IADL依赖到独立，与风险降低相关（hr分别为0.83和0.80）。结论ADL依赖的改善与抑郁症状的风险降低有关，而依赖的恶化则显著增加抑郁症状的风险。临床意义常规评估功能状态和早期干预以维持或恢复日常生活独立性可能有助于预防老年人抑郁症状。有针对性的康复和支助服务可在减轻老龄人口心理健康负担方面发挥关键作用。

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引用次数: 0

BMJ Connections Mental Health, a new BMJ journal. BMJ杂志与心理健康的联系，一个新的BMJ杂志。

0 PSYCHIATRY

BMJ mental health

Pub Date : 2025-09-12 DOI: 10.1136/bmjment-2025-302078

Andrea Cipriani

引用次数: 0

Beyond the methodological binary: coproduction as the third pillar of mental health science. 超越方法论的二元论：合作生产是心理健康科学的第三个支柱。

0 PSYCHIATRY

BMJ mental health

Pub Date : 2025-09-09 DOI: 10.1136/bmjment-2025-301807

James Downs

BACKGROUNDMental health research has long been structured around qualitative and quantitative methodologies, often marginalising experiential knowledge and reinforcing hierarchies of expertise. Although coproduction has gained traction as a participatory approach, its methodological status remains contested, leading to inconsistent practices and risks of tokenism.OBJECTIVEThis paper explores whether coproduction should be recognised not merely as a participatory ideal but as a third methodological pillar in mental health research, with distinct philosophical, ethical and practical foundations.METHODSThis paper critically integrates interdisciplinary sources from empirical research and theoretical literature to examine coproduction as a distinct methodological paradigm in mental health research. The analysis is informed by the author's reflexive engagement as a lived experience researcher.FINDINGSFive inter-related challenges to meaningful coproduction are identified: persistent tokenism; the emotional labour required of lived experience contributors; power imbalances in decision-making and recognition; structural exclusions in participation and systemic barriers within academic governance and norms. In response, the paper proposes five strategies for integrating coproduction as a distinct methodological paradigm: creating sustainable fora for dialogue across difference; establishing coproduction as a core research competency; embedding a relational culture of care; fostering methodological innovation and evaluation; and challenging narrow definitions of academic value, authorship and output.CONCLUSIONSReframing coproduction as a third methodological pillar offers a way to address the exclusion of knowledge derived from lived experience and can enhance the rigour, relevance and inclusivity of mental health science. This shift requires systemic changes in how research is conceptualised, taught, funded and evaluated.CLINICAL IMPLICATIONSEmbedding coproduction as a core methodology can improve the relevance and responsiveness of research to clinical realities. Grounding research in lived experience offers insights that enhance service design, build trust and support more equitable, person-centred care, ultimately contributing to better clinical outcomes and more inclusive mental health systems.

长期以来，心理健康研究一直围绕定性和定量方法进行，往往将经验知识边缘化，并强化了专业知识的等级制度。虽然合作制作作为一种参与性方法已经获得了吸引力，但其方法地位仍然存在争议，导致不一致的做法和象征性的风险。目的：本文探讨是否应该承认合作生产不仅是一种参与的理想，而且是心理健康研究的第三个方法支柱，具有独特的哲学、伦理和实践基础。方法本文批判性地整合了来自实证研究和理论文献的跨学科资源，以检验合作生产作为心理健康研究的独特方法论范式。分析是由作者作为一个生活经验研究者的反射性参与。发现确定了有意义的合作的五个相互关联的挑战：持久的符号主义；生活经验贡献者需要的情感劳动；决策与认同中的权力失衡；参与中的结构性排斥和学术治理与规范中的系统性障碍。作为回应，本文提出了将合作生产整合为一种独特的方法论范式的五种策略：为跨越差异的对话创造可持续的论坛；建立合作生产作为核心研究能力；建立关怀的关系文化；促进方法创新和评价；挑战学术价值、作者身份和产出的狭隘定义。结论将合作生产作为第三个方法学支柱提供了一种解决排除来自生活经验的知识的方法，并可以增强心理健康科学的严密性、相关性和包容性。这种转变需要对研究的概念化、教学、资助和评估方式进行系统性的改变。临床意义将合作生产作为一种核心方法可以提高研究对临床现实的相关性和响应性。以生活经验为基础的研究提供了加强服务设计、建立信任和支持更公平、以人为本的护理的见解，最终有助于改善临床结果和更具包容性的精神卫生系统。

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引用次数: 0

Strong association between psychiatric disorders co-occurrence and dementia: a Bayesian approach on a 14-year clinical data warehouse. 精神疾病共发生与痴呆之间的强烈关联：对14年临床数据仓库的贝叶斯方法。

0 PSYCHIATRY

BMJ mental health

Pub Date : 2025-09-09 DOI: 10.1136/bmjment-2025-301651

Edouard Baudouin,Emmanuelle Duron,Marie Verdoux,Matthieu Gasnier,Yann Pelloux,Hugo Bottemanne,Emmanuelle Corruble,Romain Colle

BACKGROUNDPsychiatric disorders alone are associated with an increased risk of developing dementia. However, the relationship between co-occurring psychiatric disorders and dementia odds remains unclear. This study aimed to assess the odds of dementia (all types) among individuals with several psychiatric disorders and identify relevant co-occurrence patterns.METHODSData were extracted from the clinical data warehouse of the psychiatry department of Bicêtre Hospital, France, between 29 August 2009 and 29 October 2023. Patients aged 45 years and older diagnosed with at least one psychiatric disorder-depressive disorders, anxiety disorders, psychotic disorders, substance use disorders, personality disorders or bipolar disorders-were included. Subgroups were created to evaluate specific patterns of psychiatric co-occurrence associated with dementia. In this case-control study, Bayesian models, including hierarchical models and logistic regression adjusted for age, sex and cardiovascular risk factors, were used to estimate posterior probabilities and ORs for dementia.RESULTSAmong 3688 subjects, the mean (SD) age at inclusion was 68.7 (12.1) in the dementia group (653 (17.7%) subjects) and 58.2 (10.5) in the non-dementia group (3035 (82.3%) individuals). Compared with those with one psychiatric disorder (2608 (70.7%) patients), the adjusted OR (95% credible interval) for dementia increased from 2.3 (1.7-3) with two comorbidities (789 (21.4%) patients) to 11.1 (5.4-22.2) with four comorbidities (65 (1.8%) subjects). Patients with co-occurrence of mood and anxiety disorders had a mean posterior probability from 48% (34.1-62.2) up to 89.6% (76.8-98.6) of dementia.CONCLUSIONSDementia odds significantly increase with the number of psychiatric comorbidities, with mood and anxiety disorder co-occurrence showing the highest posterior probabilities. Targeted screening strategies should be developed for these patients, with a special focus on patients developing more than one psychiatric disorder.

背景：精神疾病本身就与痴呆风险增加有关。然而，共同发生的精神疾病和痴呆几率之间的关系尚不清楚。本研究旨在评估患有几种精神疾病的个体患痴呆（所有类型）的几率，并确定相关的共发生模式。方法数据取自法国Bicêtre医院2009年8月29日至2023年10月29日精神科临床数据仓库。年龄在45岁及以上的患者被诊断患有至少一种精神障碍——抑郁症、焦虑症、精神病性障碍、物质使用障碍、人格障碍或双相情感障碍。建立了亚组来评估与痴呆相关的精神病学共同发生的特定模式。在本病例对照研究中，使用贝叶斯模型，包括分层模型和调整年龄、性别和心血管危险因素的logistic回归，来估计痴呆的后验概率和or。结果3688例受试者中，痴呆组（653例（17.7%））和非痴呆组（3035例（82.3%））的平均年龄（SD）分别为68.7岁（12.1岁）和58.2岁（10.5岁）。与患有一种精神疾病的患者（2608例（70.7%））相比，痴呆症的调整OR（95%可信区间）从2.3（1.7-3）例伴有两种合并症的患者（789例（21.4%））增加到11.1（5.5 -22.2）例伴有四种合并症的患者（65例（1.8%））。同时出现情绪和焦虑障碍的患者患痴呆的平均后验概率为48%（34.1-62.2）至89.6%（76.8-98.6）。结论随着精神疾病合并症数量的增加，痴呆的发生率显著增加，其中情绪障碍和焦虑障碍合并症的后验概率最高。应该为这些患者制定有针对性的筛查策略，特别关注患有一种以上精神疾病的患者。

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引用次数: 0

Quantifying care, qualifying experiences: a systematic review of measurement-based care in psychiatry from patient and provider perspectives. 量化护理，合格经验：从患者和提供者的角度对精神病学中基于测量的护理进行系统回顾。

0 PSYCHIATRY

BMJ mental health

Pub Date : 2025-08-27 DOI: 10.1136/bmjment-2025-301663

Ayan Dey,Ze'ev Lewis,Josh Posel,Rachel Yunqiu Pan,Karen Wang

BACKGROUNDMeasurement based care (MBC) is a patient-centered approach that is gaining popularity in healthcare systems, particularly in mental health settings. However, attitudes towards MBC vary among mental health clinicians and patients, leading to variable implementation.OBJECTIVEThis systematic review synthesises clinician and patient perspectives on the benefits and drawbacks of measurement-based care (MBC) in psychiatry.STUDY SELECTION AND ANALYSISWe searched Ovid MEDLINE, EMBASE, EBM Reviews, APA PsychINFO and CINAHL databases from inception to January 2024. After screening 1644 titles and abstracts, 48 full papers were reviewed, and 24 studies were ultimately included. Quality assessment was conducted using the Mixed Methods Appraisal Tool, and key patterns were extracted using thematic analysis.FINDINGSThe review reflects opinions of 901 patients and 2831 clinicians across various settings. Patients valued MBC for enhancing communication, self-awareness and reducing stigma. However, they expressed concerns about the adequacy of measures in reflecting their clinical state and uncertainty about how responses influence treatment decisions. Clinicians appreciated MBC for improving patient involvement, tracking treatment response and enhancing communication efficiency. Concerns included inadequate capture of clinical complexity, potential reporting biases, time constraints, insufficient training and concerns with respect to data usage and privacy.CONCLUSIONS AND CLINICAL IMPLICATIONSWhile patients and clinicians recognise significant benefits, including enhanced communication, improved insight and more structured clinical decision-making, they also identify important limitations. These include concerns about the adequacy of scales to capture complex clinical presentations, potential impacts on the therapeutic alliance and increased administrative burden. Moving forward, successful integration of MBC into routine care will require addressing these challenges through improved clinician training, clear guidelines for interpretation, greater transparency with respect to how data will be used and more seamless integration with existing clinical workflows.PROSPERO REGISTRATION NUMBERPROSPERO CRD420250651562.

背景：基于测量的护理（MBC）是一种以患者为中心的方法，在医疗保健系统中越来越受欢迎，特别是在精神卫生环境中。然而，心理健康临床医生和患者对MBC的态度各不相同，导致实施情况不一。目的：本系统综述综合了临床医生和患者对精神病学中基于测量的护理（MBC）的利弊的看法。研究选择和分析我们检索了从成立到2024年1月的Ovid MEDLINE， EMBASE, EBM Reviews， APA PsychINFO和CINAHL数据库。在对1644篇标题和摘要进行筛选后，对48篇全文进行了审查，最终纳入了24项研究。使用混合方法评估工具进行质量评估，并使用主题分析提取关键模式。研究结果：该综述反映了不同背景下901名患者和2831名临床医生的意见。患者认为MBC可以加强沟通、自我意识和减少耻辱感。然而，他们对反映其临床状态的措施是否充分以及反应如何影响治疗决策的不确定性表示担忧。临床医生对MBC提高患者参与度、跟踪治疗反应和提高沟通效率表示赞赏。担忧包括对临床复杂性的把握不足、潜在的报告偏差、时间限制、培训不足以及对数据使用和隐私的担忧。结论和临床意义虽然患者和临床医生认识到显著的益处，包括加强沟通、提高洞察力和更结构化的临床决策，但他们也认识到重要的局限性。这些问题包括对衡量复杂临床表现的量表是否足够的担忧，对治疗联盟的潜在影响以及增加的管理负担。展望未来，将MBC成功整合到常规护理中需要通过改进临床医生培训、明确的解释指南、提高数据使用方式的透明度以及与现有临床工作流程的无缝整合来应对这些挑战。普洛斯彼罗注册号普洛斯彼罗crd420250651562。

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引用次数: 0

Quantifying care, qualifying experiences: a systematic review of measurement-based care in psychiatry from patient and provider perspectives. 量化护理，合格经验：从患者和提供者的角度对精神病学中基于测量的护理进行系统回顾。

IF 4.9 0 PSYCHIATRY

BMJ mental health

Pub Date : 2025-08-27 DOI: 10.1136/bmjment-2025-301663

Ayan Dey, Ze'ev Lewis, Josh Posel, Rachel Yunqiu Pan, Karen Wang

Background: Measurement based care (MBC) is a patient-centered approach that is gaining popularity in healthcare systems, particularly in mental health settings. However, attitudes towards MBC vary among mental health clinicians and patients, leading to variable implementation.

Objective: This systematic review synthesises clinician and patient perspectives on the benefits and drawbacks of measurement-based care (MBC) in psychiatry.

Study selection and analysis: We searched Ovid MEDLINE, EMBASE, EBM Reviews, APA PsychINFO and CINAHL databases from inception to January 2024. After screening 1644 titles and abstracts, 48 full papers were reviewed, and 24 studies were ultimately included. Quality assessment was conducted using the Mixed Methods Appraisal Tool, and key patterns were extracted using thematic analysis.

Findings: The review reflects opinions of 901 patients and 2831 clinicians across various settings. Patients valued MBC for enhancing communication, self-awareness and reducing stigma. However, they expressed concerns about the adequacy of measures in reflecting their clinical state and uncertainty about how responses influence treatment decisions. Clinicians appreciated MBC for improving patient involvement, tracking treatment response and enhancing communication efficiency. Concerns included inadequate capture of clinical complexity, potential reporting biases, time constraints, insufficient training and concerns with respect to data usage and privacy.

Conclusions and clinical implications: While patients and clinicians recognise significant benefits, including enhanced communication, improved insight and more structured clinical decision-making, they also identify important limitations. These include concerns about the adequacy of scales to capture complex clinical presentations, potential impacts on the therapeutic alliance and increased administrative burden. Moving forward, successful integration of MBC into routine care will require addressing these challenges through improved clinician training, clear guidelines for interpretation, greater transparency with respect to how data will be used and more seamless integration with existing clinical workflows.

Prospero registration number: PROSPERO CRD420250651562.

背景：基于测量的护理（MBC）是一种以患者为中心的方法，在医疗保健系统中越来越受欢迎，特别是在心理健康环境中。然而，心理健康临床医生和患者对MBC的态度各不相同，导致实施情况不一。目的：本系统综述综合了临床医生和患者对精神病学中基于测量的护理（MBC）的利弊的看法。研究选择和分析：我们检索了Ovid MEDLINE、EMBASE、EBM Reviews、APA PsychINFO和CINAHL数据库，检索时间从成立到2024年1月。在对1644篇标题和摘要进行筛选后，对48篇全文进行了审查，最终纳入了24项研究。使用混合方法评估工具进行质量评估，并使用主题分析提取关键模式。研究结果：该综述反映了不同背景下901名患者和2831名临床医生的意见。患者认为MBC可以加强沟通、自我意识和减少耻辱感。然而，他们对反映其临床状态的措施是否充分以及反应如何影响治疗决策的不确定性表示担忧。临床医生对MBC提高患者参与度、跟踪治疗反应和提高沟通效率表示赞赏。担忧包括对临床复杂性的把握不足、潜在的报告偏差、时间限制、培训不足以及对数据使用和隐私的担忧。结论和临床意义：虽然患者和临床医生认识到显著的益处，包括加强沟通、提高洞察力和更结构化的临床决策，但他们也认识到重要的局限性。这些问题包括对衡量复杂临床表现的量表是否足够的担忧，对治疗联盟的潜在影响以及增加的管理负担。展望未来，将MBC成功整合到常规护理中需要通过改进临床医生培训、明确的解释指南、提高数据使用方式的透明度以及与现有临床工作流程的无缝整合来应对这些挑战。普洛斯彼罗注册号：普洛斯彼罗CRD420250651562。

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引用次数: 0