Karen Fortuna

Geisel School of Medicine at Dartmouth | DMS · Department of Psychiatry

Rates of loneliness in people with SMI are consistent with estimates in the general population. High-risk groups for loneliness including Black Americans, people with schizophrenia, people residing in congregate housing, and women residing in scattersite housing were associated with higher likelihood of being lonely. Unlike the general population,...

Background Peer-support specialists—individuals with diagnosed mental illnesses who provide support services to other adults with diagnosed mental health issues—often feel stigmatized and undervalued at work, leading to negative personal- and job-related outcomes. Given their important link to positive service user outcomes, this study assessed how...

These findings are important and may be a matter of living a meaningful life in older adulthood or not. The mental health of employees is an essential topical area for academic journals and for the real world. As such, it is also important for employers, especially after our global experience of COVID-19 and potential mental health challenges of ou...

Background Certified peer support specialists often use technologies such as smartphone applications to deliver digital peer support in community mental health centers. Certified peer support specialists are individuals with a mental health diagnosis, trained and accredited by their state to provide mental health support services. Digital peer supp...

Background: Video and computer games are popular activities, with 72% of adolescents aged 13 to 17 years reporting video game use on either a computer, game console, or portable device. Despite high levels of video and computer game use in adolescence, relatively little scientific literature exists examining the association and effects of video an...

BACKGROUND Over the past decade, growing scientific evidence shows that community engagement in research produces more relevant research, increases uptake of research findings, and better clinical outcomes OBJECTIVE The purpose of this study was to assess the feasibility, acceptability, and preliminary effectiveness of a dyadic virtual training on...

Digital health technologies such as smartphone apps and remote monitoring present a promising path for intervention delivery; however, equal opportunities to engage in these technologies are a challenge in science presently. Some factors contributing to these inequalities include inaccessibility, exclusivity, redlining, and more. Innovations in tec...

Importance: People with serious mental illness (SMI), defined as a diagnosis of schizophrenia spectrum disorder, bipolar disorder, or disabling major depressive disorder) die approximately 10 to 25 years earlier than the general population. Objective: To develop the first-ever lived experience-led research agenda to address early mortality in pe...

Objective: This study aimed to estimate gaps in supportive housing services for racially and ethnically diverse older adults with SMI residing in supportive housing. Methods: This study had a total of 753 respondents split into two diagnostic groups, the Delusional and Psychotic Disorders Group, and the Mood (Affective) Disorder Group. Demograph...

The number of adults aged 50+ years with serious mental illness (SMI; schizophrenia spectrum disorder, bipolar disorder, and major depressive disorder) is rising in the United States. The 3.4 million older adults with SMI (2.9% of the US population) experience significant impairments in psychosocial functioning and physical health conditions and in...

Adults with serious mental illnesses are disproportionately affected by chronic health conditions that are linked to inadequately managed medical and psychiatric illnesses and are associated with poor lifestyle behaviors. Emerging intervention models emphasize the value of peer specialists (certified individuals who offer emotional, social, and pra...

Family caregivers of people with dementia are critical to the quality of life of care recipients and the sustainability of healthcare systems but face increased risk of emotional distress and negative health outcomes. The purpose of this study was to examine the usability, acceptability, and preliminary effectiveness of a technology-based and careg...

Background: When the COVID-19 pandemic lockdown measures were instituted, the wide-scale necessity for remote mental health care increased among professional clinicians, such as psychiatrists, psychologists, social workers, and certified peer support (CPS) specialists. Factors contributing to increased demand include concern for the safety of loved...

BACKGROUND Video and computer games are popular activities, with 72% of adolescents aged 13 to 17 years reporting video game use on either a computer, game console, or portable device. Despite high levels of video and computer game use in adolescence, relatively little scientific literature exists examining the association and effects of video and...

The prevalence of anxiety symptoms in children and adolescents aged 4 to 18 years has nearly doubled after the first year of the pandemic. However, only one in five adolescents diagnosed with anxiety is treated. We R H.O.P. E. is a school-based mental health program that includes evidence-based principles designed to engage children and adolescents...

Mobile health (mHealth)—that is, use of mobile devices, such as mobile phones, monitoring devices, personal digital assistants, and other wireless devices, in medical care—is a promising approach to the provision of support services. mHealth may aid in facilitating monitoring of mental health conditions, offering peer support, providing psychoeduca...

This Viewpoint describes how open innovation has been used by communities to support individual and community health and discusses how scientists and clinicians could apply this idea- and resource-sharing strategy to generate breakthrough advances that may extend the life span of people with serious mental illness (SMI).

Background Research has demonstrated the effectiveness of peer support specialists in helping people with severe mental illness increase community tenure, decrease hospitalization, boost treatment satisfaction, improve social functioning, and increase quality of life. Objective The purpose of the present study was to evaluate positive organization...

One in five older adults experience symptoms of depression and anxiety. Digital mental health interventions are promising in their ability to provide researchers, mental health professionals, clinicians, and patients with personalised tools for assessing their behaviour and seeking consultation, treatment, and peer support. This systematic review l...

Peer telemental health recently became Medicaid reimbursable during the COVID-19 crisis, increasing the need for standardized training on digital peer support (DPS) services. DPS has the potential to reduce barriers to services and expand the reach of peer support specialists. The 4-h Digital Peer Support Training program was developed to train pee...

Background: The United Nations has called for wide-scale community mental health psychoeducation; however, few programs currently exist. Emotional Connecting, Empowering, Revitalizing (eCPR) is a community education and training program developed by individuals with a lived experience of mental health challenges or trauma. It is designed to provid...

BACKGROUND Digital peer support may show longevity past the COVID-19 era. In April 2020, a survey of 180 peer support specialists from 23 states found a 95% increase in peer support specialists offering digital peer support and a 90% increase in peer support specialists’ confidence in digital peer support. OBJECTIVE The purpose of this study is to...

Background Digital peer support enhances engagement in mental and physical health services despite barriers such as location, transportation, and other accessibility constraints. Digital peer support involves live or automated peer support services delivered through technology media such as peer-to-peer networks, smartphone apps, and asynchronous a...

Peer telemental health recently became Medicaid reimbursable during the COVID-19 crisis, increasing the need for standardized training on digital peer support (DPS) services. DPS has the potential to reduce barriers to services and expand the reach of peer support specialists. The 4-h Digital Peer Support Training program was developed to train pee...

Objective: Individuals with serious mental illness (SMI) experience a 10–25-year reduced life expectancy when compared to the general population that is due, in part, to poor health behaviors. Yet, in spite of the development of health promotion and self-management interventions designed for people with SMI to promote health behavior change, the mo...

To examine the feasibility, acceptability, and initial validity of using smartphone-based peer-supported ecological momentary assessment (EMA) as a tool to assess loneliness and functioning among adults with a serious mental illness diagnosis. Twenty-one adults with a diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disor...

BACKGROUND Social distancing and lockdown measures due to the COVID-19 pandemic has transformed the delivery of mental health care from in-person to remote services supported through the use of technologies. When the COVID-19 pandemic lockdown measures were instituted, wide scale necessity for remote mental health care emerged not only for professi...

Background When the COVID-19 pandemic lockdown measures were instituted, the wide-scale necessity for remote mental health care increased among professional clinicians, such as psychiatrists, psychologists, social workers, and certified peer support (CPS) specialists. Factors contributing to increased demand include concern for the safety of loved...

Adults with serious mental illness commonly experience comorbid chronic physical conditions and experience a reduced life expectancy of 10-25 years compared to the general population (Saha et al. in Arch Gen Psychiatry 64(10):1123–31. 2007; Hayes et al. in Acta Psychiatr Scand 131(6):417–25. 2015; Walker et al. in JAMA Psychiatry 72(4):334–41. 2015...

The purpose of this article is to delineate the current state-of-the-knowledge of peer support following the framework employed in the 2004 article (Solomon, Psychiatr Rehabil J. 2004;27(4):392–401 1). A scoping literature was conducted and included articles from 1980 to present. Since 2004, major growth and advancements in peer support have occurr...

Objective: Individuals with mental health challenges are at particularly high risk of experiencing negative outcomes (e.g., worsening of mental health, increased risk of mortality) due to the coronavirus disease (COVID-19) pandemic. Peer specialists may have the benefit of several protective factors, including higher levels of social support and b...

Background: Suboptimal adherence to data collection procedures or a study intervention is often the cause of a failed clinical trial. Data from connected sensors, including wearables, referred to here as biometric monitoring technologies (BioMeTs), are capable of capturing adherence to both digital therapeutics and digital data collection procedur...

As the digitalization of mental health systems progresses, the ethical and social debate on the use of these mental health technologies has seldom been explored among end-users. This article explores how service users (e.g., patients and users of mental health services) and peer support specialists understand and perceive issues of privacy, confide...

Objective: To assess the feasibility, acceptability, and preliminary effectiveness of digital peer support integrated medical and psychiatric self-management intervention ("PeerTECH") for adults with a serious mental illness. Methods: Twenty-one adults with a chart diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disor...

Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of middle-aged and older adults. An emerging workforce of certified older adult peer support specialists aged 50 years or above...

Functional decline in older adults can often be mitigated by physical activity. As older adults increasing adopt wearable technology, an understanding of how remotely monitored activity is associated with clinical outcomes is needed. Data was analyzed from two cohorts of older adults with obesity (□65 years, BMI (□30kg/m2)) who completed weekly die...

Rural older adults aged ≥65 years with obesity (body mass index (BMI) ≥30 kg/m2) showed an overall favorable response to a six-month, technology-based weight-management intervention. Our objective was to characterize how friends or family support for eating and exercise behaviors at baseline was associated with baseline weight and intervention resp...

Community of Practice, a community-engagement method that encourages a group of people to interact regularly towards a common goal, may promote satisfying experiences in patient-outcomes research among marginalized populations. Peer support specialists are increasingly being involved in peer-informed mental health research due to their lived experi...

This encyclopedia brings together a comprehensive collection of work highlighting established research and emerging science in all relevant disciplines in gerontology and population aging. It covers the breadth of the field, gives readers access to all major sub-fields, and illustrates their interconnectedness with other disciplines. With more than...

Peer support specialists (i.e., lay interventionists representing one of the fastest-growing mental health workforce) are increasingly using technologies to support individuals with mental health challenges between clinical encounters. The use of technology by peers has been significantly increased During COVID-19. Despite the wide array of technol...

Older adults with serious mental illness (SMI) have complex care needs across medical, psychiatric, cognitive, and social domains. This growing population exhibits high levels of medical comorbidity and sedentariness. Innovative interventions that promote holistic recovery for this group are needed, especially in the context of the COVID-19 pandemi...

Serious mental illness (SMI) is a leading disability worldwide. Partnering with people with SMI to co-produce smartphone apps to support mental health outcomes throughout the software development lifecycle may support patient engagement with smartphone health app interventions. Partnering with this community is often challenging and requires a high...

Community of Practice, a community-engagement method that encourages a group of people to interact regularly towards a common goal, may promote satisfying experiences in patient-outcomes research among marginalized populations. Peer support specialists are increasingly being involved in peer-informed mental health research due to their lived experi...

BACKGROUND Older adults who engage in physical activity can reduce their risk of mobility and disability. Short amounts of walking can improve their quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues...

Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation co...

BACKGROUND Sub-optimal adherence to data collection procedures and/or a study intervention is often the cause of a failed clinical trial. Data from biometric monitoring technologies (BioMeTs) can measure adherence to both digital therapeutics and digital data collection procedures, thereby providing the opportunity to identify the determinants of a...

This study aimed to test the validity and reliability of the Kessler Psychological Distress Scale-6 (K6) with a nationally representative clinical sample with various mental health disorders. The cross-sectional, nationally representative, and publicly available data were extracted from the 2014 Health Center Patient Survey (HCPS), which was sponso...

Background: For digital tools to have high usability and fit service users' health needs and socio-environmental context, it is important to explore usability with end-users and identify facilitators and barriers to uptake. Objective: To conduct user testing of the smartphone health application, PeerTECH, in a Norwegian community mental health s...

BACKGROUND The United Nations has called for wide-scale community mental health psychoeducation; however, few programs currently exist. Emotional Connecting, Empowering, Revitalizing (eCPR) is a community education and training program developed by individuals with a lived experience of mental health challenges or trauma. It is designed to provide...

Individuals with serious mental illness (SMI) experience a 10- to 25-year reduced life expectancy compared with the general population. Early mortality for people with SMI has mainly been attributed to unhealthy behaviors (e.g., poor diet, sedentary lifestyle), which has led to the development of health promotion and self-management interventions s...

Older adults with serious mental illness (SMI) experience increased medical comorbidities, disability, and early mortality, but little is known about how they perceive the process of aging. This study explored attitudes and beliefs about aging among n=20 middle aged and older adults (M = 59.8 years; range 47-66) with SMI in a state psychiatric hosp...

With Internet connectivity becoming increasingly accessible and mobile, more people are turning to the Internet for news. With this has come concern about partisan echo chambers, misinformation, and online filter bubbles which silo users into separate, often disparate media universes shaped by culture, confirmation bias, and personalized content. T...

Peer specialists, or individuals with lived experience of mental health conditions who support the mental health recovery of others, often work side-by-side with traditional providers (non-peers) in the delivery of treatment groups. The present study aimed to examine group participant and peer provider experiences with peer and non-peer group co-fa...

The present study aimed to examine the acceptability, feasibility, and preliminary effectiveness of an older peer and clinician co-facilitated Behavioral Activation for Pain Rehabilitation (BA-PR) intervention among adults aged 50 years and older with comorbid chronic pain and mental health conditions. This was a mixed-methods research design with...

UNSTRUCTURED As digital peer support is quickly expanding across the globe in wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice such as social work, psychiatry, and psycholog...

Background: As digital peer support is quickly expanding across the globe in wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice such as social work, psychiatry, and psycholog...

Mounting scientific evidence over the past decades in the field of psychiatry has shown community engagement in research produces more relevant research, increased uptake of research findings, and better clinical outcomes. Despite the need for the integration of community engagement methodologies into the scientific method, doctoral and master's le...

The app evaluation framework of the American Psychiatric Association (APA) has emerged as an adaptable tool for those seeking to navigate the ever-growing space of mental health apps. The authors describe a meeting convened in December 2019 to refine the APA framework. The expert panel comprised 16 individuals across health care fields, with repres...

Objective: The primary purpose of the study was to explore and identify how components of recovery are associated with occupational performance and health among peer support specialists. Methods: One hundred and twenty-one peer support specialists were recruited from statewide peer certification training programs and the International Association o...

Unstructured: One of the most at-risk groups during the COVID-19 crisis are older adults, especially those who live in congregate living, seniors' care facilities, are immune-compromised, and/or have other underlying illnesses. Measures used to contain the spread of the virus are far-reaching and older adults were amongst the first groups to have...

Schizophrenia is a serious illness and one of the most expensive psychiatric disorders.It is anticipated that the number and proportion of older patients with schizophrenia will continue to increase. By 2025, it is anticipated that patients 55 and older with schizophrenia will comprise 25% of all patients with schizophrenia. This research symposium...

With the emergence of the COVID-19 vaccine, we have the potential to live longer and healthier lives through the reduction of the transmission of the virus and bring this pandemic to an end. Yet, not all groups will achieve the promise of healthier lifespans—including older adults who represent racial and ethnic disadvantaged groups, rural resident...

Background: Resistance-based exercises effectively enhance muscle strength, which is especially important in older populations as it reduces the risk of disability. Our group developed a Bluetooth-enabled handle for resistance exercise bands that wirelessly transmits relative force data through low-energy Bluetooth to a local smartphone or similar...

Background: Certified peer support specialists (CPS) have a mental health condition and are trained and certified by their respective state to offer Medicaid reimbursable peer support services. CPS are increasingly involved as partners in research studies. However, most research ethics training in the protection of human subjects is designed for p...

BACKGROUND Certified peer support specialists (CPS) have a mental health condition and are trained and certified by their respective state to offer Medicaid reimbursable peer support services. CPS are increasingly involved as partners in research studies. However, most research ethics training in the protection of human subjects is designed for peo...

To explore the association between loneliness and efficacy to engage in health behaviors that are known to reduce the risk of early mortality in people with serious mental illness (SMI). This secondary data analysis was based on a cross-sectional study of 113 participants with SMI residing in New Hampshire. Ordinary Least Squares regressions were u...

Purpose: The purpose of this study was to examine the intermediary role of physical health quality of life and ability to participate social roles and activities in the relationship between pain intensity and mental health quality of life in veterans with mental illnesses. Methods: This is a cross-sectional correlational design study. Our partic...

Introduction: The immediate impact of COVID-19 on morbidity and mortality has raised the need for accurate and real time data monitoring and communication. The aim of this study is to document initial observations from multiple digital services providers during the COVID-19 crisis, especially those related to mental health and wellbeing. Materials...

Individuals with serious mental illness (SMI) have a reduced life expectancy of approximately 10–25 years. Early mortality in persons with SMI is frequently related to unhealthy lifestyle behaviors (i.e., smoking, poor diet, poor sleep habits, sedentary lifestyle) and psychiatric disorders impact on aging biology. The accelerated aging theory of SM...

PeerTECH is older peer-delivered and technology-support integrated medical and psychiatric self-management intervention developed by older adult peer support specialists. Older adult peer support specialists are older adults with a lived experience of a mental health condition, who are trained and accredited to provide support services to others wi...

Recovery narratives are an effective healing art medium that support individual development by virtue of the shared human experience transmitted through each story. Older adult recovery narratives are unique as they share their experiences of aging with a mental health conditions to support others with similar difficulties. Older adult recovery nar...

As increasingly more older adults in the general population utilize smartphones to access health services, the digital divide between older adults with serious mental illness (SMI) and the general older adult population continues to widen. The purpose of this study was to examine older adult peer support specialists’ and older people with SMI’s per...

As health indicators such as life expectancy have improved for many older adults, some older adults experience a disproportionate amount of preventable disease, death, and disability. The causes of health disparities among older adults are multidimensional in that disparities are due to multiple, interacting factors such as socioeconomic status, di...

PeerTECH is a peer-delivered and technology-support integrated medical and psychiatric self-management intervention developed by peers. A pre/post trial by our group has shown PeerTECH is associated with statistically significant improvements in self-efficacy for managing chronic disease and psychiatric self-management skills. This presentation wil...

Objective Despite recent concerns over the increase in opioid misuse among aging adults, little is known about the prevalence of lifetime nonmedical opioid use in underserved, vulnerable middle-aged and older patients with psychiatric disorders. This study aims to determine the lifetime prevalence of nonmedical opioid use among underserved, vulnera...

Adherence research commonly happens in a silo, focused on a particular disease state or type of therapy. Learning from outside disciplines can bring new insights and ideas. This article presents adherence research as related to people with a diagnosis of a serious mental illness (SMI) and medication adherence through smartphone applications (apps)....

This study examined certified peer specialists’ perceptions of the barriers and facilitators to mobile health (mHealth) engagement. A total of 267 certified peer specialists from 38 states completed an online survey. Of this sample, 74 certified peer specialists completed open-ended questions. Data were analyzed from the 74 respondents who responde...

As use and availability of mobile health apps have increased, so too has the need for a thorough, accessible framework for app evaluation. The American Psychiatric Association’s app evaluation model has emerged as a way to critically assess an app by considering accessibility, privacy and security, clinical foundation, engagement, and interoperabil...

Background: Peer support specialists offering mental health and substance use support services have been shown to reduce stigma, hospitalizations, and health care costs. However, as peer support specialists are part of a fast-growing mental health and substance use workforce in innovative integrated care settings, they encounter various challenges...

BACKGROUND The COVID-19 pandemic has led to a global mental health crisis, highlighting the need for a focus on community-wide mental health. Emotional CPR (eCPR) is a program and practice developed by persons with a lived experience of recovery from trauma or mental health challenges to train community members from diverse backgrounds to support o...

This study explored the association between loneliness and psychiatric hospitalizations, functioning, and physical health conditions in people with serious mental illness. Data were included from 349 individuals with serious mental illnesses, aged 18+ years, who participated in two consecutive crosssectional survey studies conducted between 2013 an...

BACKGROUND Older adults with mental health conditions experience co-morbid physical health conditions, premature nursing home admissions, and an earlier mortality compared to the general population of older adults. Older adult peer support specialists are increasingly using technology to deliver peer support services related to addressing both ment...

Background Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of adults aged 50 years or above. An emerging workforce of peer support specialists aged 50 years or above or “older...