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Digital doppelgangers are individualized, continuously updated digital representations of a person constructed from behavioral, physiological, and contextual data streams, including smartphone metadata, wearable sensor outputs, social media activity, and environmental sensors. Whereas conventional digital twins in physical medicine primarily replicate anatomical structures and physiological parameters, psychiatric digital doppelgangers are designed to capture dynamic mental states, emotional trajectories, and behavioral pathways through aggregated multimodal digital traces. Preliminary research suggests potential clinical utility across several domains, including earlier detection of depressive and bipolar episodes, risk stratification for suicidal crises, and individualized treatment planning; however, most applications remain at the feasibility and proof-of-concept stage and have not yet achieved prospective clinical validation. Implementation raises substantive challenges, including informed-consent complexity under fluctuating decisional capacity, algorithmic bias arising from non-representative training datasets, diagnostic ambiguity in the interpretation of behavioral signals, inequitable access to required technology infrastructure, and the risk of reconfiguring the therapeutic relationship into a surveillance mechanism. Responsible development requires interdisciplinary collaboration among clinicians, technologists, ethicists, regulators, and patient communities, alongside robust ethical frameworks, prospective validation regimes, and genuine patient partnership throughout the development cycle. Digital doppelgangers represent a conceptually distinct but adjacent framework to digital twins, digital phenotyping, and AI-driven cognitive science models; their trajectory in psychiatry depends on whether technological ambition is matched by equally rigorous governance and a primary commitment to patient welfare.
Background:Patient utilization of diabetes technology differs based on sociodemographic and other factors. Underserved patients have reported that providers decline to prescribe continuous glucose monitors (CGMs) and insulin pumps. This qualitative study elucidated provider perspectives regarding facilitators and barriers to the prescription and patient use of diabetes technology. Methods:Sixteen diabetes care providers (75.0% MD, 18.8% APRN, 6.3% PharmD, and 50.0% adult endocrinology) at academic health centers, a Veterans Affairs Medical Center, and a safety net hospital in the southeastern United States were surveyed and interviewed from January to May 2024. Survey data were analyzed using descriptive statistics; a thematic analysis was used for interview transcripts with an adapted version of the social-ecological model (SEM) as the coding framework. Results:On the survey, providers estimated that 80% (IQR 58.0%-86.0%) of their patients who met American Diabetes Association criteria for CGMs and 50% (IQR 48.0%-63.0%) for insulin pumps regularly used them. System factors (e.g., lack of insurance, high device costs, and insurance bureaucracy) were perceived by providers (62.5%-93.8%) as patients' top barriers to use. Across the interviews (n = 362 codes), providers' top prescribing barriers were also system-level (65.7%), including working with insurance, durable medical equipment (DME) companies, and pharmacies (15.7%), checking eligibility requirements (11.0%), and electronic health record (EHR) limitations (9.7%). Interpersonal prescribing barriers (7.5%) were tied to patients having low health literacy (3.6%) and communication with non-English-speaking patients (1.7%). Individual prescribing barriers (26.0%) included patients expressing concerns about device adhesives/appearance (5.5%) and patients having limited knowledge/interest (3.0%). Facilitators across SEM levels included simplified eligibility criteria, EHR order sets, shared decision-making, and proactive insurance/DME companies. Conclusions:These findings indicate the need for multilevel solutions to improve the prescription and use of diabetes technology. Future research and clinical practice should aim to enhance EHR functionality and system integration, improve patient-provider communication, and streamline insurance criteria and processes.
Background: There are well-documented disparities in diabetes care outcomes and technology usage, stemming from differences in healthcare access, distrust in healthcare providers, and other factors. This study evaluated patient-level outcomes of a diabetes support coach (DSC) intervention aimed at improving underserved adults' diabetes technology use, diabetes distress, and HbA1c levels. Methods: As part of a Project Extension for Community Healthcare Outcomes (ECHO) Diabetes program, a social support intervention involving 28 DSCs was piloted at 33 Federally Qualified Health Centers (FQHCs) in Florida and California from May 2021 to May 2022. DSCs, who were adults with diabetes, served in a capacity similar to peer mentors and community health workers and received uniform training/oversight by a clinical team. Intervention participants (n = 74 adults with insulin-requiring diabetes at FQHCs) self-enrolled and engaged with DSCs via text messages, phone calls, and events. Participants' outcomes were evaluated cross-sectionally via the Diabetes Distress Scale (DDS-17) and a diabetes technology usage survey and longitudinally via HbA1c tests upon enrollment and at 6-month follow-up. A group of adults with insulin-requiring diabetes from the same FQHCs who did not receive the DSC intervention (n = 363) was used for comparison. Descriptive statistics were computed for all outcomes (n, percentage; mean, SD/95% CI). Between-group comparisons were evaluated via chi-squared and t-tests. Results: DSC intervention participants reported significantly lower diabetes distress than the comparison group (DDS-17 score mean = 1.6 vs. 2.1, p < 0.001), and significantly more participants in the DSC intervention regularly used continuous glucose monitors (CGMs) than the comparison group (69.9% vs. 38.8%, p < 0.0001). There were no significant differences in insulin pump usage or HbA1c. Conclusions: Lower diabetes distress and greater CGM usage among intervention participants suggest that the DSCs' shared lived experiences and healthcare navigation support positively influenced underserved adults' outcomes. These findings show DSCs' potential for improving diabetes care and technology equity.
Despite the common perception of farming as a tranquil and healthy way of life, the agricultural industry has the highest fatality rate. To comprehensively assess suicide within a specific group, it is essential to consider biological, psychological, and social variables. However, research on the risk factors associated with farmer suicide is limited, with only a few nations having reported on the issue. This scoping review aims to systematically assess the evidence on factors related to farmer suicides across different countries and cultural contexts, providing insights to inform suicide prevention strategies. A comprehensive literature search was conducted using PubMed, Google Scholar, and PsycINFO databases for studies published up to July 1, 2024. Eligible studies included original research articles examining farmer suicides or suicidality (suicidal ideation, attempts, and deaths). Data were extracted and synthesised to identify key risk factors, including financial stress, psychiatric comorbidities, social isolation, and access to lethal means. Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool and the Joanna Briggs Institute (JBI) checklists. The 26 articles analysed in this review identified several significant factors associated with farmer suicides, including drought, financial and administrative issues (e.g., debt associated with farming expenses), relationship difficulties, rural lifestyle and mentality, psychiatric comorbidities, substance use, coping strategies, and ready access to firearms. This article presents information regarding the escalating burden of suicide among farmers and the associated factors, encompassing biological, social, and psychological dimensions. Further interventional studies are necessary to understand these factors better, as many can be partially controlled through mental health interventions and government policies.
Purpose This article uses care convoys as a theoretical framework to study care-related transitions. Design/methodology/approach Eight pairs of participants, consisting of a disabled person plus a carer/care worker, were interviewed (sixteen semi-structured interviews), with follow-up interviews with the disabled participants after two months (twenty-four interviews in total). Findings A thematic analysis was carried out. Three aspects of the care convoy model cast a critical lens on participant experiences: (1) whereas the convoy model suggests progression, disabled people were often blocked in their life course changes; (2) disabled participants had small convoys even at a relatively young age; (3) convoys were “decentred”, with people offering each other mutual support. Research limitations/implications Our contribution is to reflect on theory rather than data that can be generalised to a population. The dataset is limited in speaking to a small group of disabled people and carers/care workers in England. Looking at the life transitions of disabled people through the care convoy lens enables us to explore the ways in which implicit assumptions in the convoy model fit – and do not fit – the experiences of working age disabled people living in the community. Future research could consider whether our insights apply to projects with larger datasets and in different localities. Practical implications Using the care convoy model can help to illuminate more starkly the care experiences that disabled people and those who are labelled as their carers/care workers experience during life course transitions. We suggest that it needs to be adapted when using it in life course research with working age disabled people living in the community: (1) the assumption of progression is not always applicable and people can experience “detransitions”; (2) due to societal barriers, people may not have built up a convoy that exists of many members and of varied “closeness”; (3) the reciprocal nature of care can be so mutual and frequent within small convoys that there is no single person in the centre. Social implications Local and national governments must continue addressing societal attitudes and structural barriers that prevent disabled people from full participation, and create more inclusive policies and practices. For professionals in social and health care services, acknowledging people's support network and working more closely together is very important – with the disabled person and their convoy as well as between professionals. Originality/value These insights can be used to adapt the care convoy model to foreground the experiences of working-age disabled people at points of care-related transitions.
