Digital Mental Health in Italy: findings from the multicentric DIGIT-PSY Study

Laura Orsolini¹Giulio Longo¹Mario Luciano²Gaia Sampogna²Andrea Aguglia^3,4Stefano Barlati⁵Giuseppe Blasi⁶Paola Calò⁷Claudia Carmassi⁸Giuseppe Carrà⁹Giovanni Castellini¹⁰Armando D’Agostino¹¹Pasquale De Fazio¹²Chiara De Panfilis¹³Giorgio Di Lorenzo¹⁴Matteo Di Vincenzo²Carla Gramaglia^15,16Valeria Latorre¹⁷Mirko Manchia¹⁸Giovanni Martinotti¹⁹Marco Menchetti²⁰Mauro Pettorruso¹⁹Federica Pinna¹⁸Gabriele Sani^21,22Gianluca Serafini^3,4Maria Salvina Signorelli²³Sarah Tosato²⁴Antonio Ventriglio²⁵Umberto Volpe^1*Andrea Fiorillo²

• ¹Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
• ²Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
• ³Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
• ⁴IRCCS Ospedale Policlinico San Martino, Genoa, Italy
• ⁵University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
• ⁶Psychiatric Neuroscience Group, Department of Translational Biomedicine and Neuroscience, University of Bari "Aldo Moro", Bari, Italy
• ⁷Department of Mental Health, Azienda Sanitaria Integrata Giuliano-Isontina, Lecce, Italy
• ⁸Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
• ⁹Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
• ¹⁰Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
• ¹¹Department of Health Sciences, University of Milan, Milan, Italy
• ¹²Psychiatric Unit, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
• ¹³Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
• ¹⁴Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
• ¹⁵Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
• ¹⁶Psychiatry Division, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
• ¹⁷Complex Organization Unit Psychiatric Diagnosis and Care Service UO San Paolo, ASL Bari, Bari, Italy
• ¹⁸Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
• ¹⁹Department of Neuroscience, Imaging and Clinical Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
• ²⁰Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
• ²¹Department of Neuroscience, Section of Psychiatry, University Cattolica del Sacro Cuore, Rome, Italy
• ²²Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
• ²³Department of Clinical and Experimental Medicine, AOU Policlinico Hospital, University of Catania, Catania, Italy
• ²⁴Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
• ²⁵Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy

Introduction: Despite an increasing interest in upscaling the digitalization process in mental health care services, there is still a gap in a deeper knowledge of the main barriers and facilitators allowing a capillary and consolidated implementation of digital mental health (DMH) and digital psychiatry (DP), particularly in the Italian context. A multicentric nationwide study (DIGIT-PSY) was designed to overview the current digitalization level of Italian mental health (MH) systems and professionals, by investigating needs/gaps to be addressed to accelerate the availability/access to DMH/DP interventions in Italy, as well as specific internal/external determinants of the process. The final goal of the DIGIT-PSY was to provide a roadmap for implementation strategies to reach a satisfactory level of digitalization of MH care settings in Italy. Methods: A survey was distributed to a multiprofessional cohort of MH professionals (psychiatrists, psychiatry trainees, psychologists, technicians in psychiatric rehabilitation and professional MH educators), from public and private Italian settings, from May 1st, 2023 to September 30th, 2023. Internal/external determinants influencing the level of digitalization, as assessed by using the Digitalization index (DIGi) were explored, by also comparing mental health (MH) professionals based on DIGi. Results: Only 16.4% of the sample showed good clinical experience in DP/DMH, with only 6.5% who received a formal DMH/DP training. Mean DIGi index was 9.9±3.5. MH professionals owning pre-COVID-19 and post-COVID-19 clinical experience in DMH/DP showed the highest DIGI (both p<0.001), suggesting a COVID-19 effect in boosting the digitalization of MH services. Working with DMH/DP knowledgeable colleagues who routinely deliver DMH/DP in clinical practice, increased the digitalization level of MH service (both p<0.001). Both education/training in DMH/DP (p=0.002) and clinical practice in DMH/DP (p<0.001) improved the chance to reach the highest DIGi. Working in public job settings negatively predicted the DIGi index (p=0.007). Discussion: National initiatives should firstly address education/training needs of the youngest mental health professionals, particularly those without a mentor/supervisor experienced in providing DMH/DP and in educating younger professionals in the digital clinical practice. Sex-sensitive consolidating strategies should be implemented in those mental health services already digitalized. Longitudinal studies should evaluate the efficacy in the long-term of country-based digitalization strategies.